OP47 Understanding education and training decision-making of nursing students in the UK: a qualitative study

Background The NHS aims to increase healthcare training intakes and to meet projected workforce demand. However, declining nursing applicant numbers and high attrition rates in nursing are pressing concerns. In England, traditional nursing degrees cost ~£9,535/year, while apprenticeships are salaried (~£22–26k), but take longer and currently have fewer places available. To better inform policy and workforce planning, it is crucial to understand the factors influencing entry into nursing. This study aims to explore factors influencing decision-making processes of nurses, with particular focus on pathway preferences.

Methods Qualitative semi-structured interviews (N = 40) were conducted online with 10 prospective nursing students, 10 current nursing students, 10 recently graduated nurses, and 10 training providers. Participants were identified through policy partners, educational institutions, and snowball sampling methods. Thematic analysis was conducted, structured using the Framework approach.

Results Six themes were generated: 1) Balancing life, learning, and livelihood; 2) Perceptions, misconceptions, and stigma; 3) Practical learning and embedded experience; 4) Career aspirations and progression; 5) Support systems; 6) Teaching and regulatory challenges. Financial stability and family commitments were considered key factors in educational choices, with the financial structure of apprenticeships perceived as preferable for mature students with children. Stigmatised perceptions of educational pathways (with apprenticeships typically perceived as less prestigious than traditional degrees) appeared to contribute to a vocational-versus-academic divide, and differential delivery approaches (concurrent-versus-sequential delivery of practical and theoretical learning) also appeared to influence choices. Negative media portrayals of nursing post-COVID reportedly discouraged recruitment. Apprenticeships were considered to have more robust support systems, facilitating positive educational experiences and mitigating academic confidence issues, with peer support and camaraderie highly valued across both routes. However, some younger students questioned their readiness to enter the workforce and reported their desire to have a more traditional university experience. Providers reported apprenticeship delivery as more costly to educational institutions due to additional regulations and administrative load, and many noted a dichotomy in learning types between pathways, rendering integration of teaching across pathways problematic.

Conclusion Addressing the shortages in applications to nursing courses in England requires a multifaceted approach. Our data suggests that national awareness campaigns to improve perceptions of nursing careers, enhanced financial support for degree students, and regulatory simplification for apprenticeship expansion may be beneficial. A more integrated approach to nursing education policy, balancing accessibility, workforce needs, and student support, is essential to address current shortages in the nursing workforce.