Kathryn Hinsliff-Smith The University of Nottingham

1. Kathryn Hinsliff-SmithThe University of Nottingham It’s nice to know that we might be doing something right. Research findings from a case study of Access learners on a UK Diploma/BSc in Nursing Programme.

2. The context – UK pre-registration nurse training • Issues: aging workforce, older population, decreasing numbers of younger traditional recruits and different expectations of nurses • “registered nurses need to possess life-long learning skills such as critical thinking and reflection and practice in order to adapt their practice to their changing environment” (DoH, 2006) • Levels of attrition – a confusing picture (Glossop, 2001, Fergy et al, 2008, Urwin et al 2009). Mulholland et al., (2008) reported attrition rates from 5% to 30%. RCN (2006) itself claimed that attrition rates vary from 3% to 65% between institutions. • Lack of consistency with data collection methods (Glossop, 2002, McCarey et al., 2007, Urwin et al., 2010) • Department of Health (2006) Managing Attrition Rates for Student Nurses and Midwives. • Gap in literature

3. Access entrants • Access to HE courses established during the 1970s as a viable route into Higher Education. More recently viewed as the ‘third route into university (Osbourne et al, 1997, Wray, 2000) • Learners usually have no formal entry qualifications, age entry requirement of 19+. 63% are aged between 20 and 29 at enrolment (McLaren, 2008) • From 2009 Access to HE Diploma, from 2010 a graded qualification (pass, merit, distinction)

4. The numbers • In 2007/2008, 35,275 registered for an Access programme in the UK (McLaren, 2008), over 6,000 on a nursing or allied to medicine pathway. • Predominately delivered as a one year full time programme in Further Education Colleges, attracting mature (over 21) female and male applicants (73%, 27%) (McLaren, 2008). • NMAS reported that for 2008/09 entry to pre-registration training programmes, 15.9% of all successful applicants were Access applicants.

5. Research aim • The overall aim of this study was to explore the experiences of Access to HE entrants on a Diploma/BSc in Nursing programme at one UK School of Nursing, in order to understand the complexities for these learners of ‘persisting’ on programme.

6. Methodology • A qualitative case study of one East Midlands university offering pre-registration Diploma/BSc programme • An internal recruitment e-mail was circulated to one of their centres of learning, Woodside (n=334). • 75 (22%) were Access to HE entrants and 27 (36%) of these responded positively to take part further. • 7 participants took part in a focus group interview, 6 female and one male held at Woodside • In order to remain anonymous data from the male participant was excluded. • All six females had child care responsibilities and four were single parents

7. Findings • Three main themes emerged from the data • Coping strategies • Advice and Guidance • Interventions by Higher Education

8. Findings – Coping Strategies • Within this theme it emerged that coping strategies could be identified under three sub-headings, childcare, family support and confidence in their own abilities. • The development of these strategies were necessary and an essential element to them succeeding on their Access course. The support network I set up was crucial, during the Access course, particularly as I had a one year old daughter [Grace] I planned my whole home situation around the new course to ensure I succeeded [Avril] It was hard but I set up support for my son and didn’t want to become reliant on my parents, it was hard as a single Mum [Ruby] • From the discussions it was evident that these strategies were transferred to their pre-registration nursing course. These were evident with 1st and 3rd year learners.

9. Findings • Studies on mature women learners have explored the issue of gender, care responsibilities and approaches to study (Glackin & Glackin, 1998, Reay, 2001, 2003, Steele et al., 2005). • This study illustrates positive messages of how Access learners cope and therefore were able to persist at higher level study . However, there was an element of guilt expressed by the six women in this study. • Reay (2003) found elements of guilt but this was related to maternal responsibilities against the time and energy needed for higher level study. • The guilt discussed in this study relates to passing responsibility to children.

10. Findings – Advice and Guidance • For these participants, and many Access learners, they are unfamiliar with support which is available. What drives them is a desire to become a nurse. • Two key services were identified to help make informed decisions: career advisors (external) and university staff from the School of Nursing • Independent visits to a university and attend open days • Access learners are more likely to live close to their FEC and HEI so can take part in a range of activities offered by HEIs. 76.4% of Access entrants live within 24 miles of their university (Watson, 2009:10). • Timely and linked information

11. Findings – Interventions by Higher Education and Further Education Colleges • This study is based on one case study, Woodside, although the six participants were from 3 different FECs. • Range of interventions; academic visits, UCAS completion, financial seminars, mock interviews, open day visits and structured one day visits to the school. • A co-ordinated and planned programme of activities was viewed as extremely useful, It was great been able to come into university, to see how friendly the academic staff were and to feel part of it even though we didn’t know at this stage if we would get in” [Avril] To meet current students who were just like us was brill, it made you feel like you could do it, you could see it for yourself. These students shared their own experiences of being a student nurse which helped with the issues of child care and worries about the workload” [Debs]

12. Discussion • Levels of persistence are higher for mature applicants compared to younger students (QAA, 2008) and classifications are higher for Access entrants compared to other mature applicants on HE courses (Wray, 2000). • Student nurses have different academic demands than traditional university students but still demonstrate lower levels of attrition than some traditional courses (UCAS, 2009) • There is a need for careers advice both at a local level and from within HEIs which is timely and accurate. • Co-ordinated interventions are extremely valuable both for the learner and for the School of Nursing who is keen to attract and keep a diverse student population.

13. Conclusion • Generalizability. • Recruitment of mature Access entrants as student nurses is important, they add value • The findings should be of interest to the 51 other institutions offering pre-registration nurse training in the UK. This is in addition to other medical related disciplines who currently attract Access entrants to their programmes.

14. Thank you I hope that you found something of interest for your own research or your organisation Contact details, should you require a full copy of the sides or paper Kathryn Hinsliff-Smith MA, PGCE, BA (HONS) E-mail ttxkh1@nottingham.ac.uk Mobile: 0788 303 2441 www.kathrynhinsliff-smith.com