Until recently, the routes into nursing were limited and university degree education was seen as the primary way to train a registered nurse. However, the introduction of the nurse degree apprenticeship, the development of the nursing associate role and other initiatives are providing employers with alternative opportunities.
The range of options available to recruit a registered nurse can create a confusing picture for employers so we have developed an infographic to help you make sense of the new and existing routes.
Since January 2021, a blended nursing degree combining digital and traditional elements of learning has offered those who may have previously encountered barriers to entering a nursing career an alternative pathway.
For more information about different routes available see below.
The nursing degree level apprenticeship provides an alternative route to become a graduate registered nurse that doesn't require full-time study at university. The programme typically takes four years to complete but this may be shortened with the use of Accreditation of Prior Experiential Learning (APEL) depending on the local Higher Education Institution's (HEI) requirements.
Apprentices achieve the same nursing qualification and standards as students using the traditional university route and on successful completion meet the requirements to apply for registration with the Nursing and Midwifery Council (NMC). Following the removal of the NHS bursary, the nurse degree apprenticeship could be an attractive route into the profession and may also help employers to increase social mobility and widen participation.
The apprenticeship levy can be used to pay for the cost of the training and end-point assessment, up to £27,000. Employers meet the salary cost of each apprentice and any additional training required.
A percentage of the apprentice’s time will need to be spent ‘off the job’ in theoretical and clinical training, in order to meet the statutory requirements to become a registered nurse. That learning time is protected through supernumerary status.
The Open University has worked with trusts to deliver pre-registration and post-registration nursing degree programmes. Watch these video case studies with Northamptonshire Healthcare NHS Foundation Trust about apprentices that have used this route into nursing, to see the benefits and how other employers can also get onboard.
Employers can find more information about the apprenticeship standard at Healthcare Apprenticeship Standards Online.
The blended learning nursing degree programme combines digital and traditional elements of learning. The interactive and integrated programme, which also supports the development of digital competencies, makes it easier for students to balance their studies with family or caring commitments and helps attract those who may previously have had barriers to a nursing career. For more information about the programme visit HEE's blended learning nurse degree web page.
NHS England has also developed a blended learning degree that offers undergraduate nursing students the chance to specialise in community, primary and social care nursing.
The nursing associate role, which is part of the nursing team, can help to bridge the gap between health and care assistants and registered nurses. While the nursing associate role is a stand-alone registered role it can also provide a progression route into graduate level nursing. Nursing associates wishing to train as a registered nurse can have their qualifications accredited against a nursing degree or a nurse degree apprenticeship, to shorten that training.
While each university sets its own entry requirements, students are likely to need at least two, sometimes three A-levels, or equivalent qualifications at level 3, plus supporting GCSEs. These include English, maths and a science (usually biology or human biology) at grade 4 to 9 (formerly grade C or above).
The university degree takes three years to complete, although this can be shortened with the use of APEL depending on the local HEI requirements. Since the removal of the student nurse bursary in August 2017 students are required to fund the course themselves and can access the student loan system.
Student finance explained - for those studying and looking to study a nursing degree our infographic shows the financial support available for student nurses and explains the repayment of these.
The RePAIR (Reducing Pre-registration Attrition and Improving Retention) report commissioned by Health Education England looks at some of the factors impacting on healthcare student attrition and the retention of the newly qualified workforce.
The report has identified a range of factors, such as supervision support and the culture of a clinical setting that can improve retention. Recommendations include ensuring that prospective learners really understand the career they have chosen and the requirements of the programme, encouraging the creation of buddy schemes to provide support to learners, and the importance of preceptorship schemes.
Employers looking to offer clinical placements to apprentices or students will need to consider the capacity of their organisation. All support, supervision, learning and assessments must comply with the NMC standards framework for nursing and midwifery supervision and assessment.
Bridging programmes can be used to help upskill your existing staff and can include maths and English skills. They are designed to help learners to develop the study skills they need to progress and succeed in nursing and other health professional education programmes, including degree level apprenticeships.
Similar to the university degree and following the removal of the nursing bursary, students will have to fund this route themselves. If you have any existing staff, or are engaging with anyone in the local community who has a degree in a related subject, this may be a good route for them to take. It takes two years to complete, with the use of APEL.
For qualified nurses who have left the NMC register and have not practiced for a while, there is an option to complete a return to practice course. The courses can take approximately three to six months to complete, although some people may take longer (up to 12 months) depending on clinical placement hours required, the length of time out of practice and length of time previously in practice.
Around 40 approved HEIs deliver the course across the UK, with a one-off cost of between £1,500 - £2,000 and Health Education England can provide financial support for costs and some expenses. For more details visit Health Careers' frequently asked questions.
Alternative return to practice route
From 28 January 2020, nurses and midwives looking to return to practice can undertake a test of competence as an alternative route to re-join the NMC register. This route does not replace the return to practice courses which are still available. There are different tests for each field of nursing such as adult, child, mental health and learning disability. The test of competence is made up of two parts:
- a multiple-choice online test
- a practical test or OSCE (objective structured clinical examination)
More information is available on the NMC website.
Staff from outside of the UK continue to make a valuable contribution to the NHS and international recruitment forms an important part of many organisations' workforce supply strategies, in line with the NHS People Plan. NHS England and Improvement is working closely with organisations to increase international recruitment with the intention of recruiting up to 18,000 overseas nurses over the next few years.
Under the newly introduced points-based immigration system, overseas candidates from outside of the UK (excluding the Republic of Ireland) must attract 70 points before they are given permission to enter or remain in the UK. Skilled nurses will come to the UK under the skilled worker health and care visa and you can read more about the points-based system, eligibility and other key information in the international recruitment section of the website.
Nurses are currently on the shortage occupation list. Professions which feature on the list attract additional points, making it easier for employers to recruit these professions internationally.
International recruitment can take up to 18 months or more. It typically takes between six to ten months for a nurse to arrive in the UK, followed by up to eight months in a pre-registration role. The NMC overseas nurse registration process requires applicants to complete a practical test of competence called the observed structured clinical exam and evidence proof of an accepted English language test before they can legally practice as a nurse.
Detailed information on how to deliver ethical, effective and collaborative international recruitment is available in our international recruitment toolkit.
Information about the accepted English language tests is available on the NMC website.
Kent Community Health NHS Trust developed a nursing careers pathway tool featuring a variety of roles available in nursing, as well as opportunities to develop your nursing workforce.