Nursing and midwifery - Listening Project: You shared, we listened

4. Focus groups with nursing and midwifery students and academics

Phase three focused on listening to the future workforce. Focus groups with both nursing and midwifery students took place separately and the Council of Deans Health (CoDH) (Scotland), with the Royal College of Midwives (RCM) supported the recruitment process. Nursing students from 5 higher education institutions (HEIs) agreed to participate (n=23). Information was gathered from these students via online focus groups (n=5) and those participating represented all 4 fields of nursing practice and all 4 years of nursing programmes. Geographically, these nursing students also represented the North, East and West of Scotland. Recruiting midwifery students proved more challenging, however, with the support of the RCM, 1 focus group with midwifery students (n=4) took place. These students represented 3 HEIs and, geographically, also represented the North, East and West of Scotland.

4.1 Nursing and midwifery students

The focus groups were structured around the following questions:

• Why do you want to be a nurse/midwife/why did you decide to study?
• What was your understanding of the role of a nurse/midwife when you joined your programme of education?
• In what way, if any, has your perception of the profession changed since you joined your programme of education, and can you explain why?
• What, in your opinion, works well in nursing/midwifery education?
• What has your experience of your programme been so far on placement?
• Who supports you on placement, and what does this support look like?
• How prepared do you feel for placement?
• What could be done to improve your programme generally?
• Based on your experience, what could be done to improve the profession?

Presentation of key themes

Student narratives were documented verbatim as focus groups progressed, taking care to probe for further information or clarity as required. Whilst the professions of nursing and midwifery differ significantly in many aspects, as do the fields of nursing, areas of similarity, where students provided similar responses, irrespective of field or profession, were identified. These areas are highlighted as part of this report. The following themes are therefore drawn directly from the student narratives, as is the explanatory text underpinning each theme.

4.1.1 Joining the profession

Both nursing and midwifery students highlighted an array of motivating factors that led to choosing a career in these professions, confirming that they are not always a first choice. Some indicated inspiration, and aspiration, from a young age because of a family member working in healthcare, whilst others highlighted previous career choices or a desire for change, sometimes because of personal circumstances.

“I was in and out of hospital when I was younger; I grew up remembering that. I also had family who were nurses and decided to be a children’s nurse because of that.”

Other nursing students mentioned experiences as a carer and how this was a catalyst for joining the profession.

“I thought about it for years, but caring for a family member at end of life was the push I needed.”

Whilst for midwifery students, personal experiences of motherhood, birthing and vulnerability were key including the impact of the care received from registered midwives.

“I applied after having my children later in life. The midwife that looked after me – the confidence the midwife instilled in me when I was having my son – it was just intrinsic in me to be a midwife after that.”

“It was something that I always wanted to do – the thought of supporting a woman in her most vulnerable state is just something that I’ve always wanted to do.”

A desire to give back was also key for many nursing students, as was the desire to seek a career beyond that of health care support worker.

“I’ve had mental health issues and have received care and want to pay back.”

“I want to go further than being a healthcare support worker.”

4.1.2 Expectations versus reality

This emerged as a particularly strong theme for both student groups, but for different reasons. Some nursing students had an idea of the practical tasks that a nurse would perhaps undertake in practice whilst others had expectations of a much broader, more holistic, role prior to programme entry.

“Helping people in emergencies, giving you medicine and looking after wounds. A cliché really – but it’s not really until you go on placement that you really understand what they do. It’s so much more than that!”

“For me it was about health promotion and being able to participate in this. I also expected to facilitate care plans and to help people make the journey to recovery or just to make them comfortable as part of palliative care.”

Student midwives were also relatively well-informed about the role and duties of a midwife prior to programme entry. They articulated well their expectations of caring for women, mentioning the importance of family. They did however allude to a sense of reality shock when identifying what they perceived as a lack of autonomy.

“The role of a midwife is about caring for the women and their families across the continuum from pregnancy to ante-natal to post-natal – and even online support.”

“Caring for women and their families. Sometimes partners and other children can be overlooked and I wanted to be a midwife that cared for the whole family.”

“We (midwives) don’t have autonomy – NMC (Nursing and Midwifery Council) say we are autonomous, but are we?”

Mismatched expectations and reality for both nursing and midwifery students included workload and staffing. Terms including ‘stretched thin’ and ‘on their feet all day’ voiced by student nurses emphasised their recognition of the workload of nursing staff. One student nurse encapsulated this more generally when stating:

“It’s not really until you’re on placement that you really understand what they (nurses) do. It’s so much more! I was quite naive and didn’t really understand about the pressures and how hard they have to work.”

Student midwives also frequently referred to work pressures for staff. This was again emphasised particularly well by two student midwives.

“Although we’re supernumerary, we’re not sure how the midwives would cope without us there to help.”

“I didn’t realise how hard midwives have to work. Until you are actually in it – I was shocked at how much midwives have to work and how much they are on their feet.”

The reality of the professional role, and professional expectations, was also not clear for some student nurses pre-programme. For one in particular it was evident that once on programme a greater understanding of professional responsibility and accountability ensued.

“The Code (NMC) must be lived both in and out of work and that has been a new concept to me. Professional and personal responsibility is clearer to me now.”

For another student nurse, a change in perception and a renewed understanding of why degree education is important also shone through.

“The programme has enhanced my appreciation of a degree and the importance of being a graduate. Having the academic knowledge to support your role is clearer to me and I understand why education has to underpin what we do clinically.”

4.1.3 Valuing vocational education

Both student groups valued the vocational nature of midwifery and nursing programmes however, it was noted that nursing students perceived that they have greater exposure to simulation and opportunities to practice in a safe and controlled environment than that of their student midwife peers. Student nurses frequently emphasised the importance of simulation and repeatedly indicated a preference for the inclusion of more of this in-programme. They spoke with enthusiasm about the preparation this afforded pre-placement and about the positive impact of this on confidence and feelings of safety.

“Simulation gives you a degree of confidence before placement - as opposed to just being taught in the classroom and being expected to do it in practice.”

“Practical learning is where we learn most. We need more skills classes because this is the best learning environment! The opportunity to practice in a safe and controlled environment is so important before going into practice.”

Midwifery students however expressed concern about lack of simulation. They also suggested that opportunities to practice skills in practice, more generally, are very limited, perhaps re-emphasising the importance of simulation for these students.

“We really need simulation that increases in complexity as we progress through our programme. When you’re in practice you’re expected to know how to do things, but that’s really difficult if you haven’t practised before.”

“When you’re asked to carry out a skill in practice it’s much less daunting if you’ve had a chance to practice it in simulation in a safe and controlled environment.”

Both student groups confirmed satisfaction with hybrid learning, emphasising that being able to learn online, as well as on-campus, can assist with travel and expenses burdens. Both groups did however recognise the social and vocational aspects of their programmes and, as part of this, confirmed that opportunities to come together on-campus with peers for face-to-face learning are important. In keeping with this, both groups also recognised the value of learning from experts in the professions and being supported to develop critical thinking and research skills from those with the necessary expertise in midwifery and nursing, emphasising again the value attributed to graduate education.

4.1.4 The practice learning environment

Satisfaction and dissatisfaction were expressed by both student groups about aspects of the practice learning environment (PLE). Both recognised the value of the practice component of programmes and, overall, felt this was crucial to ensure their readiness for registration. However, it was also evident that both felt there are barriers and challenges which can negatively impact on the PLE experience. This included expressions of frustration at feeling unwelcome when arriving at the PLE, with some student nurses citing particularly negative comments expressed by staff.

“Not everyone is welcoming in the PLE when you arrive.” (student midwife)

“I heard a member of staff say ‘Thank God I don’t have students this time – I’ve had them the last 4 times!’” (student nurse)

“Who are you? I don’t have anyone to look after you” isn’t very welcoming” (student nurse)

There were also complaints about being made to feel like a burden, especially when they hear staff say they do not want a student.

“I’ve heard staff say, “I hate students” or “they know not to give me students because I hate them.” It’s just awful, so awful that I don’t want to go to placement sometimes.”

“The feeling seems to be that they are ‘landed’ with students, and they see it as baby sitting and not nurturing the profession – I wish they could see it differently. I wish they could realise that they can tip you over the edge to leave the profession. How is that type of attitude helping to build the workforce?”

Both student groups attribute some of these issues to problematic or ‘patchy’ communication between HEIs and practice, suggesting that this needs to improve. Both also feel that the culture in the PLE more generally needs to shift from students being viewed as burdensome, to that of them being viewed as the future workforce. Student nurses in particular requested more emphasis for registrants regarding their role in teaching students. Alongside this however, both student groups expressed empathy for registrants. This was evident in the way they discussed registrants’ workload and workload pressures.

”It can be draining to always get students to look after when you’re busy.” (student nurse)

”Severe staff shortages make it very difficult for midwives – I’m not sure how they would manage without us” (student midwife)

Both student groups however also recognised the need to stand up for their supernumerary status and to protect their right to learn.

”You have to constantly advocate for yourself and fight for learning.” (student nurse)

”I had to advocate for myself on more than one occasion as I was missing out on lots of opportunities because I was being used as a pair of hands.” (student nurse)

”On paper we are supernumerary – but in reality, it’s different. You have to point that out sometimes.” (student midwife)

This confirms that although both student groups have empathy for registrants, they are very aware of their programme requirements and what they must achieve.

4.1.5 The learning journey

Both student nurses and midwives placed importance on financial support to enable them to engage effectively with programmes. Whilst they recognised the provision of non-means tested bursary and travelling expenses for Scottish domiciled students, both groups expressed concern around managing within the confines of this support. Both also felt that their learning journey could be improved if financial worries could be addressed more effectively.

“You have to juggle your finances just to stay on the programme.” (student nurse)

“Even if you are one million percent committed you can still drop out because of money.” (student nurse)

“Being told by the university (HEI) that this (the programme) is your job is unrealistic on a £10,000 per year bursary” (student nurse)

“I will be leaving this programme with significant debt and have to use a foodbank to make ends meet” (student midwife)

Programme organisation and content were also flagged as requiring restructure. For midwifery students, practice learning and simulation were key concerns, with some comparing midwifery simulation to simulation provision for nursing students.

“We really need simulation that increases in complexity as you progress through the programme - and not just one-time only practice and then move on.”

“The nurses have some amazing simulation – but there isn’t enough staff to do this for us. In fairness our HEI (higher education institution) is listening and is trying to add more of this into our programme, but it is definitely traumatising to go out into practice if you have only ever been taught about normality.”

Student midwives also suggested that communication between the HEIs and practice needs to improve to ensure that practice supervisors and assessors are more confident and informed about what they can do on placement, particularly in relation to completion of the practice assessment document. Student nurses agreed with the need for better communication generally, but also highlighted a sense of unfairness around student assessment burden when speaking to fellow student nurses from other HEIs. Alongside this, and despite acknowledging the availability of simulation as part of nursing programmes, most student nurses spoke of the need for more simulation as part of programmes, particularly in relation to the more complex skills.

4.1.6 Improving the professions

Both student groups flagged staffing as integral if wishing to improve the professions. Student midwives highlighted the ‘predominantly female nature of the workforce’ emphasising the need for better childcare provision, family-centred shift patterns and flexible working arrangements to better support registrants. Student nurses also flagged this, adding that ‘recompense for childcare’ would better support staff. In terms of readiness for registration, student nurses highlighted the benefits of being employed as a Band 4 whilst on programme.

“Getting a Band 4 has really helped me to develop my confidence in the clinical area – I think everyone should be encouraged to do this when they are a student.”

Renumeration in the role of registrant was viewed as essential by both groups if wishing to improve the professions. Both emphasised the importance of being valued and paid appropriately. Alongside this however were concerns about staff setting precedents that they (students) view as unhelpful in the workplace. This was articulated by a student nurse who felt registrants should lead by example.

“I also think people need to take breaks and they need to lose the attitude of hero complex for not taking breaks. People getting praised for staying behind for 3 hours after work and being praised by leaders for not taking breaks – that’s a really terrible ethos to encourage and leads to burn out. It also puts everyone else under pressure to do the same or you feel like you’re not pulling your weight!”

Both student groups agreed that learning in practice is reliant on robust supervision and assessment, and both also commented that there should be ‘dedicated time’ for this to make it a ‘better experience’ for students and registrants. Student midwives referred to the need for ‘a change in culture,’ indicating that they can feel unwelcome in PLEs. Student nurses expressed similar sentiments, specifically referring to bullying and the culture that can present at times in nursing.

“Nurses eat their young is still there and needs to be addressed – bullying and horizontal violence needs to be addressed too.”

“There can be a type of gang culture when you get a lot of one gender together and it makes you want to leave the profession.”

Although both student midwives and nurses recognised that learning can be supported in practice, with one student midwife referring to being ‘taken under a registered midwife’s wing,’ it was apparent that these supportive experiences were often viewed as being over-shadowed by more challenging experiences. Complaints of staff being ‘short-sighted’ in their treatment of students surfaced with regularity. In particular, ‘treating them as a pair of hands’ was a frequent message conveyed.

Student nurses discussed transitioning to registrant and conflicting viewpoints were expressed regarding whether newly qualified nurses (NQN) could provide practice supervision. Some believed NQNs deserve time and space to ‘settle into the profession,’ whilst others valued their recent experience as a student, and subsequent transition to practice supervisor. Student nurses also expressed the desire to feel valued in the NQN role, discussing the need for continuing professional development (CPD).

“Make it clear to staff what the opportunities are for career development and progression to inspire them!”

Student nurses also felt that clearer marketing messaging was required to ensure that nursing can be the profession for all, irrespective of age, gender, or ethnicity.

4.2 Nursing and midwifery academics

Focus groups (n=7) and an interview (n=1) with HEI nursing and midwifery academics took place with the support of the CoDH (Scotland) and RCM (Scotland) to recruit to the project. Nursing academics (n=27) from 6 HEIs and midwifery academics (n=3) agreed to participate. The nursing academics represented all 4 fields of nursing practice. Geographically, the academics collectively represented the North, East and West of Scotland. In total, the number of participants in each of the academic focus groups ranged from 4 to 5 participants.

Focus Group/Interview Questions – Nursing and Midwifery Academics

Key open questions were generated to initiate a conversational approach, the aim being to enable the academics to provide more detailed answers as the focus groups/interview progressed. Time was given to raise issues of importance and, as with students, it was not always necessary to ask every question or to prompt the academics to respond, mainly as areas of concern or importance were often communicated freely as the conversation took place.

The focus groups were structured around the following questions:

• Can you talk to me about what it is like to teach student nurses/midwives?
• What are your experiences of working as a nurse/midwife?
• Why did you choose to move into academia?
• What, in your opinion, works well in nursing/midwifery education?
• Changes since Covid?
• Workload issues for staff?
• Role of nurses/midwives and how this is matched to the education provision?
• Support for practice learning?
• What doesn’t work so well and what could be done to improve things?
• What can we do to attract more people to become nurses/midwives?

Presentation of key themes

The discussion with academics was documented verbatim as each focus group and interview progressed, taking care to probe for further information should a comment be made that was unclear. In keeping with the verbatim approach to gathering this information, the following themes are drawn directly from the academics’ narratives, as is the explanatory text underpinning each theme.

4.2.1 Becoming an academic

Career pathways and development have been a focus of the Taskforce, and academics also shared their experiences, and reasoning, for transitioning from clinical roles to academia. Some nursing and midwifery academics indicated that a career in academia had always been an aspiration, with a variety of reasoning underpinning this decision-making.

“I loved teaching and supporting students as a clinician and the whole ‘learning to learn’ fascinated me - it was an aspirational thing for me to be an educator.’

‘When I was in practice, I always believed I could shape practice and influence students. If you come into teaching, you can influence policy, practice, and research – it’s now my happy place.”

“I wanted to encourage and inspire students to be excited about the profession.”

Some nursing and midwifery academics indicated that a desire for CPD and ‘involvement in research’ had naturally led to employment in HEIs. A midwifery academic voiced frustration at an HEI’s ‘requirement for a PhD’ to enter academia, viewing this a block to entering teaching. At times, both nursing and midwifery academics voiced general frustration at the lack of clarity or pathway to academia, and, in some cases, about being unable to maintain tangible practice links.

“It’s challenging to be able to continue in practice and be an academic – over the years I’ve vowed to try to achieve that. But because of the nature of the job – and being an LME (Lead Midwife for Education) – it’s not possible. I’m sad about that.”

“It was another member of (academic) staff who told me I could teach – because I didn’t think I would ever be capable or would ever be considered. I was encouraged because of my clinical knowledge and was told that I could learn how to teach. It was that shove in the right direction – I miss my clinical, but it was a good jump.”

For others, careers in academia happened by chance, or because of a preferred clinical career no longer being available. As described by one nursing academic.

“I really wanted to be an advanced nurse practitioner, but all posts were withdrawn, so I ended up teaching clinical skills and being employed by a university (HEI).”

What is apparent across most responses is that the route to academia from a clinical role is not particularly well-defined.

4.2.2 Nurturing the profession

Midwifery and nursing academics expressed ‘passion and enthusiasm’ for teaching and supporting students. Central was recognition of the importance of ‘communication and interaction,’ emphasising the need to ensure face-to-face contact with students as part of programme delivery. ‘Seeing them (students) mature and seeing their confidence growing’ was recognised as motivators to continue in the role by nursing academics in particular.

“When they get it (learning), it is the most beautiful thing ever – there is no better thing than being an academic when that happens!”

“When you feel you’ve reached them and made that concept understandable it’s (being an academic) a great job!”

Midwifery academics however also highlighted a sense anxiety from students, much of which they interpret as stemming from students’ experiences in practice. These academics recognise their role in supporting students to overcome this anxiety.

“Not all students have great experiences - some pick up on the stress of midwives out there. From an education point of view staffing has become a lot worse and that comes back to us and our ability to be there and support students as best we can. I think we all have passion for teaching, but that’s sometimes just not enough.”

Alongside this, nursing academics recognise the ‘continuous learning and development’ that takes place when employing research and applying evidence as an academic, viewing this as both challenging and exciting.

“You grow personally and professionally with your students, and it is really magical – watching the trajectory of their growth!”

This, combined with subject expertise, is also viewed as key to nurturing students to become registrants.

“Having a variety of subject experts in a faculty gives you a good opportunity to provide a better student experience and to provide those life experience stories as part of teaching – teaching is a performance and its reliant on your expertise and your ability to make it authentic.”

Nursing academics are also conscious that they must role model appropriate behaviours as an academic, both from a student and public perception standpoint.

“I see positive role modelling as essential as an academic – I want students to remember me for the right reasons when they register.”

Midwifery academics concurred, reflecting on their role in nurturing careers however, they expressed concerns regarding recruitment of experienced clinicians to academia. They spoke specifically of the challenges of enticing experienced clinicians to leave a clinical career at the top of the pay scale to potentially enter the academic pay scale at the lower end. They highlighted that, to grow and nurture academics, it is essential to be able to recognise the value of ‘clinical experience’ when negotiating these salaries.

4.2.3 Strengths and challenges of nursing and midwifery education

Nursing academics reflected on the strengths of contemporary nursing education, with most agreeing that ‘meaningful service user involvement’ and ‘co-production with students and other stakeholders’ are essential for programme enhancement. Similarly, midwifery academics commented on the strengths of ‘stakeholder stories and external speakers’ and harnessing these for student learning. They spoke, in particular, of how these components are ‘valued by students.’

Mixed views were shared by nursing academics regarding Nursing and Midwifery Council’s (NMC) standards however, with some viewing the opportunity for all 4 fields of nursing students to engage in shared learning as ‘positive and holistic’, and others questioning the role of a more ‘generalist’ approach to nursing education. The balance of 2300 hours of each theory and practice was considered by those who commented as positive in terms of programme structure, as was the presence and input from the national practice education team, led by NHS Education for Scotland (NES).

In keeping with the students’ views, employment of students in the Nurse Bank as healthcare support workers (HCSWs) was also viewed as positive by academics.

“These hours as a healthcare support worker help students financially, keep them in the health and care environment and also help them (students) with their confidence in practice.”

Again, in keeping with students’ views, the opportunity to practise skills in simulation, with academics who are clinically current, was also viewed as positive, and as an important ‘confidence builder’ for students before practice learning experiences. Most academics agreed that clinical currency is important, alongside the ‘drive, enthusiasm and passion’ of academics to teach.

“Skills content and students having time in practice – having a great skills team with contemporary knowledge of practice too – all of this is essential to help build students’ confidence.”

From a more practical standpoint, and reflecting post-Covid, nursing and midwifery academics both recognised the importance of face-to-face interaction with students, acknowledging the ‘humanity’ that is central to both professions. There was also an acknowledgement of the role of small group work in building relationships.

“It’s a really important part of relationship building and also enables students to build a sense of identity when it (small group work) takes place in-person.”

Midwifery academics in particular referred to ‘peer support and student collaboration opportunities on-campus’ and the importance of this, highlighting that ‘face-to-face teaching always works best.’ Nearly all academics agreed that it was essential to encourage ‘peer-to-peer dialogue’ and group interaction as part of this.

Challenges experienced in contemporary education were discussed. These included, what is considered, by nursing academics, to be the ‘knee-jerk response’ of some HEIs to the National Student Survey (NSS) results each year. A sense of frustration was conveyed, suggesting it would be better to take time to consider the results before taking action. Midwifery academics also highlighted frustrations regarding staffing issues when attempting to action change in response to the NSS results.

Student non-attendance for theory hours was raised by nursing academics, suggesting ‘stricter compliance’ requirements, more in keeping with the fastidious processes employed when recording clinical hours.

“As with NMC, theory hours should carry equal importance to that of practice when recording attendance.”

Nursing academics, whilst supportive of the student bursary, conveyed attendance should be linked more strictly to bursary payments, ensuring ‘students are more accountable for their attendance.’

Midwifery academics viewed simulation in both a negative and positive light, the former relating more to the perceived lack of funding to deliver this effectively for students. This chimes with the viewpoint expressed by midwifery students.

“Simulation works, and could work, really well in midwifery, but resources and investment are required to make this more effective.”

Finally, the unique selling point (USP) of HEIs was also questioned as a consequence of ‘cumbersome and time-consuming NMC quality assurance processes’ and, following on from this the ‘Once for Scotland’ approaches were, for some academics, also viewed in a negative light, with the suggestion that they potentially ‘remove opportunities for originality’.

4.2.4 Workload

All midwifery and nursing academics reported significant concerns regarding workload. Year-round delivery, unrealistic marking timelines, and general workload burdens were mentioned by all. Reports of working evenings and weekends, just to keep on top of workload, without financial recompense, were uniformly reported across those who participated and all reported feelings of burnout and stress.

“University (HEI) work allocation models need to be revisited as these are unrealistic and do not reflect of our workload. We are exhausted and the model does not recognise this. We cannot stop long enough – even to catch our breath!”

“Nursing doesn’t fit in with university (HEI) processes. The 3-week marking turnaround time for marking is completely unrealistic and our working week is not 35 hours per our contract. I know that most of us work weekends and evenings and I for one regularly work 60 hours per week, as well as regularly working until 2 – 3am

during marking periods. My work-life balance is terrible.”

“I’m constantly spinning multiple plates – I feel stressed and burnt out.”

Many nursing academics felt their efforts are also not recognised as they were not viewed as being ‘frontline’ because they are not ‘in practice.’ However, it is their perception that they frequently go ‘above and beyond’ to meet deadlines and ensure that teaching can take place without interruption. All academics also reported that they cannot ‘switch off’ at the end of the day as there is ‘no-one to hand-over to.’ One nursing academic did however report that ‘lessons had been learned’ from staff who had felt overwhelmed and ‘a structured induction’ was in place for new staff with a ‘plan for building up to an increased workload’ to ease the burden.

Overall, the morale of all academics was reported as low, with repeated references to ‘burnt-out’ and ‘exhaustion.’ All requested more consideration of the nuances of these programmes, which bring with them ‘considerable pastoral support needs and regulatory requirements’ adding exponentially to burden. Unfavourable academic pay scales were viewed as linked to recruitment difficulties, adding to workload burdens. More ‘transparent workload modelling’ was also called for, with midwifery academics in particular voicing concerns regarding workload modelling and pedagogy.

“The workload allocation model really impacts on the motivation of staff as it really restricts the number hours per student per module and it doesn’t allow us to be creative in teaching delivery. If you attempt to apply innovation, then you are told by your manager you only have x amount of time for this and if you do any more than this amount of time then you are effectively working for free – this really restricts our ability to be motivated and to be creative. So, pedagogy is in total conflict with the workload allocation model.”

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4.2.5 Improving the profession

Both groups of academics agreed that an effective national marketing campaign was required to help with recruitment. Both recognised the impact of the media, and how this could perhaps be harnessed in a positive sense for the enhancement of the professions. This was discussed in the context of the risks of negative media attention and how this might currently be discouraging applicants to the professions.

“There needs to be a more positive media presence about midwifery – there are so many wonderful projects going on, and led by midwives, there are also so many great careers available as a consequence of midwifery. It’s all about widening the lens and making it more accessible.”

“We need to flood the media generally with adverts for nursing as a career – we need to advertise. It’s a generational issue; what’s important to us is not as important to the new generation and we need to consider this in our marketing strategies.”

Nursing academics cited more recent negative media about nursing as a blocker to revitalising the profession. Statements such as ‘that (negative media) needs to be addressed as it is really toxic and damaging to the profession’ were commonplace. Alongside this, for both nursing and midwifery academics, was the need to address ‘staffing, pay and conditions.’ Both groups agreed that these significantly influence negative press. This, combined with better representation of the professions more generally, would substantially improve the professions, and the public’s perception of these. One nursing academic perhaps encapsulated this best in this statement.

“It’s about the core perception of what is a nurse – the focus on the caring profession limits the public’s perception about what it is that we actually do. It makes us the hand-holder and the toilet-taker and removes all focus on us as the critical thinkers that we are. It demeans us and it really grinds my gears – we need to sell ourselves as what we are. It has to be national message that we are scientific professionals who are on par with other scientific healthcare professions. We constantly sell ourselves short and it has to change.”

Conveying more effectively that a career in nursing involves ‘caring, planning and analytical thinking’ were viewpoints expressed by most nursing academics, and not achieving this was viewed this as potentially damaging to the profession. Some also expressed disquiet about the perception of nursing in the aftermath of the pandemic, suggesting that, in some cases, this detracted from the reality of the diversity and magnitude of what really goes on in nursing, focusing solely on the ‘superhero image.’

There was recognition of the ‘diversity of the students that are attracted to nursing’ and, alongside that, a plea to support these students more effectively to enable them to stay in the profession, especially in practice. However, nursing academics also suggested that there has to be robust assessment of reasonable adjustment to ensure protection of the public when ‘selecting candidates for recruitment.’ As part of recruitment, recognition of how best to appeal to those interested in a contemporary nursing career was also considered.

“Our young people have changed, and we forget that when we’re recruiting. Adverts for nursing need to be shown with people without uniforms, as well as with people with uniforms. We need to remove this stereotypical image of nursing and bring it into the 21st century.”

“We need to think about offering part-time opportunities and flexibility, giving more freedom for life choices and career aspirations rather than imposing our choices on them.”

HEI workforce issues were raised again as central to improving the profession by both groups of academics, including funding and resourcing of programmes and ensuring sufficient resources to best deliver these programmes. For nursing academics in particular, the recruitment of ‘very inexperienced clinicians’ was a concern, with suggestions that this could be addressed if pay in the sector was reviewed and improved to be more in line with NHS pay scales. Midwifery educators also agreed that this issue must be addressed to recruit and retain staff in the sector.

“NHS pay is so much higher than academic pay – their (clinical staff) pay has increased exponentially and ours hasn’t. There is a considerable pay gap, and we feel undervalued - I also think this adds to issues of recruitment and attraction in academia. I don’t understand why this isn’t recognised.” (Nursing Academic)

The move towards the introduction of shortened routes into nursing was considered, with some viewing this as less about education and the ‘development of critical thinkers’ and more about ‘filling posts.’ This was linked to the perception of nurses as ‘angels,’ which was considered as not necessarily helpful. This emphasises again academics’ viewpoint that nurses should be viewed as ‘scientific professionals, critical thinkers and caring individuals,’ confirming that it is about recognition as a well-rounded ‘graduate profession.’ This chimes with previously raised concerns about the perception of the nursing profession more generally.

Nursing academics discussed increasing recruitment targets year on year, recognising the importance of meeting workforce need. Recruiting suitable candidates who are a best fit for the profession was also considered important, however and was linked directly to progression and retention. Academics emphasised the need to identify the drive and motivation of those applying to nursing programmes, ensuring that candidates came prepared to demonstrate appropriate behaviours and values reflective of the profession. They emphasised how important recruitment processes were in ensuring this. Nursing academics also considered student motivation to remain on programme as closely associated with motivation to remain in the profession post-graduation, confirming the need for appropriate behaviours and attitudes to be nurtured in students while on programmes.

Midwifery academics called for change and development of new entry routes into the profession in Scotland.

“It’s all about widening the lens and making it more accessible – I love that in England there is an apprenticeship programme that helps people onto the path of midwifery without them having to sacrifice their current job. So having ways to enter midwifery, rather than straight onto a degree programme is essential.”

Alongside this, the ability for nursing students to articulate into year 2 was also cited as something to potentially strive for in the future in midwifery; currently not permitted by NMC. Midwifery academics also suggested improvements in the profession stemming from better support for international recruitment. Finally, midwifery academics also recognised the ‘co-morbidities that women can experience,’ calling for more conversion programmes to enable nurses to become midwives, seeing this as a ‘real benefit to the profession.’

And at a more fundamental level, midwifery academics quite simply called for improvements in workplace culture.

“We simply need to learn to be nice to each other.”

This workplace culture was linked to some of the challenges in practice experienced by midwifery students, and how being treated unkindly can negatively impact on their experience of the programme and learning more generally. It was clear that this type of culture was viewed as risking ‘negativity about the midwifery role’ and was considered to be a risk in terms of student retention and satisfaction.