Your future nurses - the different routes to recruiting your workforce


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.

We have also set out more information about the different routes below.

Nursing degree apprenticeship

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.

Employers can find more information about the apprenticeship standard at Healthcare Apprenticeship Standards Online.

Nursing Associate

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.

If you would to find out more information about the role, read our guide on nursing associates.

University degree

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.  

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. 

When planning to recruit apprentices, or attract students onto university programmes, you may consider these options as part of your supply route:

If targeting existing staff such as healthcare assistants, assistant practitioners or nursing associates, you may be able to use APEL to shorten their training time.

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

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. You can find out more about the Skills for Health bridging programme on our webpages.

Post-graduate degree

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. 

Return to practice

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 our Health Careers' frequently asked questions.

International recruitment

Staff from outside of the UK continue to make a valuable contribution to the NHS and international recruitment forms an important part of the workforce supply strategy of many NHS organisations.

Nurses are currently on the shortage occupation list, which allows employers to recruit internationally and issue a certificate of sponsorship (CoS) without the requirement to meet the minimum thresholds set out by the Home Office, for example, around pay.

Under the current points-based immigration system, overseas candidates from outside the European Economic Area (EEA) must pass a points assessment before they are given permission to enter or remain in the UK. There are a four different tiers depending on tiers of visas, and nurses and midwives will enter the UK under either a Tier 2 (General) Visa, or the Visitor (Standard) route. You can read more about the points-based system on our website.

International recruitment from outside of the EEA can take up to 18 months, with six to 10 months before a nurse can 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 (OSCE) and show proof of an accepted English language test before they can legally practice as a nurse.

More detailed information can be found in our International recruitment section.

Information about the accepted English language tests is available on the NMC website.

Implications of the EU referendum

If the UK leaves with a deal, EU/EEA citizens will be able to enter the UK to live and work until 31 December 2020 and will receive the same rights as EU citizens currently living in the UK do now. They will then need to apply for settled status to remain in the UK using the EU Settlement Scheme.

If the UK leaves without a deal, from the agreed leave date until 31 December 2020 EU citizens will be able to apply for a maximum of 36 months visit, work or study. They will then have to apply to the new immigration system, expected to be in place from 1 January 2021.

You can read more about the arrangements in place for EU Staff in our UK Departure from the EU section.

Case studies and resources

You can find a range of good practice and resources produced on the different routes into nursing in our case studies and resources pages.

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