Agenda Item 9
Briefing Paper: Improving Retention on Nursing and
Midwifery programmes
Author: Libby Sedgley
Date: 11th February
Audience: North West LETB
Version: 1.0
Introduction
The purpose of this paper is to update the LETB on developments on the current work
programme with the aim, as described in the HEE Mandate to ‘reduce unnecessary attrition
from training programmes by a third over the next 3 years.’ North West data indicates that
retention has been improving, particularly following the introduction of Nursing Degree,
however there are distinct differences between HEIs within the region and stakeholders. The
reasons behind the differences in attrition are complex, as the factors affecting retention are
multifactorial relating to the individual, the HEI and the trusts in which students receive their
placements.
Whilst retention on commissioned programmes is undoubtedly an important area to consider
the retention of newly qualified nurses and midwives is of equal relevance. In simple terms
the later in the process of training and transition into a fully competent NHS employee, the
greater the consequent financial impact to HENW and the greater the negative impact on the
individual involved. This area has less well developed data and the regional picture is less
clear with difficulties in identifying accurate first post destination information and the retention
of newly qualified staff within trusts.
HENW Retention work stream 14/15
Following a successful bid for national forerunner monies a comprehensive programme of
work was instigated to improve the retention of students in North West Higher Education
Institutes and of newly qualified nurses and midwives within North West that go from
commissioned courses into NHS employment.
Work programme 14/15
Synthesis of current evidence base
for pre- registration students and
post qualification nurses and
midwives
Detail
Up to date review completed and disseminated
through a half day conference and eWIN website
https://www.ewin.nhs.uk/events/item/5122/improvingretention-in-nursing-and-midwifery
Development of benchmarking to
assess relative, weighted retention
outcomes on Nursing and Midwifery
courses.
Data exports from PETD being undertaken for MMU
analysis to identify attrition related characteristics. A
recent Forerunner Fund bid has been agreed to
enable the project to complete the development of a
benchmarking tool.
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Triangulation of first post destination
from PETD, PEF data and ESR
A temporary analyst has been employed to pull
together data to improve the current picture of the
flow from HEIs to NW NHS Trusts and identify the
data quality issues.
Collection of National Insurance
Numbers by HEIs
Following a recommendation from HEIs at the half
day conference discussion is underway to utilise the
East Midlands approach re: collection and storage
on Nino to allow tracking through ESR to first post
(where available).
3 HEIs Liverpool, Salford and Cumbria e.g. to be
supported to begin collection on the NINO,
Commission research on current
preceptorship provision, impact on
newly qualified attrition, development
and piloting of preceptorship
framework.
Tender awarded to the University of Chester. Initial
survey to develop knowledge of the current picture to
be followed by further qualitative work on looking at
both retention and attrition and the relationship to
preceptorship and other trust factors.
The final stage of the project (Sept 15-Sept 16) will
pilot an evidence based attrition framework with a
small number of trusts.
Support for local initiatives e.g.
 Deep dive into trust specific
newly qualified attrition
 Emotional intelligence
initiatives e.g. Schwartz
Rounds and LAMLAY (CBT
based course) with all health
students at an HEI
 Disseminating Associate
lecturer role development
and impact information from
UCLan
All at the initiation stage and to report back in the
new financial year.
Data Analysis
The first graph, below, shows data for completers in the years 11/12, 12/13 and 13/14, from
September and March intakes. These are completers of the nursing degree only and
exclude data from the Diploma. The figures include all completers e.g. students who have
taken up to the maximum of 5 years to complete and not just the standard pathway of 3
years. The calculation used is the DH Definition adjusting for transfers in and out.
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The graphs shows a downwards trend overall with C+L levels currently comparable to C+M
which has more fluctuation. The GM figure is skewed by a relatively large number of
transfers in which has given rise to negative attrition rates in one of the HEIs.
The second graph below utilises a pure attrition calculation, simply the percentage that
completed the year from those that started. The 3rd and 4th graphs contain the same data for
years 2 and 3. Years 2 and 3 include transfers in as these give a new starting number of
students at the beginning of the year.
Pure Attrition (%) for Adult Nursing Degree Year One (Sept Intake Only)
25.00
20.00
15.00
Cumbria/ Lancs
10.00
Cheshire/ Merseyside
Greater Manchester
5.00
North West
0.00
Year One 2011/12
Year One 2012/13
Year One 2013/14
Cumbria/ Lancs
19.53
19.02
12.34
Cheshire/ Merseyside
11.72
10.68
5.48
Greater Manchester
12.18
11.20
5.30
North West
13.61
12.70
6.94
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Pure Attrition (%) for Adult Nursing Degree Year Two (Sept Intake Only)
10.00
9.00
8.00
7.00
6.00
5.00
4.00
3.00
2.00
1.00
0.00
Cumbria/ Lancs
Cheshire/ Merseyside
Greater Manchester
Year Two 2011/12
Year Two 2012/13
Year Two 2013/14
Cumbria/ Lancs
5.60
3.64
1.74
Cheshire/ Merseyside
9.16
4.29
6.88
Greater Manchester
6.82
7.13
6.54
North West
7.59
5.09
5.62
North West
Pure Attrition (%) for Adult Nursing Year Three (Sept Intake Only)
10.00
8.00
6.00
4.00
2.00
Cumbria/ Lancs
0.00
Cheshire/ Merseyside
-2.00
Greater Manchester
-4.00
North West
-6.00
Year Three 2011/12
Year Three 2012/13
Year Three 2013/14
Cumbria/ Lancs
7.49
5.57
5.78
Cheshire/ Merseyside
6.37
2.98
7.15
Greater Manchester
6.52
2.71
-4.16
North West
6.67
3.46
3.08
Year 1 has by the highest attrition rates by some magnitude and work by the HEIs to reduce
attrition is clearly having a significant effect on this priority intervention point. The picture for
year 2 is more variable, C+L have the lowest rates and a downward trajectory with the
increase in the C+M rate skewing the NW average to increase between 12/13 and 13/14.
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Year 3 rates are consistently higher than year 2 with improvements in retention slowing in
one case and declining in another. Again the GM rate is skewed by transfers in the 3rd year.
We also investigated post 36 month pure attrition rates however as we have only consider
degree students the numbers taking longer than the standard pathway is too small to draw
any conclusions. Further work is needed to draw out the detail of attrition in non-standard
pathways to compare with those taking a longer timescale. This is particularly timely as the
NMC are currently consulting on removing the 5 year limit.
The modified attrition rate, graph below, is comparable to the HESA calculation and allows
us to compare to their published data. This definition excludes attrition within the first 10
weeks of commencing study and as such removes a significant proportion of students
included in the DH definition. The summary graph below compared with the first chart shows
this shift and further work is intended to compare this data to the subject amalgamated
codes in HESA as a preliminary benchmark, utilising the HESA portal.
Modified Attrition (%) for Adult Nursing Degree Year One (Sept
Intake Only)
20.00
18.00
16.00
14.00
12.00
10.00
8.00
6.00
4.00
2.00
0.00
Cumbria/ Lancs
Cheshire/ Merseyside
Greater Manchester
Y1 2011/12
Y1 2012/13
Y1 2013/14
Cumbria/ Lancs
17.71
15.00
10.72
Cheshire/ Merseyside
10.24
8.26
4.94
Greater Manchester
8.75
7.56
5.15
North West
11.40
9.52
6.29
North West
The table below uses data from ‘Non-continuation rates at English HEIs- Trends for entrants
2005-06 to 2010-11’ published by HEFCE.
2010-11 entrants no longer in Higher Education after one year by subject area
Subject
Medicine and Dentistry
Subjects allied to medicine
Education
Computer Science
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Modified attrition rate
2.3
8.35
7.55
14.65
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Comparing the national statistics as to the regional we can see that the from the first year
one in 11/12 to the last in 13/14 the North West has improved its position to below the
average for subjects allied to medicine. Whilst the timeframes can’t be comparable due to
the start dates of the degree course, it is clear that the North West is in an improving to a
relatively good position.
15/16 Retention programme
The proposed budget for next year is shown below and recognises the critical role that both
the HEIs and the NHS has in supporting retention across academic and clinical learning
environments. The shared responsibility across these environments is central to continued
progress against HEE Mandate requirements. It is envisaged that work will focus on the
Trust learning environments and driving their engagement within the planning and
commissioning cycle.
Retention Budget 15/16
Proposed projects
Deep dive into current placement
information held within HENW develop
regular reports within PETD
Invitation to quote for further qualitative
and quantitative work to assess
experience and support for student on
placement
Following pilot sites, further one of
funding to allow HEIs to capture current
and
historical
National
Insurance
Numbers
Targeted student engagement and health
and wellbeing initiatives (may include roll
out of current and FF bid projects that
provide(d) evidence of success)
Time
March- May
Cost
10K extension for temporary
analyst post
May- Jan
40K
April- Dec
30K
Sept- Feb
Invitations to bid 40K
Roll out and embedding of benchmarking
tool across NW and Nationally
30K
150
Libby Sedgley
Programme Manager- Education Commissioning
HENW
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