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The University of Surrey European Institute of Health and Medical Sciences Centre for Research in Nursing and Midwifery Education

An Evaluation of the Diploma in Higher Education Nursing Studies (Adult) Pre-registration Part-time Programme

Final Report April 2005

Pam Smith Mike O'Driscoll Carin Magnusson

X/Chichester/Evaluation report/Final report 18.10.05 (USE) 05 CONTENTS

Acknowledgements...... 5 EXECUTIVE SUMMARY...... 6 1.1 Evaluation aims______6 1.2 Expected outcomes and benefits of the evaluation______6 2. Literature Review...... 6 2.1 Existing part-time provision from other HEIs______7 3 Research Design...... 7 3.1 Methods______7 3.2 Analysis______8 4. Findings...... 8 4.1 Instructional System______8 4.2 The Learning Milieu______8 4.2.1 Recruitment, induction and retention...... 9 4.2.2 Support for students______10 4.2.3 Contribution to policy objectives...... 11 5 Recommendations...... 11 5.1 Recruitment and retention______11 5.2 Support for and involvement of students______11 5.3 Other recommendations______12 6. Summary...... 12 MAIN REPORT...... 13 1. Background...... 13 1.1 Evaluation aims______13 1.2 Expected outcomes and benefits of the evaluation______14 2. Introduction...... 15 2.1 Literature review______15 2.1.1 Characteristics of part-time students...... 17 2.1.2 Experiences of part-time students...... 17 2.1.3 Outcomes from part-time programmes...... 18 2.1.4 Understanding part-time pre-registration programmes...... 19 2.1.5 The future of part-time pre-registration programmes...... 20 2.2 Existing provision from other HEIs______21 3. Research Design and Methods...... 23 3.1 Research Design______23 3.2 Methods______23 3.3 Analysis______24 3.4 Ethics______24

2 4. Findings...... 25 4.1 The ‘Instructional System’______25 4.1.1 Curriculum...... 25 4.1.2 Validation and approval...... 25 4.1.3 Format of programme...... 25 4.1.4 Philosophy of Programme...... 26 4.1.5 Aims and outcomes of the Programme...... 26 4.1.6 Teaching and learning strategies...... 27 4.1.7 Assessment...... 28 4.1.8 Student Support...... 28 4.2 The ‘Learning Milieu’______29 4.2.1 Teaching facilities at St Richard’s (Chichester)...... 29 4.2.2 Teaching facilities at Stag Hill Campus (Guildford)...... 30 4.2.3 Part-time students...... 30 a) Programme and Personal/ Family circumstances...... 31 b) Family...... 31 c) Not getting enough notice of the timetable of the programme...... 32 d) Portfolios...... 32 e) Placements...... 32 f) Paid employment and benefits...... 33 g) Recruitment and Induction...... 33 h) Academic support...... 34 i) Personal support...... 35 j) Placements...... 35 k) Completing the Programme...... 36 l) Differences between the 2003 and 2004 cohorts...... 39 4.2.4 Students who have left the programme...... 40 a) Family Background...... 40 b) Recruitment process...... 41 c) Balancing competing demands on time...... 41 d) Academic support...... 41 e) Support while on placements...... 41 f) Personal support...... 42 g) Reasons for leaving the programme...... 42 h) Suggested changes to the programme...... 43 4.2.5 Tutors...... 43 a) Perceived Family/personal/demographic characteristics of students...... 43 b) Recruitment...... 44 c) Support for students...... 45 d) Academic support...... 45 e) Library access...... 46 f) Access to computer, internet and e-journals...... 46 g) Personal support...... 46 h) Placements...... 47 i) Achieving learning outcomes...... 47 j) Completing the programme...... 48 k) Contribution to policy objectives...... 48 4.2.6 Key staff...... 48 4.2.7 Mentors...... 49 a) Mentors’ roles and qualifications...... 49 b) Mentors’ perceptions of the adequacy of their mentoring...... 50 c) Relationship of mentoring and completing the programme...... 50 d) Mentors’ perceptions of whether learning outcomes are met...... 51 4.2.8 Full-time students...... 51

3 4.4 Discussion - common themes______52 a) The value and ‘status’ of the part-time programme...... 52 b) Recruitment/induction...... 53 c) Support for students...... 53 5. Conclusions...... 54 5.1 Recruitment and retention______54 5.2 Support for students______54 5.3 Contribution to policy objectives______55 6. Recommendations...... 55 6.1 Recruitment and retention______55 6.2 Support for and involvement of students______56 6.3 Other recommendations______56 7. References...... 58 8. Appendices...... 60 Appendix 1: Time scale and scope of evaluation...... 60

LIST OF TABLES

Table 1: Provision of part-time pre-registration nursing programmes in English HEIs (other than the University of Surrey)______22 Table 2: Curriculum stated aims regarding skills and learning outcomes______27 Table 3: Data collection summary______29 Table 4: Demographic profile of part-time diploma adult nursing students by cohort (source: University of Surrey admissions database).______31 Table 5: Student attrition from the part-time programme______37 Table 6: Demographic profile of part-time and full-time diploma adult nursing students by programme mode______52

4 Acknowledgements

The evaluation team would like to sincerely thank all those who participated in, and assisted with, the evaluation.

5 EXECUTIVE SUMMARY

1.1 Evaluation aims

The evaluation of the Diploma in Higher Education Nursing Studies (Adult) Pre- registration Part-time Programme aimed to: i) develop a contextual overview of the education and support for students undertaking part-time pre-registration nursing programmes at English Higher Education Institutions (HEIs) ii) provide formative evaluation of the delivery of the part-time pre-registration nursing studies programme offered by the European Institute of Health and Medical Sciences (EIHMS) University of Surrey, in relation to structure, content and process iii) evaluate the educational outcomes of the programme iv) evaluate the contribution of the programme to the development of current educational and health policy (e.g. widening participation for students from non- traditional backgrounds; developing a flexible workforce) v) examine the feasibility of assessing the viability and cost effectiveness of continuing the programme at its current location and assess the advantages and disadvantages of relocating the programme to another site vi) examine whether increasing the ‘family-friendliness’ of the full-time programme might be a valid alternative to the part-time programme.

1.2 Expected outcomes and benefits of the evaluation

The main outcomes of the evaluation were: i) an increased understanding of the student experience on the Diploma in Higher Education Nursing Studies (Adult) Pre-registration Part-time Programme. ii) an increased understanding of the recruitment and retention issues of the programme. iii) recommendations for the future development of the programme.

2. Literature Review

There is some evidence from the literature e.g. Hooper (1975) and Bond (1992), to indicate that part-time programmes are a valuable means of widening participation to non-traditional students while also contributing to the needs of the local health economy. There is also some evidence to suggest that although part-time programmes may be relatively expensive to run in the short-term they may produce greater returns, in the medium to long term, than full-time equivalents.

6 2.1 Existing part-time provision from other HEIs

Part-time pre-registration programmes continue to be provided by a small number of HEIs, predominantly in ‘new’ universities. Although central government and other bodies such as the Royal College of Nursing (RCN) and the Nursing and Midwifery Council (NMC) appear to value part-time programmes it is unclear whether this espoused support is matched by financial or material support.

3 Research Design

The model of evaluation used in this study is a modified version of ‘illuminative evaluation’ (Parlett & Hamilton 1977). This model includes the analytically powerful distinction between ‘the instructional system’ (e.g. espoused aims of curriculum documentation) and the Learning Milieu (the curriculum as experienced ‘in action’). Illuminative evaluation aims to be problem-focused (i.e. the focus of the evaluation can change as new understandings are formed) and practitioner-oriented (i.e. it provides information for educators). A multi-method approach, which comprised both qualitative and quantitative elements, was used within this model.

3.1 Methods

The main methods of data collection were qualitative (semi-structured interviews and focus groups) which were complemented by the quantitative data from mentor self- completion forms and data relating to attrition and the demographic profile of students. The evaluation strategy comprised: i) Documentary analysis of curriculum and associated documents ii) Semi-structured interviews with the programme director and key staff iii) Semi-structured interviews with tutors iv) Self -report forms for mentors v) Focus groups with students from the part-time programme vi) One-to-one interviews/postal questionnaires for students who have left the programme vii) Focus groups with full-time students viii) Secondary analysis of quantitative data from the University of Surrey student database to provide baseline demographic information to 'profile' the student body.

7 3.2 Analysis

The quantitative survey data from questionnaires and interviews were analysed using descriptive statistics with SPSS. Qualitative data derived from interviews and focus groups were recorded and analysed using established content analysis procedures (e.g. Morse & Field 1995; Patton 1990) to develop analytic categories from the data in relation to the evaluation aims. Curriculum materials were subject to documentary analysis.

4. Findings

4.1 Instructional System

 The part-time programme is a pathway within the approved (May 2001) curriculum for the Diploma in Higher Education Nursing Studies (Adult) Pre-registration programme. A modification approval document was submitted prior to programme validation, detailing the additional curriculum requirements for this programme, but part-time students do not have a bespoke curriculum document.

 The local Workforce Development Confederation (Kent, Surrey & Sussex) requested that part-time provision should be made available and a needs analysis showed demand for the programme in the Chichester area.

 Teaching and learning strategies are described as facilitating student learning and emphasise the development of reflective skills to integrate theory and practice.

 Enquiry based learning (EBL) is part of the curriculum philosophy and is described as encouraging students to become active learners and facilitating integration between modules.

 Life-long learning and continuing professional development are also encouraged throughout the curriculum.

 Assessment strategies focus on achieving practice and theory learning outcomes. Such strategies include portfolios of practice evidence, reflective accounts, essays, critical incidents, personal development plans and traditional examinations.

 A range of support mechanisms is described in the documents including professional tutor groups, locality teams and other University support systems.

4.2 The Learning Milieu

The programme is primarily delivered from teaching facilities on the first floor of the Mother and Baby unit of St. Richard’s hospital (Chichester). Additional facilities and resources are available both within the hospital itself and in the adjacent University College Chichester (UCC) Campus. Students also have access to library and other support services at the Stag Hill Campus.

8 4.2.1 Recruitment, induction and retention

 Most part-time students could be regarded as non-traditional university students in that they had children, were over 25 and did not possess ‘A’ Levels. Furthermore many of them were in paid employment. However, it was not possible to make direct comparisons between part-time and full-time students on each or any of these variables since the latter did not respond to an invitation to participate in the study.

 It would appear that demand for the University of Surrey’s part-time pre-registration nursing programme continued to be strong in the Chichester locality and that, as there were a restricted number of places, no active marketing was considered necessary.

 Many of the students expressed their appreciation of the opportunities offered by the programme and the support given to them by tutors often from their personal time.

 Problems associated with recruitment interviews, such as interviewing staff not having adequate knowledge of the programme or the particular needs of part-time students, have been recognised and addressed in order to improve the recruitment process.

 Attrition from the first cohort of students to the programme was relatively high but interviews with tutors indicated awareness of the problem and a determination to deal with the causes. This is evidenced by the fact that a year on year comparison shows a greatly reduced rate of attrition.

 Major drivers of attrition identified by stakeholders included: financial pressure on students; students having to engage in paid employment as well as maintain programme and family responsibilities; changes in family circumstances; a perceived lack of academic support for students; an inability on the part of some students to cope with the academic demands of the programme; a gap between students’ expectations and reality in terms of what the programme demanded and an inability to cope with the demands of clinical placements perhaps because of a lack of previous relevant experience.

 Some students reported that neither the recruitment nor the induction process had prepared them adequately for the demands of the programme. This gap between expectation and reality was also recognised by tutors and key staff and was reported by some as a tension between professional and academic preparation.

 Some students appeared to be uncertain about the future of the programme despite assurances that were given to the contrary by the University of Surrey.

 Many students felt under a great deal of pressure as a result of having to balance the competing demands of programme, family and (in some cases) paid employment on their time.

 All stakeholders participating in the evaluation felt that the idea of adapting the full- time programme to be more family-friendly, as an alternative to the part-time programme, was an interesting one but were mostly sceptical about the possibility of an adapted full-time programme adequately meeting the requirements of existing part-time students.

9 4.2.2 Support for students

 Students appeared to be unaware of, and therefore not utilising, all the available sources of support, particularly student support services at the Stag Hill Campus. Some students felt that although there was much support on offer it was not adequate to meet their needs (e.g. for timely access to one-to-one tutorial support).

 Awareness of the part-time programme and the needs of the students appeared to be low among some stakeholders (including tutors at the Stag Hill Campus who were not involved in the actual programme delivery), the placements team and the ward based mentors. This may create difficulties for students in terms of appropriate recruitment interviews, obtaining timely information prior to placements and appropriate support during placements.

 Some tutors and staff who managed and administered the programme considered that part-time students needed extra support, on both an academic level (e.g. with information technology. and academic referencing systems) and on a personal level (e.g. relationship difficulties). Tutors indicated that many sources of support were in place to meet this need.

 Although one-to-one tutorial support is available students felt particularly unsupported in relation to accessing such support in a timely fashion. Regular one- to-one tutorials are now planned.

 Bonding between the students on the part-time programme was strong and they were a major source of support to each other.

 Students strongly expressed the feeling that portfolios were a particular challenge for them and wanted more support in relation to these.

 Although many support mechanisms exist for students during placements (e.g. mentors, student buddies, clinical placement facilitators, link tutors) students reported many instances where they had no source of support available. The reasons given for this included mentors being on holiday, the student not having the same shift pattern as their buddy or mentor, or placement locations not being informed in advance of the students’ arrival.

 Although the particular needs of part-time students in relation to clinical placements were recognised by tutors, managers and administrators on the programme some students were still experiencing difficulties in negotiating the work pattern of their placement (i.e. some placement locations were not offering students flexibility in the placement hours that they could work).

 Several students reported receiving inadequate notice of their placement times or placement locations from the placements office at the Stag Hill Campus, Guildford. Some students also said they found it difficult to get adequate notice of the structure of the programme (such as which days of the week it was to run) and in some cases this made it difficult for them to put childcare arrangements in place. Some tutors indicated that they were aware of this problem.

 Mentors reported they were largely satisfied with the level of support they were giving to students and considered they had adequate knowledge of the learning outcomes of the programme. Given the low response rate, the findings have been interpreted

10 with caution since it is recognised the respondents may not be representative of the group as a whole.

4.2.3 Contribution to policy objectives

Students, tutors, mentors and staff responsible for managing and administering the programme valued it highly and the vast majority were highly committed to its aims and the contribution which it is making to policy objectives, including widening participation and increasing the flexibility of the healthcare workforce.

5 Recommendations

5.1 Recruitment and retention

 The recruitment strategy, which has been strengthened, should be consolidated and formalised to ensure careful design of the recruitment process in terms of the staff who participate and the information they give to potential / beginning students. It is essential that students' expectations of the programme are clarified and that they are given a realistic picture of what will be expected of them on the part-time programme. The programme organisers need to fully consider the students’ personal circumstances at the outset of the programme and make realistic judgements about the support required for successful completion.

 A feasibility study should be undertaken before rolling the programme out to any other localities. In particular there needs to be an assessment of transport links and journey times to the Stag Hill Campus from any locality where provision of the programme is being considered as well as an assessment of the academic and support facilities available in the locality.

 Where teaching staff, from other HEIs, are contracted to deliver teaching it is essential that regular channels of communication which may be available (such as module meetings with the University of Surrey teaching staff and programme management team) should be appropriately utilised and sustained. Existing channels of communication should also be regularly reviewed and publicised.

 The programme should be clearly marketed to take account of the local health economy and the local population in order to both respond to, and meet the needs of, key stakeholders, including the Strategic Health Authority and the local market in relation to programme provision for ‘non-traditional’ students.

5.2 Support for and involvement of students

 Although key staff reported that there are nominated student representatives from each cohort there was an apparent need for even more student involvement and representation in the management of the programme to take account of their requirements.

 Further student representation would increase agreement between staff and students about the aims, structure and content of the programme (for example in relation to the most appropriate dates for submission of portfolios) and also make staff aware, on a regular basis, of how the student body feels about the programme.

11  Existing mechanisms for feeding data from module evaluation into the management of the programme should be fully utilised to ensure that concerns raised by students are acted upon.

 The date for completion of portfolios needs to be given careful consideration to avoid coinciding with school holidays. The amount of support available to assist students to complete portfolios should be increased and they could be shown examples of successfully completed portfolios.

 It would appear that students who commence the programme in 2004 onwards have been given a choice of two personal tutors thus achieving parity with the full-time students. This choice should be extended to the 2003 intake and maintained for all future intakes. This will ensure that one-to-one support is available in a more timely fashion and will also reduce pressure on tutors.

 Regular one-to-one meetings between students and personal tutors are planned and their early establishment is to be welcomed and supported on an ongoing basis.

 Consideration should be given to providing extra support to students who have children as well as being in paid employment during the programme as they are likely to be under the greatest pressure. The form of this support could be worked out in consultation with students or their representatives and might include priority access to academic or personal support.

 Although some opportunities for students to get to know each other are built into the curriculum, it would be beneficial to have more planned opportunities, early in the programme, for them to meet, socialise and bond, either on Campus or in an informal setting. This would facilitate the development of peer bonding and support for all students.

5.3 Other recommendations

It would appear that raising the profile of the part-time programme amongst all stakeholders, including tutors, mentors and the placements team would be beneficial in ensuring appropriate recruitment interviewing, mentoring and liaison. Approaches might include highlighting the aims of the programme, raising awareness of the profile of the students in terms of their support needs, and recognising the important contribution the programme makes to DH policy objectives such as widening participation. The exact form that such communications take could include a regular newsletter, a dedicated web page or staff development seminars focused on part-time programmes.

6. Summary

The Diploma in Higher Education Nursing Studies (Adult) Pre-registration Part-time Programme is making a valuable contribution to policy objectives such as widening participation, developing a flexible healthcare workforce, the skills escalator and providing a model for flexible teaching and learning to support non-traditional students. However, ongoing challenges remain to be addressed in order to ensure the students’ unique needs for appropriate support are met.

12 MAIN REPORT An Evaluation of the Diploma in Higher Education Nursing Studies (Adult) Pre-registration Part-time Programme

1. Background

The Centre for Research in Nursing and Midwifery Education (CRNME) was requested to carry out this evaluation by the Head of Programmes (Professional Preparation) at the European Institute of Health and Medical Sciences (EIHMS).

The programme is one of a small number of similar programmes in England that offer a Diploma in Higher Education Nursing Studies (Adult) Pre-registration Part-time Programme. The programme takes four years and seven months to complete but can optionally be completed in four years and six months. This timeframe recognises the Nursing and Midwifery Council (NMC) requirement that part-time Diploma programmes be completed within seven years. Minimum entry requirements are five GCSEs (grades A-C), GNVQ or Access course.

The development of the part-time programme is in line with national policy developments to encourage widening participation in the health care workforce. For example the report Making a Difference (DH 1999:13) states that:

‘ more people must be attracted into nursing, midwifery and health visiting….they are needed in sufficient numbers not only to remedy shortages, but also to enable employers to offer the flexible working conditions expected of a modern service.'

Making a Difference goes on to describe how access to education and training should also be widened and that structures should be put in place to ‘accommodate family, domestic and other commitments' (DH 1999:15).

The programme aims to cater for the particular needs and difficulties of mature students, especially those with young families or other domestic commitments as suggested by the Department of Health’s Improving Working Lives Standard (2004), by taking into account the timing of school half-terms, summer holidays and school day start and finish times.

The programme is provided by the EIHMS, a school of the University of Surrey, in dedicated teaching facilities in Chichester. These facilities have recently been refurbished and are adjacent to a local acute NHS Trust. The nearby University College of Chichester (UCC) assisted with the delivery of the programme in partnership with EIHMS through a service level agreement. Demand for the programme is relatively high; 22 students were admitted to the first cohort in February 2003 and 27 were admitted in February 2004 (from a total of 61 enquiries). In early 2004 five students had already expressed a firm interest in enrolling in February 2005 (although this was before the decision to discontinue new intakes to the part-time programme at Chichester was made).

An initial analysis of issues relevant to the proposed evaluation and the proposed methodology and time-scale is given below.

1.1 Evaluation aims

The evaluation of the Diploma in Higher Education Nursing Studies (Adult) Pre- registration Part-time Programme aimed to:

13 i) develop a contextual overview of the education of and support for students undertaking part-time pre-registration nursing programmes at English Higher Education Institutions

ii) provide formative evaluation of the delivery of the part-time pre-registration nursing programme offered by the University of Surrey, including structure, content and process

iii) evaluate the educational outcomes of the programme

iv) evaluate the contribution of the part-time programme to the development of current educational and health policy (widening participation for students from non-traditional backgrounds; increasing the flexibility of the workforce)

v) examine the feasibility of assessing the viability and cost effectiveness of continuing the programme at its current location and to assess the advantages and disadvantages of relocating the programme to another site

vi) examine whether increasing the ‘family-friendliness’ of the full-time programme might be a valid alternative to the part-time programme.

1.2 Expected outcomes and benefits of the evaluation

The main outcomes of the evaluation are: i) an increased understanding of the student experience on the Diploma in Higher Education Nursing Studies (Adult) Pre-registration Part-time Programme ii) an increased understanding of the recruitment and retention issues of the programme iii) recommendations for the future development of the programme.

14 2. Introduction

2.1 Literature review

Part-time programmes currently appear to be few in number in England1. Part-time provision appears to have declined over the last few decades despite the growth in the provision of full-time programmes and the large increase in the number of nursing, midwifery and allied health profession over recent years. There is a limited amount of literature on the particular characteristics of these programmes and their evaluation.

At least one hospital-based school of nursing in the north of England offered a programme leading to qualification as a SRN in the 1950s2 and Hooper (1975) describes a successful and popular part-time pre-registration programme provided in the south- west of England (Portsmouth) from 1970. Hooper describes this scheme as ‘experimental’ indicating that there was little, if any, part-time provision prior to this programme. The limited literature that exists in relation to part-time pre-registration nursing programmes suggests that part-time provision did not take off following the success of the pioneering part-time Portsmouth programme. Buchan (1989) found that there was considerably less provision of part-time programmes in the late 1980s than there had been in the mid 1970s and states that in 1986 only 260 out of 64,650 learner nurses in England were classified as part-time - just 0.4% of the total.

In 1990 the then General Secretary of the Royal College of Nursing (RCN) Christine Hancock estimated the number of part-time students at 105 out of a total population of 45,000 (0.23%) (in Bond 1992: 7).

Bond (1992) carried out a review of part-time pre-registration provision (commissioned by the Department of Health) in 1991 interviewing part-time mature students (and a smaller number of full-time mature students); recruitment allocation officers; programme tutors and college principals at four out of the 16 institutions which she was able to identify as providing, or having recently provided, part-time pre-registration programmes at that time. Bond estimated that ‘500 mothers’ were enrolled on such programmes at 16 colleges. Most of these programmes seemed to have commenced in the mid-to-late 1980s. Bond quotes Department of Health (DH) statistics for 1991 showing that, taking nursing, midwifery and health visitor programmes together there were 630 part-time students.

Clearly then, although there may be differences between estimates of numbers of part- time students, all sources seem to agree that the numbers are, up to the early 1990s, small (probably 1% or less) of the total number of students at that time. Bond (1992:32) also notes that less than a third of the part-time programmes which she identified were planning further intakes - i.e. the majority of programmes were being wound down.

It might seem strange that part-time pre-registration provision was in decline in the late 1980s and early 1990s as there was then concern that a ‘demographic crisis’ was going to hit nursing due to a decline in the number of 18-year-old female school leavers. The Secretary of State for Social Services wrote to the Chair of the UKCC in 1988 stating that in view of ‘future demographic trends’ it was important that the UKCC examine ways in which access for students of all ages could be provided’. The DH’s Strategy for Nursing (1989) urged the nursing profession to:

1 See ‘existing provision from other HEIs’ section 2.2 for details 2 personal communication from Pam Smith

15 ‘ look outside its traditional recruitment areas for candidates, to mature students and under-represented groups such as men and ethnic minorities. Many of these students will require additional input to get back to formal studying, and home commitments will require flexible, possibly part-time courses to be arranged’.

The RCN also recognised the need for ‘a rapid expansion' of opportunities for mature entry including part-time programmes in all branches of nursing (Hancock in Bond 1992:3).

As well as this encouragement of measures such as part-time programmes, by the Government and professional bodies, Hooper (1975), Bond (1992) and Stark and Redding (1993) all reported strong local demand for such provision from potential students.

However, demand for part-time programmes, at a local and political level, did not apparently produce a significant increase in the actual provision of part-time programmes. It would seem that a number of factors provided a counterbalance to this demand for provision of part-time programmes.

Firstly, the early 1990s was a time of relatively high unemployment leading to an increase in the supply of applicants for full-time nursing programmes and a reduction in the number dropping out from such programmes. This led to targets for numbers of NHS staff being met without any special recruitment drive aimed at ‘mature’ candidates. The demographic crisis in nursing (i.e. falling levels of young recruits leading to recruitment shortfalls) which had been predicted thus failed to materialise.

Secondly it would appear that the Project 2000 changes may have negatively impacted on part-time provision. Bond (1993:52) notes that:

‘ Courses that were modified to meet mothers’ needs are now disappearing with the introduction of Project 2000.’

The move from college settings (where most part-time provision had traditionally been offered) to HEIs may have restricted the flexibility in the types of programmes offered. Bond mentions the perceived difficulties (from programme organisers’ point of view) of combining part-time and full-time students on placements and the apparently higher costs per student of running part-time programmes.

It would seem that while the case for part-time provision is widely recognised amongst nurse educators, in pragmatic terms it is easier and cheaper (at least in the short term) to provide and manage a ‘standard’ full-time pre-registration programme with a large intake than an equivalent part-time programme with a small intake of students who each have particular circumstances and commitments outside of the programme which need to be taken into account.

Maslin-Prothero (1992:25) supports the argument that Project 2000 has been detrimental to those wishing to study nursing part-time:

‘ Before Project 2000, some colleges ran excellent mature entrant courses specifically tailored to meet the requirements of mature students. This included part-time hours and education taking place within school hours, which enabled students to care for dependents as well as gaining a nursing qualification. With the advent of the new diploma course it appears that many students are having to adapt to the new diploma course rather than find a course which recognises their needs and commitments outside the college’.

16 2.1.1 Characteristics of part-time students

Hooper (1975:102) describes the students on the Portsmouth programme as typically being female, married, aged 33-44 and with children aged 5-12. Most students possessed a basic level of educational qualification - the minimum entry requirements for the programme were 3 ‘O’ Levels, a School Certificate or a General Nursing Council test. The personal circumstances of the students were also considered as part of the admission criteria. In particular, prospective students’ partners were interviewed to ensure that they understood the commitment that the student would be undertaking and that they were supportive of it. Many had to travel considerable distances to take up placements but seemed to manage satisfactorily.

Stark and Redding’s (1993) description of a part-time Project 2000 programme at the North-East Essex Institute for Health Studies shows that the vast majority of students were married, had partners who were in employment and had an average age of 35. All had children and the majority of these children were aged 5-11 years. ‘O’ Levels were the highest level qualifications obtained in most cases although students had a variety of previous work experience. Many were travelling considerable distances to the programme and/or to placements.

Newport and Downer (1993) were students on the programme described by Stark and Redding and, in their short paper on the programme, found that all students were female and all had children but were from a variety of age groups and occupational backgrounds. Students were described as highly committed to the programme, juggling university and home life despite often facing prejudice from full-time colleagues.

Bond (1992) does not provide detailed quantitative data in relation to her student respondents but makes it clear that all were mothers with dependent children and most were over 25. Bond (1992:10) finds the majority of those students she interviewed had no formal qualifications but had entered part-time training on the basis of the DC test3.

2.1.2 Experiences of part-time students

Bond (1992), Hooper (1975) and Stark and Redding (1983) found that part-time students experienced considerable pressure in trying to reconcile the competing demands on their time of studying and (in most cases) dependent children. Some students had a further demand on their time of part-time paid employment (quantitative data on the proportion of those taking paid employment while training appeared to be unavailable). Although part-time programmes have in all cases been designed with the needs of mothers with school-age children in mind (such as shorter days enabling drop-off/collection of children from school and holidays synchronised with half-term/summer holidays) many students still felt that they were performing a fairly stressful juggling act to successfully manage all aspects of their personal, academic and working lives. Any unplanned change in circumstances potentially creates a crisis, which must somehow be resolved. Both Bond (1993:51) and Newport and Downer (1993:49) find that part-time students are the victims of prejudice from their teachers (who may doubt their commitment) and ward staff (who may view them as having a comparatively easy time due to their 'fewer' hours). Despite the ‘juggling act’ and the prejudice a picture emerges from these four papers of part-time students as resourceful, highly committed, motivated and supportive of each other.

3 A test formerly accepted as an entry gate to a Diploma Course. The NMC decided to discontinue its use from September 2003

17 2.1.3 Outcomes from part-time programmes

Despite the challenges of being a part-time nursing student the literature appears to show that outcomes from part-time programmes are superior to those of full-time programmes. Caution must be exercised though, as the number of part-time programmes which are reported in the literature is small and the number of students on these programmes is also, in most cases, small.

Hooper (1975) found that in the first four years of the Portsmouth programme, attrition averaged 10%. There was a 100% pass rate on written exams and, of those who had completed the programme, 78% (18 out of 23) were working in nursing in the Portsmouth area. Hooper also found that the level of sickness and other absence compared favourably with the full-time programme. Satisfaction with the programme amongst students was high.

Bailey (1988) found that on a part-time programme for mental health nursing students, exam achievement was higher over a 10-year period than for the equivalent full-time cohorts.

Bond (1992:22) estimated average attrition from eight part-time programmes which she examined to average 14%, which compares favourably with attrition figures from contemporaneous full-time programmes of around 20% (e.g. Lindop 1988; Vousden 1988). Bond also provides some quantitative evidence that there were lower levels of sick leave on part-time programmes than on full-time programmes but this is based on one site only. Bond does not report any data on exam success, as most of the programmes which she looked at were so new that they had not seen a full cohort through the programme. Bond found that early evidence appeared to support Hooper’s (1975) findings that on qualification part-time students were more likely to enter practice in their local area and to have longer careers as nurses than were their full-time counterparts.

Newport and Downer (1993) report attrition as being ‘virtually zero’ in relation to the part- time programme in Essex which they reported on. Stark and Redding (1993) (in relation to the same programme) found average attrition to be around 9% (eight out of 90 students from four cohorts having left the programme). Absenteeism was found to be lower amongst the part-time students than among the full-time students. Exam pass rates were also higher amongst part-time students than amongst full-time students.

In summary the literature appears to show that students on part-time pre-registration nursing programmes are more likely to pass exams and to complete the programme than are their full-time counterparts. They are more likely to practice in their local area than are full-time students on similar programmes possibly because they are less geographically mobile due to having family commitments such as children at school in the area.

There is also some evidence (Waite et al., cited in Bond 1992: 28) that part-time students may practice for longer than those who have qualified through traditional full- time programmes. This may be because part-time students are more likely to have completed their families by the time they enter practice – full-time students may take a break to start a family or rear children and a certain proportion will not return to nursing.

This evidence suggests that although, in the short-term, part-time programmes may be relatively expensive to provide there is a greater return in the medium to long-term than there might be from comparable full-time programmes.

18 2.1.4 Understanding part-time pre-registration programmes

Jeffreys (1998) defines non-traditional students as those over 25; those who have English as a second language; those from an ethnic or racial minority; those with dependent children and, in the case of nursing, males. Bean and Metzner (1985) add to this the criteria of being a part-time student and/or a commuter. It would seem reasonable to add to this list of criteria being in paid employment while studying or having domestic responsibilities other than children/partner (e.g. being a carer for a parent) as either of these roles involve serious responsibilities outside of the programme. Students from a lower socio-economic group (i.e. working class) background should also be considered as non-traditional for a variety of reasons. Amongst these reasons are that such students may be at a disadvantage in terms of understanding the ‘culture’ of Higher Education and are also more likely to struggle financially. Clearly all students on the programme are ‘non-traditional’ on the criteria suggested by Bean and Metzner of being part-time. However the students on the Diploma in Higher Education Nursing Studies (Adult) Pre-registration Part-time Programme may be further distinguished from traditional students on criteria of age (they are older than traditional students; see table 4:p.31), having dependent children and importantly, the fact that many are in part-time paid employment.

It might be supposed that, to the extent that the intake of part-time pre-registration nursing programmes (or pre-registration nursing programmes in general) is disproportionately composed of students from ‘non-traditional’ backgrounds then the literature which relates to students from non-traditional backgrounds could be used to inform evaluation of the part-time programme. However the literature suggests that in terms of some key outcomes (such as completion of programme, exam success) part- time pre-registration nursing students do not match the profile of non-traditional students. It must be borne in mind though that the literature only shows a small number of cases and therefore the evaluation does not exclude any insights which may be gained from literature relating to non-traditional students.

Within the limited amount of literature that exists in relation to part-time pre-registration nursing programmes there is a common assumption that part-time programmes are mainly, or even exclusively, for mothers who are old enough to be classified as mature students. The title of Bond’s 1992 report ‘Nurse Education for Mothers’ is one such example. While a large majority of students on part-time pre-registration programmes may indeed be mature females with children it would seem important not to assume that such provision should only be aimed at this group or that it is only used by this group. In particular the terms ‘mature students’ and ‘part-time students’ should not be used interchangeably. The characteristics of the students must be seen as distinct from those of the educational provision. For example the high exam success, low attrition and low absence rates referred to in the literature may be more explicable in terms of the age of students on part-time programmes and/or their familial status rather than the characteristics of part-time programmes. It is possible to imagine that married female mature students with children who appear to do well in part-time programmes might do just as well on a full-time programme.

The extent to which full-time programmes can be adapted to suit the needs of those who would traditionally seek to study part-time is not something that appears to have been addressed within the literature.

19 2.1.5 The future of part-time pre-registration programmes

At the current time changes are taking place in the funding of healthcare students which may make part-time programmes more financially attractive to students. The government has announced (The Guardian 15.05.04) that from September 2004 nursing, midwifery and physiotherapy students with parental responsibilities, including part-time students, will be eligible for a childcare allowance that will pay up to £114 per week for students with one child and up to £170 per week for those with two children or more. It is estimated that this may cover up to 85% of childcare costs. The allowance will be means-tested so that students whose partners are earning may not be eligible but it is likely to result in an improved financial situation for those on part-time programmes who have previously had difficulty in claiming benefits because of the bursary they receive, even though that bursary is often inadequate to live on. Part-time students may be able to reduce the number of hours which they spend in part-time employment reducing the pressure created by trying to reconcile the competing demands of home, study and family. In the present study, it is unclear at this stage how many of the students currently on the part-time programme would be able to benefit from the new childcare allowance and the focus groups with students indicated very low awareness and take up in relation to this allowance.

Parish (2004) reports that a spokesperson for the Department of Health appeared to restate the government’s support for part-time programmes as expressed in Making a Difference and that the NMC also supports the provision of part-time programmes provided they meet the statutory requirements for registration (4,600 hours of study divided equally between theory and practice). The RCN education forum placed a resolution on the agenda of the 2004 RCN Congress, which called on the RCN to run a campaign to encourage and support part-time programmes (RCN 2004). This resolution was carried with a 98% vote in favour.

However some scepticism about part-time programmes remain - former RCN President Betty Kershaw (quoted in Parish 2004) states that there is little demand for part-time programmes nationally. Kershaw explains that one of the reasons for this is the financial disincentive of part-time study but, as mentioned earlier, the new childcare allowance may go some way to removing this disincentive. It is also hard to judge demand for part- time programmes, as many providers, including the University of Surrey, do not appear to engage in proactive marketing of these programmes.

It is also worth noting that if the personal circumstances which lead students to undertake part-time study are still present after they complete their training, and they therefore choose to work part-time as nurses, it is likely they will encounter much diminished career prospects in comparison to their full-time counterparts (Lane 2004). Looking at attitudes to part-time workers within a wider context, Hochschild (1997) describes the negative perceptions of, and resistance to, part-time working in American corporate culture and the reluctance of many workers to take advantage of flexible working opportunities, where they are available. This is partly because they fear discrimination and partly because they have internalised the idea that commitment to one’s employment can be gauged by how many hours one spends in the office. At the current time, in a world of flexible learning and flexible employment, part-time study and part-time employment would seem to offer many opportunities but these may be accompanied by disadvantage and discrimination of a kind which has yet to be fully defined or researched.

20 2.2 Existing provision from other HEIs

Information about other part-time nursing programmes in England have been collected from a number of sources. According to the NMC there are 17 Universities in England that have been validated (approved) to run part-time programmes. These Universities and programmes are identified in Table 1 (below). The NHS careers website also lists eight HEIs that are approved to run part-time nursing programmes or that are planning to do so in the near future (NHS Careers, 2004). In addition, individual HEI web-sites have been searched for further information.

There would not appear to be any definitive and reliable source of information regarding part-time pre-registration nursing programmes. The various sources occasionally contradict each other and there is no way of knowing whether or not the information is complete. For example, one HEI’s part-time programme was not listed with the NMC or NHS Careers - findings regarding existing provision should therefore be treated with caution. Bond (1992) describes similar problems in trying to establish the population of part-time programmes and it is perhaps disappointing that there has been no apparent improvement in this respect in the subsequent 12 years.

It was noticeable that the majority of HEIs validated to provide part-time pre-registration nursing programmes are ‘new’ universities and this may relate to a greater commitment to widening participation at these institutions.

There would appear to be a need for a complete mapping of current provision of part- time Nursing Programmes in England and this would probably necessitate direct contact with Programme Leads at all HEIs offering nursing programmes in England (currently around 65 Institutions).

21 Table 1: Provision of part-time pre-registration nursing programmes in English HEIs (other than the University of Surrey)

4(HEIs where current provision of the programme was confirmed (n=9) are listed in the first half of the table and highlighted in bold). University NMC Listed on Comments/ Approved to NHS Information collected run part-time Careers programmes Website Y/N Y/N London South Bank Y Offers a number of 4-year programmes termed ‘In Service’. University E.g. ‘B.Sc. in Nursing and Social Work’, ‘B.Sc./Dip.H.E. Nursing Studies’ (Adult, Child, Mental Health). These programmes run over a 38 week academic year (compared to 45 weeks full-time) Kingston University & St Y Offers Dip.H.E. in Nursing (all branches) with B.Sc. (Hons) George's Hospital ‘top up’. Run over 6 years. University of Portsmouth Y Offers BN (Hons) Registered Nurse (Adult) full-time or part- time. Entry Requirements: Serving military personnel. The Open University Y Nursing Diplomas available running over up to 6 years. Employer must sponsor student. University of the West of Y Y Both Degrees and Diplomas offered part-time (up to 5 years England - Bristol – based on a 22.5 hour week) Liverpool Edge Hill Y Y Offers ‘Dip.H.E. in Nursing Studies (Adult, Child) College Approximately 4 years and 8 months, based on an average of 3 days per week University of Central Y Offers part-time BSc and Dip.H.E. (Child). Programme runs Lancashire over 4,3 years. Practice element consists of 26.5 hours/week. Manchester Metropolitan Y Y Offers Dip.H.E./B.Sc. Nursing (Adult, Mental Health). Runs University over up to 6 years. University of Teesside, Y Offers ‘B.Sc. (Hons) Nursing Studies’ (All branches) and Middlesbrough ‘DipHE in Nursing Studies’ 4-4.5 years part-time. University of Huddersfield Y No information about part-time programmes on HEI website Buckinghamshire Chilterns Y Univ College No information about part-time programmes on HEI website Middlesex University Y No information about part-time programmes on HEI website Anglia Polytechnic Y No information about part-time programmes on HEI website University University of Brighton Y No information about part-time programmes on HEI website Canterbury Christchurch Y Y No information about part-time programmes on HEI website Univ College Oxford Brookes University Y HEI website states that some programmes might be available part-time (run over up to maximum of 6 years) University College Y Y HEI website states that some Nursing and Midwifery Worcester programmes may be available part-time. Offered to individuals based on their personal circumstances. University of Y Y Only Conversion programmes available. Runs over 5 years. Wolverhampton University College Chester Y No information about part-time programmes on HEI website London, City University Y Appears that only M.Sc available part-time. Liverpool, John Moores Y No information about part-time programmes on HEI website

4

22 3. Research Design and Methods

3.1 Research Design

The model of evaluation used in this study is a modified form of ‘illuminative evaluation’ (Parlett & Hamilton 1977). This model includes the analytically powerful distinction between the ‘instructional system’ (e.g. the espoused aims of curriculum documentation) and the Learning Milieu (the curriculum as experienced ‘in action’). Illuminative evaluation aims to be problem-focussed (i.e. the focus of the evaluation can change as new understandings are formed) and practitioner-oriented (i.e. it provides information for educators).

Within this model a multi-method approach was used to address evaluation questions which comprise both qualitative and quantitative elements. Kevern and Webb (2001) point out that, given the complexity of nurse education, and the diversity of the backgrounds of the students which nursing tends to attract, quantitative methods alone may be inappropriate or inadequate.

‘The nature of the student body and the complexity of their course experience indicate that reliance on quantitative methods and structured questionnaires to access students’ views and opinions will not capture the diversity and quality of the student experience, nor do they allow an exploration of group norms and behaviour’

The experience of nurses undertaking part-time programmes is likely to be particularly complex. As the literature indicates, part-time students are more likely to be ‘non- traditional’ in terms of having commitments outside the programme such as part-time paid employment and/or family/childcare responsibilities compared with their full-time colleagues.

3.2 Methods

In order to achieve the evaluation aims the main methods of data collection were qualitative (semi-structured interviews and focus groups) which complemented the quantitative data relating to attrition and the demographic profile of students. The qualitative data allow the meaning and perceptions of non-traditional students undertaking part-time study to be captured. Specifically the evaluation strategy comprised: i) Documentary analysis of curriculum and associated documents ii) Semi-structured interviews with programme director and key staff iii) Semi-structured interviews with tutors iv) Self -report forms for mentors v) Focus groups with students from the part-time programme vi) One-to-one interviews/postal questionnaire for students who have left the programme vii) Focus groups with full-time students.

23 viii) Analysis of quantitative data from the University of Surrey student database to provide baseline demographic information to ‘profile’ the student body.

3.3 Analysis

The quantitative survey data from questionnaires and interviews were analysed using descriptive statistics with SPSS. Qualitative data derived from interviews and focus groups were recorded, transcribed and then analysed using established content analysis procedures (e.g. Field & Morse 1995; Patton 1990) to develop analytic categories from the data in relation to the evaluation aims. Documentary analysis was carried out on curriculum materials.

3.4 Ethics

Ethical clearance was obtained from the University of Surrey’s Ethics Committee. The evaluation was carried out within the guidelines of the University of Surrey’s Code on Good Research Practice and the Department of Health’s Research Governance Framework for Health and Social Care (2001).

It was suggested that the involvement of NHS staff (mentors) might necessitate the agreement of Trusts and/or the Local Research Ethics Committee (LREC) to obtain ethical clearance. In order to clarify the situation, consultation with the appropriate LREC representatives was made. In the event LREC secretaries confirmed that LREC clearance was not necessary for the evaluation

Particular care was taken to inform potential participants that their participation was voluntary, that if they did take part they might withdraw from the evaluation at any time, that their anonymity would be protected and that any data obtained would be stored securely. In the case of students it was particularly important to make it clear that their decision to participate or not participate in the evaluation would in no way affect their assessment on the programme. A full audit trail for the evaluation was created so that the means by which data were collected and the way they were analysed were transparent and open to independent inspection.

24 4. Findings

The findings are presented according to the methods used and, in the spirit of illuminative evaluation, are organised according to the ‘instructional system’ as documented in the curriculum material and the ‘learning milieu’ i.e. how the curriculum is implemented in practice as described by stakeholders.

4.1 The ‘Instructional System’

4.1.1 Curriculum

This section summarises key features of the curriculum and the programme as stated in the documentation.

A documentary analysis was undertaken using a range of relevant materials. This included Programme Handbooks, Module handbooks and curriculum submission documents. The documents provided detailed information about the programme under evaluation, including aims, intentions, outcomes and available student support services. The documentary analysis builds on Parlett and Hamilton’s (1977) model of illuminative evaluation, which draws on two key concepts: the ‘instructional system’ and the ‘learning milieu’. The former looks at the curriculum and associated documentation and the latter deals with how the curriculum is implemented in practice.

4.1.2 Validation and approval

The part-time programme is a pathway within as the approved (May 2001) curriculum for the Diploma in Higher Education Nursing Studies (Adult) Pre-registration programme. A modification approval document was submitted prior to programme validation, detailing the additional curriculum requirements for this programme, but part-time students do not have a bespoke curriculum document.

The proposal of modification (i.e. offering part-time mode), was approved by the Schools’ Policy and Strategy Committee in July 2002. A ‘modified programme approval form’ details the rationale, proposed format and resource implications of the modification to the programme. The documentation suggests that there were a number of drivers for offering the programme on a part-time basis. Firstly, the EIHMS wished to widen participation and opportunities of access to groups such as parents with younger children and carers. In addition, the local Workforce Development Confederation (Kent, Surrey & Sussex) requested that part-time provision should be made available. Finally, a needs analysis showed that many prospective students in the Chichester area made enquiries about part-time studying.

4.1.3 Format of programme

The successful completion of the part-time programme leads to the award of the Diploma of Higher Education Nursing Studies: Registered Nurse (Adult nursing), part 12 of the NMC Professional Register.

Intake for the part-time programme is in February or March each year and the stated maximum intake is 20 students. The programme follows the full-time curriculum and has

25 the same modules, but differs in length. The part-time programme runs over 4 years and 7 months. Both theory and practice learning is based on attendance being 25 hours per week during term-time. Half-term and summer holidays are free from teaching and students are not required to attend. As a result, each calendar year consists of 42 weeks of planned theory and practice learning. The theoretical teaching is delivered at the Chichester site of the EIHMS between 9.30 and 16.00 on identified days for each module.

The programme consists of 18 months Common Foundation Programme (CFP) and a three year branch programme. The CFP consists of three modules:

1. Fundamental and Professional Skills 2. Care Delivery 3. Health and Social Care

The branch programme (3 years) has a further six modules:

4. Community and Public Health 5. Health Care Interventions 6. Acute Care 7. Rehabilitation and Continuing Care 8. Leadership and Practice Development 9. Supervised Practice

The curriculum states that the days and the shift pattern of practice learning is negotiable by the student and should not exceed 25 hours each week. Practice placements are in one of the following Trusts:

1. Royal West Sussex NHS Trust 2. Royal Surrey County Hospital NHS Trust 3. Surrey and Sussex NHS Trust

4.1.4 Philosophy of Programme

The CFP aims to develop basic nursing skills and understanding of the theoretical frameworks underpinning care delivery. During the CFP there are learning opportunities in all four branches. Students are encouraged to take responsibility for their own learning and for the development of ‘learning skills’. The curriculum documents state that the Adult nursing branch is influenced by a number of policy initiatives informing practice. These are: Making a Difference (DH 1999), The NHS Plan (DH 2000) and Saving Lives: Our Healthier Nation (DH 1999). Guiding principles for the programme include; maximising the quality of individual lives; moving beyond disease-orientated approaches; reducing inequalities in health; protecting human rights and developing greater user and carer involvement.

4.1.5 Aims and outcomes of the Programme

The stated aims of the programme are to enable students to; practice anti- discriminatorily and towards holistic care; contribute to the wider healthcare agenda; achieve NMC competencies; practice safely; develop a sound underpinning of theoretical knowledge and to adapt to change.

26 The programme outcomes are clustered around four areas, which each have a set of distinct learning outcomes. The table below provides a summary of skills and associated learning outcomes: Table 2: Curriculum stated aims regarding skills and learning outcomes Skills: Synopsis of learning outcomes (students’ ability at

end of programme): 1) Professional Practice Adhere to NMC Code of Professional Conduct, follow

Skills and Attributes ethical and legal frameworks, use best available

evidence 2) Knowledge and Undertake needs assessments, formulate care plans

Understanding and provide rationales for care, knowledge of effective

inter-professional working practices, participate in

change management 3) Cognitive Skills Evaluate outcomes of nursing interventions, display

sound clinical judgement and critical thinking 4) Key skills Demonstrate; literacy, numeracy and application of

information technology, problem solving and working

with others

4.1.6 Teaching and learning strategies

Stated key aims of the teaching and learning strategies are facilitating student learning and emphasising the development of reflective skills. The relevant documentation describes this as students being able to relate new knowledge to experience and to reflect on their experiences. Reflection is also described as facilitating the integration of theory and practice through the use of a number of teaching and learning approaches. Reflections are recorded in the students’ diaries and should follow a structured five stage process

Enquiry based learning (EBL) is another approach used within the EIHMS and is described as encouraging students to become active learners and to facilitate integration between modules. The approach uses triggers, situations and scenarios with the aim of engaging students in the learning process. Life-long learning and continuing professional development are also encouraged throughout the curriculum and students are expected to take responsibility for their own learning.

4.1.7 Assessment

Strategies focus on achieving practice and theory learning outcomes. Assessment includes a portfolio of practice evidence; reflective accounts; essays; critical incidents and personal development plans. The pass mark for all the assessment components is

27 40% and to be eligible for the Diploma and Professional registration a minimum of 50 credits must be achieved at level 0 (during CFP), 160 credits at Level 1 (CPF and branch) and 210 credits at level 2, making a total of 420 credits accrued.

4.1.8 Student Support

The student handbook and curriculum documents describe a range of support mechanisms available to students:

Professional tutor groups: all students become members of groups consisting of 10-20 students time-tabled to meet monthly. The aim of the groups is to facilitate application of knowledge to practice and to develop greater understanding of professional knowledge. A range of teaching and learning strategies is used, with a particular focus on the portfolio of practice evidence.

Locality teams: these consist of professional tutors, who ensure practice areas are suitable for learning, provide sessions in practice and prepare and update mentors.

Other support services described include library and computing services; the network of University support services (such as Student Health Service, Careers Service, Student’s Union, ‘Nightline’ and student counselling services available both at the Stag Hill Campus and in Chichester). Mentors and clinical placement facilitators are identified as support services for students in relation to practice placements.

28 4.2 The ‘Learning Milieu’

The table below (table 3) summarises the data collection methods, samples and response rates which contributed to an understanding of the learning milieu.

Table 3: Data collection summary

Group Total Sample Response Method identified (of rate population population % and n* and identified in population July 2004) identified at July 2004 (in brackets) Part-time students (2003 22 (13 ) 100% 61% (n=8) 1 x focus group cohort) Part-time students (2004 27 (24) 100% 66% (n=16) 2 x focus groups cohort) Former part-time students (left 12 (9) 100% 55% (n=5) 1 x telephone interview programme) 4 x postal questionnaires Full-time students (based in 70 100% 0% (n=0) 2x focus groups were Chichester locality and who planned: These were commenced in 2003 or 2004) abandoned due to lack of response. Tutors (Stag Hill Campus 6 Convenience 100% (n=4) 4 x one-to-one semi- Guildford based) sample: 4 structured interviews tutors (66%) approached Tutors (University College 3 100% 100% (n=3) 1 x focus group Chichester [UCC] based) Key programme staff 3 100% 100% (n=3) 3 x one-to-one semi- structured interviews Mentors of students from the 25 100% 16% (n=4) 4 x self completion audit part-time programme forms

4.2.1 Teaching facilities at St Richard’s (Chichester)

The EIHMS has teaching facilities on the first floor of the Mother and Baby unit of St. Richard’s hospital (Chichester) and is accessed through a dedicated side entrance.

The facilities consist of three large teaching rooms, two of which can be joined together by the removal of a partition. There are a small number of offices of average size for tutors, administrators and other staff. There is a computer room for students with six computers which have internet access and access to e-journals. Some nursing journals are available in hard copy. Key staff reported that the computer room is busy but that students usually get access to a computer when needed and no formal booking system was therefore necessary. Students can also use the library facilities (including access to e-journals) and a café/restaurant within the main hospital building. Students may also become associate members of the nearby UCC library and borrow a limited number of books. There is a small kitchen area and a hot drinks vending machine. Students have limited access to photocopiers.

29 There is an administrator based on this site who is regularly approached by students for support. While all teaching staff for the part-time programme are based at the Duke of Kent building on the Stag Hill Campus they do have office facilities at the St.Richard’s site. UCC staff delivered parts of the programme under a service level agreement with the University of Surrey.

As a large majority of part-time students have family responsibilities and live in the Chichester locality, there is little or no requirement for accommodation at St. Richard’s Hospital.

The site is modern, clean and well maintained and, in conjunction with the library and dining facilities available in the main hospital, offers most of the facilities expected to ensure a comfortable learning milieu. Access to Chichester City Centre is a 15-minute walk or a short bus journey and links from Chichester to many of the surrounding areas by train, bus and road are reported to be good.

4.2.2 Teaching facilities at Stag Hill Campus (Guildford)

Only a very small proportion of the programme is delivered from the Stag Hill Campus. However part-time students may use the facilities at Stag Hill on the same basis as full- time students including full access to a modern and well-stocked university library, study rooms, computers with internet access, electronic journals and student support services.

The journey from Chichester to Guildford is approximately 45 minutes by road but can take up to 2 hours or (normally) just over an hour by train. However the ‘door-to-door’ journey time from St. Richard’s site to the facilities at the Stag Hill Campus was felt by many students to be prohibitive. Students also reported problems in accessing parking spaces at the Stag Hill Campus.

4.2.3 Part-time students

All current part-time students, from 2003 and 2004 cohorts, were invited to either a one- to-one interview or to participate in a focus group at the Chichester site. No students took up the offer of one-to-one interviews but a total of three focus groups were held with part- time students (one with the 2003 cohort in July 2004 and two with the larger 2004 cohort in September 2004). On average eight students attended each group.

All students who had left the programme from the 2003 cohort (n=9) were contacted by post to offer them one-to-one interviews at a time and place of their choice or a telephone interview5. One former student was interviewed by telephone. The response rate from this ‘hard to reach’ group was increased by delivering an attractively designed postal questionnaire to students who had left the programme and by offering a modest financial incentive (a £10 voucher for a high street store). Four former students participated through this method making a total of five interviews or questionnaires completed with former students. This response rate is good taking into account that students who have left the programme might be expected to have low motivation to participate in the evaluation. However, as it represents a relatively low proportion of the

5 During the course of the evaluation 2 students from the 2004 cohort went to ‘programme interrupt’ status (they plan to resume the programme in Feb 2005) and one student withdrew. It was decided not to contact these students as data collection was already underway at this time.

30 population, care must be exercised in interpreting the results and particularly in generalising the results to the population of former students. a) Programme and Personal/ Family circumstances

All the students who attended the focus groups were female and the majority were women of white ethnicity in their twenties or thirties with young children. The overwhelming majority of students chose to study part-time and locally because it allowed them to spend time with their family while studying and many students also felt compelled to study part-time so they could combine study with part-time paid employment to finance themselves through the programme. Nearly all students lived in the Chichester area although a small number lived a considerable distance from Chichester (e.g. Caterham which is 56 miles from Chichester and Redhill which is 47 miles from Chichester) but had been attracted to the programme due to the lack of alternative part-time provision nearer home.

Table 4: Demographic profile of part-time diploma adult nursing students by cohort (source: University of Surrey admissions database). The n shown refers to the total number of students for whom data were available in relation to each item

Cohort Number of Mean age Ethnicity % % married students (years) white British commencing at programme programme entry 2003 22 32.43 (n=22) 100% (n=9) 18% (n=22) 2004 27 36.26 (n=25) 96% (n=25) 12% (n=25)

Table 4 (above) shows that the mean age of students on the 2004 cohort at programme entry is nearly four years greater than that of the 2003 cohort and that the vast majority of students are of white British ethnicity. Nearly one in five of those in the 2003 cohort (18%) are recorded as married while just over one in ten (12%) of the 2004 cohort are recorded as married. However it is not clear if this database is up to date or merely shows what the marital status of the student was at the time of admission. Also it is important to note that data regarding students’ partners, other than whether they had a spouse or not, was unavailable and consequently students who were unmarried but living with a partner were merely recorded as ‘not married’. Data relating to whether students had children or not, or the number of children were unavailable. b) Family

Many students reported experiencing a tension between the demands of their family and the demands of the programme and most felt that it was extremely difficult to manage this tension and achieve a balance amongst the competing demands on their time. One student said that:

‘it’s only manageable in that something has to give..you have to give up your social life’.

It seemed that many students were primarily responsible for the care of their children and running of the home and the extent to which their partners were able or willing to offer support was variable. One student commented:

31 ‘ My husband is not supportive of me studying. That makes it ten times harder. My husband makes me feel very bad. I have to work to help paying the bills. I have to work two days each week’.

However several students indicated that their partners were very supportive. Those who relied on partners for support could find that they were in difficulty if their partner’s circumstances changed. One student who had left the programme indicated that a change in her husband’s working pattern, so that he was no longer able to look after their children during the early evening, was one of the main factors that had led to her leaving the programme. Students recognised that they could reasonably have anticipated that the programme would be difficult but one student also pointed out that there was no real way of knowing what the experience would actually be like until they had been on the programme for a period of time.

Some students expressed feelings of guilt about not being able to spend enough time with their children because of the programme. Students recognised that the programme is designed to cater for students with family responsibilities, in terms of the required hours each day, and having half-terms and summer holidays off and they were, on the whole, satisfied with the structure of the programme in this respect. However, students identified some aspects of the programme structure which created conflict with responsibilities outside the programme. c) Not getting enough notice of the timetable of the programme

Several students reported that they had had considerable difficulty in obtaining information about the planned timetable. Students felt that they needed to have this information well in advance of the commencement of the academic year so they had adequate notice to put childcare arrangements into place. There are also obvious difficulties in committing to patterns of paid employment until the programme timetables have been confirmed.

One student reported not being able to obtain the timetable information despite several requests and several students said that they had not been given the information about which days they would be required to study on the programme until a few days before the programme began. Some students reported being given inaccurate or contradictory information about which days the programme would run on and one student reported being informed (incorrectly) that the days of the programme would change each week. d) Portfolios

Several students pointed out that the deadline for the handing in of portfolios occurred during half-term. This was felt to be inconvenient because students may be unable to concentrate fully on portfolios during half-term when many of them have their children at home. Portfolios were identified by many students as a particular source of difficulty and many also felt that they needed a great deal more support in the completion of portfolios.

Portfolios were also identified by some students as a particular risk in terms of them not completing the programme because of the academic challenges which they represented. e) Placements

Although students do in theory have the power to negotiate the times and days of their practice placements several of them reported that the reality was more complex. One student reported that her placement provider had not allowed her any say at all in the

32 working pattern of her placement. While students felt that many placement providers were accommodating and flexible in relation to the needs of part-time students to work on particular days and within particular hours, there were several reported cases of practice providers not being aware that the student was part-time, or if aware, not understanding their particular needs.

Several cases were reported of negative judgements about part-time students from staff at their placement location, particularly in relation to the fact that some students were not able to make early morning handovers (at around 7am) or that they had to leave early to pick up children from school. Several students reported they had been made to feel guilty that records had to be referred to again when they had missed handover and one student stated that she felt discriminated against. One student reported that she had been told by a member of staff at the placement location that other students with children managed to work regular hours and this member of staff therefore felt that this student should do the same. The member of staff had failed to recognise the particular work pattern and responsibilities of the part-time student. f) Paid employment and benefits

Students on the part-time programme receive a standard bursary pro rata. However in order to make the programme work for them financially many students were in part-time employment. Many students therefore have three major spheres of their life to balance; work, family and study.

One student who described herself as a single parent said that she worked in paid employment on Sunday, Monday and Tuesday, and then attended the part-time programme on Wednesday, Thursday and Friday. Her only day ‘off’ was Saturday. This student felt that as a single parent she had no option but to work as she needed the income.

Some students felt that being a part-time student, with income from bursary, paid employment, benefits meant that they had a complex financial situation. In addition, for many students, their partner's income also had to be taken into account for tax and benefit purposes. This made eligibility for some benefits or tax credits difficult to calculate.

Although a tutor reported that students had been informed about the childcare allowance for health professional students introduced in September 2004 it would appear that there was only limited awareness or understanding of this allowance and it did not appear that any student was claiming this. Some students felt that they might not be eligible for the benefit due to the income from paid employment that either they or their partner received. Students expressed an interest in receiving more information about this.

Other benefits which students thought they might be entitled to included council tax benefit (a reduction in their council tax). Some students had had problems in claiming this in 2003 but these problems appear to have been resolved by the personal tutor. g) Recruitment and Induction

Some students felt that the recruitment process had not made them sufficiently aware of the academic standard of the programme for which they were enrolling. One student, who was interviewed some months after leaving the programme, felt that the academic level expected in relation to anatomy and physiology was so high that only those with at

33 least ‘O’ level Biology, and preferably ‘A’ level, should be admitted. Many students were critical of the induction process. Students felt somewhat excluded during the induction week at the Stag Hill Campus, which they perceived as being dominated by references to the full-time programme. Several students felt there had been little recognition of part- time students and a lack of staff available to advise about the part-time programme. h) Academic support

There was a perception amongst some part-time students that they received more support than full-time students, particularly in that they had smaller groups, and therefore had more opportunities to ask questions during lectures, and to access tutors, than full- time students. However it would seem that this level of support was still perceived as inadequate. Several students commented that they found it difficult to get time with tutors and that contact with tutors (outside of lectures) appears to be discouraged except through emails. Students were not entirely satisfied with this arrangement because they felt that there were times when face to face contact was needed. As one student put it;

‘ Yes we can ask questions but there’s not somewhere you can go and say ‘look I’m stuck on this referencing’’.

One student in the 2004 cohort perceived that some tutors did not recognise their need for more support:

‘but whenever we say that we feel like second class citizens.. it’s not being addressed.. they say "oh you get more support than the full-timers’’ '.

Students in the 2004 cohort acknowledged that they had now been promised short regular one-to-one sessions with their personal tutor. The absence of sufficient one-to- one tutorial support was one factor identified by one former student as a reason for leaving the programme.

Portfolios were mentioned by students in both cohorts as a particular source of stress and difficulty. Students mentioned that they had difficulty in understanding what was required from them in producing a portfolio and would like to have much more support such as getting feedback on their portfolios before submission and being able to access good examples of completed portfolios.

Although the curriculum identified professional tutor groups as a particular source of support in relation to the preparation of practice portfolios it was not clear how students were using this support and whether or not they found it useful.

Some students felt that there was too much academic work in the programme and that the standard was higher than they felt they would need as practising nurses. Examples cited were the need to understand the Harvard referencing system and the number of reflections and triggers that they were asked to produce. One student commented:

‘there is very little relation between the academic standard we are expected to get up to and the work we will be doing.’

Another student added:

‘I feel like I’m doing a degree course and when I’m finished I might as well go and be a lecturer…’

34 These perceptions are perhaps partly formed by the fact that the 2004 cohort were at an early stage of the programme and had not, at the time of the evaluation, had as much practical as academic experience of the programme. It may be that these students anticipated that they would be working in a practice-based profession and did not therefore feel they would need a high level of academic knowledge to practise as a nurse. i) Personal support

The programme administrator at the St. Richard’s EIHMS Campus was seen as a major source of personal support for students and was much praised by them. Students also said they were sometimes able to speak to tutors, including their personal tutor, for personal support. However the overall perception of students appears to be that the levels of support are inadequate.

Some students reported feeling isolated from the university but felt that they compensated for this by supporting each other very strongly. The strong bonding amongst the students was evident at the focus groups although it seemed that in one focus group not all students were included in this group support.

There were no references to contacting student support (student care services) at the Stag Hill Campus. j) Placements

As discussed above, many cases of inadequate notice of the location of placements were reported. Most students felt that the responsibility should be on the university to provide this information in a timely fashion but that in fact the student had to take the lead in trying to obtain the information about their placement.

Experiences of placements were mixed. One student described their placement experience as:

‘..a nightmare…no mentor..no buddy, no-one knew we were coming.’ and another student concurred with this.

This contrasted with the experience of another student who said that the placement providers had been:

‘fantastic, they were lovely to me; I told them the hours I could work and they said "fine’’'.

Another student related her experience of taking up a placement in the private sector:

‘I was on day care for the whole placement, in private sector, all (patients) were fit and well coming in for endoscopy…I just filled in forms and took blood pressures’.

This student felt that there were benefits in terms of taking up a placement in the private sector, such as that she had more time to talk to staff but she believed that the placement provider had not had a placement student before so didn’t understand her required learning outcomes. As referred to above, placements were identified as a particular time when balancing other demands such as family and paid employment may become particularly difficult.

35 Students perceived that placement providers were variable in the extent to which they were aware that the students were part-time and the extent to which they recognised the particular needs of part-time students and were prepared to accommodate them. Also, as reported above, one student reported she had had no say at all in the placement pattern that she was able to work.

The student quoted above (who had had a placement in the private sector) reported that she did not have a mentor for the duration of her placement. Another student reported that her mentor had gone on holiday during her placement and that she was therefore reporting to, and being assessed by, a trainee mentor.

Many students reported difficulty in locating or spending time with their mentor and there were several instances of mentors being absent for the duration of a placement. Students thought that it would be a good idea to have two named mentors for each student to increase the chances that at least one mentor would be available when the student needed to see them. Students felt that access to mentors might be a greater problem for part-time students than for full-time students. One student gave an example where her mentor’s work schedule only overlapped with her own for 15% of the week. The student therefore had very little chance of being able to make contact with the mentor.

Students considered they should contact the Clinical Placement Facilitator (CPF), who has overall responsibility for placements if they had problems relating to mentors. The students were very positive about the support and help they had received from the CPF.

A link tutor, who is responsible for overseeing and co-ordinating placements from the programme, is also available to provide support to students in relation to queries or problems they may have regarding placements or mentors. It was not clear to what extent students accessed this source of support.

A ‘buddy’ system, (which pairs the student up with a more experienced student on placement) was being piloted at the time of the evaluation. The students were very positive about the buddy system but felt that it could be improved in terms of making it easier for students to locate and spend time with their allocated buddy. k) Completing the Programme

Progression data

Data relating to students’ progression through programme modules indicate that the vast majority of students are reaching or exceeding the required pass marks on the first attempt. This also applies to practice portfolios which students identified as a particular challenge. The data supplied showed that two students from the 2004 cohort and two from the 2003 cohort had their portfolios ‘referred’ meaning that the student had to carry out further work on it. It would seem that those students from the 2003 cohort whose portfolios were referred went on to produce portfolios of a pass standard. The equivalent data for the 2004 cohort was not available at the time of the evaluation.

The progression data suggest that only one student was coded ‘programme terminated’ i.e. that they were unable to reach pass standard in their portfolio work and therefore were not allowed to proceed.

36 Attrition data

Data supplied to the evaluation team are summarised in Table 5 below. Attrition rates nine months into the programme between the cohorts are compared (no later comparison is possible since the 2004 cohort were approximately nine months into the programme at the time of this report).

Table 5: Student attrition from the part-time programme

Cohort cohort start n left or % left or n left % left or (intake) no. programme programme programme programme interrupt interrupt or interrupt programme at programme at programme (cumulative approx. 9 approx. 9 interrupt total total) at Dec months into months into at December 2004 programme programme 2004 2003 22 5 22.7% 9 40.9% 2004 27 3 11% 3 11%

There would appear to be a marked reduction in attrition from the programme in terms of the number of students who had left the 2003 cohort by the 9 month mark (40.9%) and the equivalent figure for the 2004 cohort (11%).

Student perspectives

There seemed to be a degree of uncertainty, amongst some students from both cohorts, about whether they would be able to complete the programme due to the academic, financial and personal challenges involved.

One student from the 2004 cohort reported that she was unsure of whether she would complete the programme:

‘I’m teetering on the brink every day…. I was in floods ….. children suffering because I am so short-tempered…my children say to me ‘mummy I hate you doing this course.’’

In one focus group, when asked how many of them thought that they would complete the programme just over half (five of nine) of a group of 2004 cohort students indicated that they thought they would do so. There is no way of knowing whether this represents an accurate picture of students' intentions but it does perhaps indicate that some students do not feel very confident about completing the programme.

During the course of the evaluation a decision was made not to have further intakes to the programme at Chichester but to continue to offer the programme only at the Stag Hill Campus. The students had been informed verbally and in writing that the programme would continue at Chichester for existing students but some students did not appear to fully accept these assurances and there was some doubt amongst the 2003 cohort about whether the programme would continue to be provided at all. As one student put it:

‘how many students do we have to get to before they pull the plug?’

Students identified a number of factors as being particularly important in terms of students leaving the programme as described below.

37 Financial pressure

Many students felt under considerable financial pressure and considered that this was an important factor in students leaving the programme. One of the students who had left the programme also considered that some students had left the programme because of pressure caused by balancing paid employment with commitments to family and the programme. This student suggested that a larger bursary would create less pressure on students to take up paid employment and therefore would result in fewer students leaving the programme.

Excessive workload

Many students felt that the amount of academic work required, in terms of portfolios and triggers, was excessive and that this pressure was part of the cause for students to leave the programme. One of the students who had left the programme gave this as one of the reasons why she had decided to leave.

Inadequate academic support

Many students felt that inadequate academic support was a major reason for students leaving the programme. Although most students thought that their personal tutor was extremely committed to them and to the programme some felt that they needed more one-to-one time. The accessibility of tutors appeared to be an issue for some students Comments ranged from the negative or ambivalent:

‘when they are here they just sit in their office.’

‘ you can’t meet with them when they are here .. we only have 30 minutes lunch and afterwards we need to rush back up to pick up the children’.

To more positive statements:

‘(our personal tutor) is good.. but it is not individualised.’

‘..we are supported when they are here. They want us all to stay. They want to see us all through. Sometimes I think perhaps we should speak to them more.’

Students also recognised that their tutors and their personal tutor were extremely busy but felt that they could get support if they really needed it. Students were also aware that there were plans to introduce regular one-to-one meetings with their personal tutor and they welcomed this development.

Some students identified that failing a portfolio or not being able to complete it could be a trigger for them leaving the programme. One student commented that:

‘portfolios..that’s why people are failing…(they) need more support from tutors.’

Another student added that:

‘even though we are diligent and hard working…(we) feel that we could fail the course when we see people failing on the (examination) boards.’

Several students expressed the desire to see examples of successful portfolios and to have less technical explanations of what was expected:

38 ‘If we could actually see one that was perfect ..what they want. To see an example.. if they could put it in layman’s terms.’

Some students also expressed an expectation that tutors could or should identify the key elements of reading lists for them so that they could then distinguish between essential and ‘non-essential’ reading.

Change in family circumstances

One of the students who had left the programme identified a change in her husband’s working pattern (so that he was much less available for looking after their children) as a major factor in leaving the programme. However this student also felt that she was not capable of the academic standard demanded on the programme (perhaps indicating a lack of academic confidence).

Other explanations

Students also recognised that some of them may not complete the programme because they have not had previous clinical experience (for example as a health care assistant) or simply because the reality of how the programme impacted on other areas of their life was greater than, or different to, what they had imagined.

In summary, students’ suggestions for assisting them to complete the programme included:

 greater academic support, particularly in relation to more frequent one-to-one tutorials, in order to assist them to understand academic referencing systems and completing portfolios.  increased opportunities for team building with their fellow students through organised social events  larger bursaries for students  more proactive support from tutors in trying to spot students who are under pressure and offering them support before the student reaches a crisis  staff being more aware that students are under pressure at particular times (e.g. when on placement or completing portfolios) and offering more support during these periods. l) Differences between the 2003 and 2004 cohorts

Although similar themes emerged from the analysis of the focus group with the 2003 and 2004 cohorts (so that the findings have been jointly presented) some differences in emphasis were evident. At the time of the evaluation the 2003 cohort had experienced many more placement weeks than the 2004 cohort. Consequently the 2003 cohort’s perceptions of the programme were much more influenced by placement-related issues than were those of the 2004 cohort.

Some students from the 2003 cohort felt that the structure of the programme, during placement periods, was difficult to manage in terms of organising childcare. During the theoretical part of the programme students are on the programme for approximately 19.5 hours per week (3 days each of 6.5 hours); while on placement this rises to 25 hours per week. For many students this meant that extra childcare had to be arranged for the duration of the placement and then re-organised at the end of the placement period. This involves extra expense and extra work in trying to organise the childcare.

39 Some students from the 2003 cohort also pointed out that they had 12 weeks in practice without a single study day (this appears to be confirmed by the programme timetable). It was felt that this was unfair since they believed full-time students had study days during their practice placements. Some students from the 2003 cohorts felt that it was extremely difficult to get portfolios completed without having such study time.

One student expressed the view that, as the first cohort on the programme, they were:

‘guinea pigs….it’s hard on us.’

There are likely to be unforeseen sources of stress or difficulty for the first cohort on any programme and this may well be one of the reasons for the relatively high attrition from the 2003 cohort. One way in which these difficulties may be identified is through the evaluation forms which students complete for each module. Although it was reported that there are formal mechanisms in place through which module evaluation findings are fed into the design and management of the programme, one student (from the 2004 cohort) felt that feedback which the students give on their module evaluation forms was not having any effect on the way the programme is delivered.

At the time of the evaluation, students from the 2003 cohort had experienced a greater number of their colleagues leaving the programme than had the 2004 cohort students which perhaps had left them feeling uncertain about the future of the programme. Several 2003 students seemed concerned that the programme might be discontinued before they had graduated from it. Several students commented that they would welcome further reassurance from the university about the future of the programme.

4.2.4 Students who have left the programme

At the time of data collection the data supplied to the evaluation team suggested that nine students had left the programme and that these were all from the 2003 cohort. Data were later supplied showing that a further three students from the 2004 cohort had left the programme but these students were not contacted as data collection was already under way. All of the students from the 2003 cohort who had left the programme were contacted by post with an information leaflet about the evaluation and an invitation to participate through a one-to-one interview at a time and place of their choice either face- to-face or by telephone. Only one student accepted this invitation and was interviewed by telephone. In view of the initially disappointing response students who had left the programme were offered a further opportunity to participate in the evaluation by means of a self-completion questionnaire (a £10 voucher for a high street store was offered as an incentive). Four students returned completed questionnaires making a total of five former students who participated in the evaluation.

The categories generated from the data collected from part-time students who had left the programme do not correspond exactly to those generated in relation to students currently on the programme. This may be partly due to the differing methodology between the two groups (semi-structured interviews and self-completion questionnaires compared to focus groups) but may also reflect the different experiences and circumstances of those students who have left the programme. a) Family Background

All students who had left the programme, and who took part in the evaluation, (n=5) were women aged between 26 and 48 who had, on average, 2.2 children aged under 18 each.

40 Three were married and two were single. All described themselves as being of white British ethnicity. b) Recruitment process

There were mixed feelings regarding the adequacy of the recruitment process. Two of five students said that they were dissatisfied with the way in which the recruitment/ induction process prepared them for the programme in terms of interviewers not understanding the needs of part-time students and also in terms of not giving an accurate idea of the academic demands of the programme. Two students said that the recruitment process was fairly good and that staff had a reasonable understanding of the needs of part-time students and one former student felt that recruitment/induction was average. c) Balancing competing demands on time

Four of five students said that balancing the competing demands on their time was very difficult. One of these four described this as a ‘huge burden’ and another said that she had been ‘having difficulty in switching between roles of mother and student’. The fifth former student did not have any children aged under 18 and had experienced fewer problems in balancing competing demands on her time.

Four of five former students felt that their academic performance was negatively affected by the other demands on their time (such as family). One student described the process of balancing these demands as ‘horrendous’. Another commented that it was not a problem most of the time but became so when completing their portfolio. Students identified that they had particular challenges in completing placements in terms of the difficulty of arranging childcare outside of normal office hours/days.

Students used a wide variety of childcare services ranging from after school / holiday clubs to childminders and spouses or relatives. Three of five former students said that affording childcare was a problem. d) Academic support

In relation to academic support three of five former students said that they were fairly or extremely satisfied with the level of academic support, which they received. These students stressed that tutors were readily available. One student was fairly dissatisfied with the level of academic support available and believed that tutors were not as readily available as they should be due to their other commitments. One student had mixed feelings about the level of academic support. e) Support while on placements

Three of five students said that they were either fairly or extremely satisfied with the support available while they were on placement. One of these five described how helpful mentors had been to her and was generally positive about the other clinical staff in terms of the support, which they had provided. Another of the five former students who was positive about the support available on placements still felt that there had been a lack of knowledge, amongst NHS staff, about the hours which part-time students were required to work and also felt that there was underlying hostility to part-timers.

41 Two of five former students said that they were dissatisfied with the support available while on placement.

There were mixed feelings about mentors; two former students were extremely satisfied with their mentor (one of these said that her mentor had been ‘great’). Two former students were fairly dissatisfied with their mentors (one said that her mentor had not been there for her often enough). The remaining former student was ambivalent with regard to mentors. f) Personal support

Two of five former students were extremely dissatisfied with the level of personal support which was available for students on the part-time programme. One of these students strongly expressed the feeling that there was no-one to turn to. One former student was extremely satisfied with the level of personal support and stated that:

‘our main tutor was very supportive at all times’.

The remaining two former students were ambiguous (neither satisfied nor dissatisfied) regarding personal support. One of these said that;

‘ I was satisfied with the support I received for personal and emotional problems but didn’t get a lot of support with financial problems’.

This perhaps underlines the different expectations which students may have of the university in terms of the support which they expect to receive. g) Reasons for leaving the programme

Reasons which former students identified as influencing their decision to leave included; the financial burden caused by being on the programme; difficulty of affording childcare; stress on family relationships and on themselves; change in partners’ circumstances making childcare difficult/more expensive; finding the programme too challenging academically and not being able to give the standard of care to patients that they would like to while on placement.

Students who had left the programme felt that the reasons why other students left were to do with a mismatch between students' expectations and the reality of the programme (student dissonance); dissatisfaction with the standard of care which they were able to provide to patients while on placement; the length of the programme; inadequate academic support; financial reasons/hardship; and the realisation on the part of students that nursing was ‘not for them’.

Suggestions for increasing support to students who might be considering leaving the programme included proactive identification of stress in students and increased support ; students being ‘given time’ to sort out personal or financial problems; bonding sessions for students; increased bursaries or financial help and a possible change in the way the programme is delivered to include more e-learning and/or home study.

Students who had left the programme felt that other students may be motivated to complete the programme by their desire to be a nurse and also that possibly, for some students, studying on the part-time programme was a relatively good financial choice compared to their other possible sources of income.

42 h) Suggested changes to the programme

Former students’ suggestions for changes to the programme included more regular personal tutorials, having a single person responsible for the programme who is always available at the Chichester site; a higher bursary for students (to decrease financial pressure generally or to make paid employment unnecessary), more careful selection of placement locations (to ensure that these are locations that actively welcome students rather than just tolerate them) and having better links with UCC. One former student suggested that single parents in particular should be made aware that unless they have emotional, practical and financial support outside of college that they should think very hard about either beginning the programme and should also be aware of the particular stress that may be caused by engaging paid employment while on the programme.

Some students felt the links between theory and practice on the programme were weak. One student felt there were some theoretical aspects of the programme, which should have been dealt with before a placement but in fact these had only been dealt with some time afterwards. Another student gave a very strongly negative rating of the information and teaching in relation to portfolios, which she clearly felt should be a key means of relating theory and practice.

In summary, former students of the part-time programme shared many of the perceptions of students who remain on the programme in terms of its challenging nature both in academic terms and in relation to balancing paid employment and family with the demands of the programme.

4.2.5 Tutors

A convenience sample of tutors based at the Stag Hill Campus who are responsible for delivering the part-time programme was approached. Semi-structured interviews were carried out with this sample. All UCC-based tutors were contacted and their preferred method of participating was through a focus group so that all could be present together. This was agreed as it was felt that this would not compromise the design of the evaluation and accommodating this request ensured the participation of the UCC-based tutors. a) Perceived Family/personal/demographic characteristics of students

Tutors perceived that most students were from non-traditional backgrounds in terms of having children, being over 25 and not possessing ‘A’ Levels. They felt that many students had family responsibilities and were aware that many were also in paid employment.

Tutors generally viewed students as having a difficult task in balancing the different responsibilities in their lives and were therefore keen to see that they received as much academic and personal (pastoral) support as possible. Most tutors felt that the students were committed and enthusiastic and enjoyed teaching them.

There was some ambiguity in tutors’ perceptions of whether part-timers are older than full-timers and whether they had different domestic circumstances (e.g. there was some feeling that part-timers were more likely to have partners and that full-timers were likely to be single). No perceived differences on the basis of ethnicity or nationality were mentioned.

43 b) Recruitment

Although most tutors recognised that the recruitment process was positive, in that it allowed non-traditional students to access the programme, most tutors also identified shortcomings in the recruitment process. These included:

 the absence of NHS staff amongst recruiters - staff involved in recruiting students were either from the Stag Hill Campus or St. Richard’s.

 some staff carrying out recruitment interviews for the part-time programme were not directly connected with the part-time programme and may therefore not have adequate knowledge of the programme. Although all staff are expected to have a certain level of knowledge in relation to all programmes offered within EIHMS some tutors felt that, in practice, this was not necessarily the case. Some students also felt that staff involved in recruitment was sometimes not able to answer detailed questions about the part-time programme.

 recruiters may not be trained in interviewing skills nor perceive the need to gain these skills. One tutor expressed doubt about the value of interview as a recruitment procedure and considered that assessment based entirely on students' previous experience would be at least as valuable as interview. (key staff pointed out that students’ previous experience is taken into account as part of the recruitment process).

 students may inadvertently be given the impression that they will spend much or all of the programme at St Richard's Hospital when in fact the programme requires they take up placements at a variety of locations in their locality in order to gain a sufficient range of clinical experience and therefore achieve the required learning outcomes. One tutor felt that this inadvertently misleading impression partly explained why part-time students did not become integrated into ‘university culture’. In this tutor’s view the result of this failure was that students were (unintentionally) being discriminated against.

Several tutors recognised a need to increase awareness of the part-time programme amongst all staff and one tutor mentioned that this might be done through staff forums or an e-bulletin.

One tutor stated that for future intakes the core interviewing team would consist entirely of tutors who had been involved in setting up the programme. This tutor explained that the staff who had carried out recruitment interviews for the 2004 intake had been considerably more appropriate, in terms of their knowledge of the part-time programme, than had the staff who interviewed potential recruits for the first (2003) intake to the programme.

UCC-based tutors explained that they sometimes received enquires from potential students which they attributed to the fact that there used to be a nurse training college in the area so that many local people still associated the UCC Bishop Otter Campus and St. Richard’s with traditional nurse training. UCC tutors said they passed the enquiries onto the Stag Hill Campus staff although they sometimes had a brief conversation with the potential applicant about the part-time programme.

44 c) Support for students

As mentioned above all tutors were aware that students on the part-time programme had unique characteristics in terms of their demographic profile and in particular their family/child commitments. All tutors were also aware that the vast majority were from non-traditional backgrounds. Most tutors consequently felt that part-time students had particular needs in terms of support. d) Academic support

Some tutors felt that part-time students needed more support than other comparable groups (such as full-time students on the adult nursing diploma). One tutor felt that part- time students needed extra support in terms of numeracy and literacy and directed students to a local Further Education college for this. There is no teacher available on site to provide these skills but this tutor pointed to the ‘home access’ to student support which is available.

Tutors identified further sources of academic support including informal advice to students from tutors, for example at the end of lectures. Both Stag Hill Campus and UCC-based tutors said they gave such informal academic and personal support to students. This was frequently offered in the tutors’ own time. In the case of the UCC tutors, this support was not included in the service level agreement with the University of Surrey but one UCC tutor explained that it was very difficult to refuse a student’s request for a personal tutorial when it related to a lecture that the tutor had just given. In theory, such requests should be referred back to the University of Surrey staff.

The personal tutor was described as a major source of support for students. This tutor can be contacted by email for one-to-one appointments and regular one-to-one sessions are soon to be introduced.

Professional tutor groups were also identified as a source of support but these groups were not discussed in detail during interview. Tutors also identified that student support services (student care services) at the Stag Hill Campus provide a range of support services to all students registered at the University.

One tutor considered that part-time students received at least as much support as full- time students and also felt that, particularly in respect of being able to ask questions in lectures, and in terms of tutor time, that part-time students had superior academic support than full-timers. Several tutors considered that part-time students did, in general, receive adequate support and levels of academic support for part-timers were often compared favourably to the support received by full-time students.

Tutors raised issues concerning part-time student choice of personal tutors and the perception that there were differences in relation to the full time programme. Tutors also recognised that there were areas relating to academic support (understood as being to do with facilities such as library access and IT) where part-time students were at a distinct disadvantage to full-time students. Tutors identified the following areas where part-time students enjoyed less favourable access to university facilities than their full- time counterparts.

45 e) Library access

Tutors felt that this had been an area of particular difficulty for the part-time students. Tutors were aware that accessing the library at the Stag Hill Campus on a regular basis was not a realistic option for part-time students due to the long journey time from Chichester. Part-time students are able to access, and borrow from, the library within St. Richard’s hospital but it was felt that the book stock at this library was inadequate in terms of the requirements of the programme. Students were also able to gain associate member status of the UCC library but were only allowed to take out three books at a time. Tutors explained that there had been a tension between the part-time students and librarians in terms of the amount of support which part-time students were requesting in relation to skills such as searching electronic catalogues. It was unclear whether students were using the distance borrowing facility from the library on the Stag Hill Campus. f) Access to computer, internet and e-journals

The majority of tutors felt that the part-time students were disadvantaged in that there were only five computers available at the EIHMS Campus at St. Richard’s (this has since been increased to six computers). Some tutors felt that these resources were just about adequate but it was felt that students did not have as much computer and internet access as they would like. While students can access e-journals via these computers some tutors felt that some students did not have the technical knowledge to take advantage of this facility and that consequently they were restricted to the limited number of journals which are kept in hard copy at the EIHMS Campus at St. Richard’s. g) Personal support

Many tutors felt that part-time students needed a high level of support and several felt that they needed more personal support than full-time students. It was felt that they needed more personal support both because of their ‘non-traditional’ background and the particular pressures generated by balancing the programme, family and (in many cases) paid employment. One tutor suggested that a crèche should be provided at the St. Richard’s site.

Several sources of personal support were identified:

 St. Richard’s site administrator

All tutors ascribed great importance to the role of the site administrator in supporting students at a personal level. Several tutors also pointed out that it was perhaps unfair to expect the administrator to provide the level and range of support which she did as this went beyond her official role.

 Chichester counselling services

Some tutors were aware that the University of Surrey has a link with Chichester counselling services so that a certain number of sessions for students are paid for. The St. Richard’s Campus administrator sometimes acted as intermediary in referring students to this personal counselling service.

46  Informal support from tutors

The majority of tutors said they spent some time giving personal support, usually following lectures. Tutors did not appear to resent giving this support although it would seem that no time is allocated in timetables for this activity (except for the students’ personal tutor). One tutor commented:

‘They have tremendous personal problems…. Every time I go up there, at the end of the day, I spend at least 10-15 minutes dealing with their personal problems...divorce, children, coping with the course, plus sometimes I have to send them home early because they have to pick up their children from the nursery which is very exceptional, full-timers they never ask you that .. so they’re missing out’. h) Placements

Most tutors said they were aware of particular challenges for part-time students, such as arranging childcare around placement hours, but most also felt that students were able to negotiate the hours and days of their placements to a reasonable extent. Several tutors pointed out that the same learning outcomes were expected of part-time students as full-time students.

One tutor felt that the main NHS Trust in the locality was very supportive of students and cited the fact that Trusts financially sponsor a small number of part-time students. This tutor stated that information is sent out to the placement provider, when the student is allocated to that placement, informing the provider that the student they are taking is part-time and is only able to work certain hours. This tutor was not aware that any student had complained about being treated differently for being part-time and felt that practitioners were keen to support students. However another tutor doubted that mentors were aware that they were mentoring a part-time student even though they had, in theory, been made aware that this was the case. The tutor attributed this to the mentors’ heavy workload. Some tutors indicated awareness that part-time students might be resented or discriminated against by nurses or other staff on account of their different working pattern.

Tutors identified support for students during placement such as mentors and clinical placement facilitators (CPFs). One tutor also explained that in the main Trust in the locality where most students on the part-time programme take up their placements, students (full or part-time) have a buddy mentor and an assessor mentor so that they will work with one or the other during their practice placement. Part-time students may have two identified buddies and one assessor because they have longer placements to achieve the hours in terms of length of weeks. This system was reported to work very well, giving independent verification of the student in terms of their ability in practice and assessment.

The CPF based in St.Richard’s was perceived by tutors as being hard-working and proactive in supporting students. i) Achieving learning outcomes

The learning outcomes of the programme are detailed above in section 4.1.5 of this report.

47 Most tutors felt that students on the part-time programme met the learning outcomes of the programme although some tutors felt that part-time students sometimes needed more support than full-time students to do so.

One tutor was also aware that some students found it easier than others to meet the learning outcomes and felt that there was a divide between those (typically) younger students who have access to the latest information via the internet and those (typically) older students who relied more on books.

Another tutor felt that the students achieved learning outcomes (at least for the module for which that tutor was responsible) and mentioned being impressed by their enthusiasm. j) Completing the programme

Some tutors felt that a significant proportion of the reasons why students leave were to do with factors which would seem outside of the university's sphere of influence such as changes in family circumstances. Examples were given of students who had left the programme because of such changes (rather than any aspect of the programme).

One tutor suggested that the length of time between the teaching of theoretical aspects of the programme and the time when students began to get placement experience was too long and that they struggled to recall theoretical teaching while in practice. This created additional pressure on them, which could act as a trigger for them leaving the programme.

This tutor also suggested that the lack of familiarity with, and lack of immersion in, university culture maybe a factor in students failing to complete the programme. k) Contribution to policy objectives

All tutors felt that the part-time programme contributed to the government policy objectives for the NHS particularly in terms of widening participation, increasing student numbers and also in responding to the needs of local trusts. Many tutors felt that contributing to such policy objectives was one of the most important aspects of the programme.

4.2.6 Key staff

Three key staff with an overall strategic responsibility for supporting, organising and/or administering the programme were interviewed in order to seek their perspectives. The themes to emerge from these interviews supported findings from other stakeholders but also added a strategic dimension in relation to recruitment and retention issues. Themes related to recruitment included the need to give realistic expectations about the programme to students and to identify and involve key stakeholders in marketing and support strategies. The importance of supporting students in practice and the active participation of the host trusts as a means to facilitating this were highlighted. The main themes to emerge from the interviews with key staff are summarised below:

 Student Dissonance between expectations and reality

It was reported that students found the part-time programme did not always meet their expectations which in turn gave rise to a tension between a programme that was

48 perceived to be academic rather than professional. Strategies for advertising, marketing and recruitment were seen as essential in order to clarify these expectations and resolve tensions by identifying and involving key stakeholders including the Strategic Health Authority.

 Support from NHS trusts

Different NHS trusts were said to have varying levels of support and interest in the programme. An indicator of this was identified as the extent to which a robust system of placements and mentorship was put in place to support the students in practice.

 Defining roles

Members of staff involved in the programme, were seen to have potentially overlapping roles. It was suggested that these roles needed to be clarified in order to ensure the smooth running of the programme and foster realistic expectations among the students in relation to "who does what?"

 Part-time student issues

Key staff identified a number of issues for part-time students, which included financial concerns, which might especially affect those recruited from areas described as "socially deprived". It was also felt that part-time students needed high levels of support for "problems associated with maturity" such as family responsibilities and lack of recent study experience. It was suggested that students might be unaware of the resources available on the Stag Hill Campus, which could be drawn on to enhance their study skills. Peer support was reported to be an important element for the students who as part-timers needed to be very resilient and learn how to manage and adapt to change.

4.2.7 Mentors

Twenty-five mentors who were identified as having been involved in mentoring of students on the part-time programme were contacted through a postal self-completion audit form. Four completed forms were returned giving a response rate of 16%. Given the low response rate, the findings have been interpreted with caution since it is recognised that respondents may not be representative of the group as a whole. a) Mentors’ roles and qualifications

Respondents occupied a variety of roles as well as their mentoring activities. These included; senior staff nurse; relief staff nurse; nurse manager; acting sister. The average time in their current post was just under 17 months.

All of the mentors who responded (n=4) had mentored less than 10 students in the previous 12 months and it was clear that part-time students comprised a small proportion of the overall number of students who they mentored. Three of the four who responded said that part-time students made up 10% or less of their mentees.

All mentors who responded said that they had received some preparation to be a mentor but the form that this preparation took varied. Two mentors had attended a general mentor preparation programme and one had the ENB 998 qualification. Two had attended a mentor preparation assessors’ update.

49 One of the four mentors stated the need for more training or support in order to develop as a mentor and specified mentor updates as an example of what they required. b) Mentors’ perceptions of the adequacy of their mentoring

Three of the four mentors who replied said that they were fairly satisfied with the support they gave to students; the remaining one reported being extremely satisfied with the support given.

However two mentors, in follow up comments to this question, mentioned that they were concerned that time constraints meant they had some element of doubt about whether they were giving enough time to the students.

Another mentor, who reported being extremely satisfied with the support given to students commented that:

‘..I do not feel that the support I give students is reciprocated by the University’.

Three out of four mentors said that they were satisfied with the amount of time they spent with part-time students; one mentor felt that not enough time had been spent with part-time students to reach a view on this issue.

Opinion was evenly split on whether part-time students required different types of support from mentors than full-time students. Two mentors said that part-time students required different support citing the fact that because the part-time programme was longer it could take students longer to gain confidence and another cited ‘lack of continuity’ as an issue.

Mentors were asked if they considered that part-time students were able to gain a full range of placement experience in relation to different shift patterns (e.g. early morning, handovers, late shifts, weekend shifts). Three out of four mentors said that part-time students were not able to gain a full range of placement experiences. One mentor stated that:

‘The student I mentored had a very limited range of shifts she was able to participate in - she pulled out of the programme later I heard’.

Two out of four mentors made comments to the effect that it depended on the student whether or not they were able to gain the full range of placement experience. c) Relationship of mentoring and completing the programme

All mentors considered that the standard of mentoring was important in relation to whether students completed the programme or not. One mentor commented that:

‘if students do not have a good mentor they lose interest in the course and learning and do not continue with it’.

Mentors were however aware that all components of the programme had an influence on whether or not students completed the programme:

‘ ..it is equally important that the standard of tutoring and relevance to the clinical placement they receive i.e. theory needs to come before the clinical placement.’

50 d) Mentors’ perceptions of whether learning outcomes are met

Two mentors said that they were fairly well informed regarding the intended learning outcomes for part-time students in their clinical area; one mentor said that they were very well informed and one said that they were not very well informed.

Three of four mentors said that the students on the part-time programme met the learning outcomes of the programme with regard to practice; one said that they were not sure.

Two of four mentors said that mentoring arrangements did not need to be expanded to better meet the needs of part-time students and the remaining two said they were not sure or didn’t know.

One mentor added that:

‘ I think the support the university gives to the mentor needs to be greatly increased to make it possible for mentors to do the job of mentoring’.

The findings from this small sample of mentors of part-time students appear to show that they mentor small numbers of students and that of those, part-time students form a very low proportion of this small number. It would seem therefore that mentors may have little experience of part-time students and may therefore have little opportunity to build up knowledge of the particular issues and challenges that these students face. However mentors considered themselves to be relatively well informed about the learning outcomes for part-time students. They were also reasonably happy with the amount of time they were able to devote to part-time students. They felt that part-time students had particular needs for support primarily because of their restricted patterns of availability for placements and as a result were not always able to experience the full range of placement settings. The challenge of ensuring continuity between theory and practice in relation to the structure of the part-time programme was also acknowledged.

4.2.8 Full-time students

An invitation (consisting of a personal letter, information leaflet, consent form and stamped addressed reply envelope) was sent to those full-time students in the Chichester locality who had commenced the full-time programme in 2003 or 2004 inviting them to participate in a focus group at the Stag Hill Campus. A reminder was also sent. Disappointingly, no full-time students responded to say they were willing to attend focus groups. Although every effort was made to locate a time and date which would be convenient for full-time students to attend, and to explain why their participation was important, it would seem that this was not persuasive enough.

Basic quantitative information in relation to the demographic profile of full-time students who commenced in 2003 or 2004 and who are based in the Chichester locality was obtained from the University’s student admissions database (Table 6 below). It is important to note that this sample of full-time students may not be representative of all full-time students in the programme.

51 Table 6: Demographic profile of part-time and full-time diploma adult nursing students by programme mode (source: University of Surrey admissions database). The n shown refers to the total number of students for whom data was available in relation to each item

Cohort/s Mean age Ethnicity % married (years) (% white British) All part-time students commencing 34.34 (n=47) 97% (n=34) 15% (n=47) 2003 and 2004

All full-time students commencing 29.47 (n=66) 93% (n=62) 11% (n=54) 2003 and 2004 based in Chichester locality

Table 6 (above) shows that the full-time students are on average nearly five years younger than the part-time students and that full-time students are somewhat less likely to be married than the part-time students. A large majority of both full-time and part-time students appear to be of white British ethnicity but data supplied on ethnicity was incomplete.

Unfortunately, as there was no participation in the evaluation from full-time students, no valid comparison between their experience and that of the part-time students can be made.

4.4 Discussion - common themes

An analysis of the findings from the various stakeholders indicates the following major themes across all groups. a) The value and ‘status’ of the part-time programme

There was a feeling across stakeholder groups that the programme did not have a universally high status within the university and that levels of awareness of the programme were not as high as they might be, particularly amongst tutors based at the Stag Hill Campus who were not involved in delivering the programme, and amongst staff arranging placements for the students on the part-time programme. There was also a perception amongst some tutors that the programme may not be valued by some colleagues.

Some tutors felt that they were having to work hard to have the part-time programme accorded parity with the full-time programme and considered that there was considerable work to be done to reach this objective. For example, some tutors perceived that low priority was given to timetabling the part-time programme in comparison to the full-time programme. As a result part-time students received their timetables much nearer to the start of the programme than did full-time students. A tutor reported that the 2003 and 2004 cohorts received their timetables only one week before the start of the programme.

A tutor reported that students on the part-time programme had been hampered by inaccurate module handbooks leading to wasted time for both tutors and students. This tutor also explained that students on the part-time programme who were not based in the

52 Chichester locality were not receiving notification of their placements (these were being sent only to the locality in which the students were based).

This tutor also stated that a letter to mentors of part-time students, which had been drafted at the start of the programme in February 2003, explaining the programme requirements for placements, had not been sent, as requested, by the placements team. It was felt that this had led to mentors questioning whether these students were absent or sick when in fact they were attending as per programme requirements.

Many part-time students clearly felt that they had a lower status than other students and the phrase ‘second class citizen’ was used on more than one occasion by students in this respect. The students based outside the Chichester locality referred to themselves as ‘third-class citizens’ because they felt their status was lowered both by being part-time and by being based outside of the Chichester locality. Issues of mentors not understanding working patterns on placements and not being given timely and accurate information about placements seemed to have contributed to the students’ perceptions that they had a lower status than full-time students. b) Recruitment/induction

Tutors, students and key staff questioned the validity and appropriateness of the recruitment and induction process. Some tutors were aware that those involved in the recruitment process, particularly with regard to the first cohort, did not necessarily have a high degree of familiarity with the programme or with the particular needs of part-time students. The recruitment process was identified by one tutor as a possible factor in failure to retain students in that students were not being made fully aware of the demands which the programme would make on them. Some students felt that the recruitment and induction process had not taken account of their particular needs or circumstances. c) Support for students

Academic support, personal support and support on placement were all felt to be key issues across stakeholder groups. There were however conflicting views about what support was available to students, how they used it and how satisfied they were with it.

While tutors felt that students needed a higher level of support than the students in the full-time programme, many felt that this higher level of support was being provided. Mentors were also fairly satisfied with the level of support they supplied to part-time students.

Students themselves however were, overall, very dissatisfied with the level of support that was received. However it was not clear whether students were aware of, or were using, all of the support that is available particularly student support services based at the Stag Hill Campus. To some extent the students seemed to be relying on informal support available locally from the Campus administrator. This could indicate that they were not receiving support from other appropriate sources resulting on an unfair burden being placed on the Campus administrator.

5. Conclusions

53 A number of key conclusions and recommendations for programme policy and planning are presented here which are intended to inform the development of the programme which has been evaluated.

5.1 Recruitment and retention

 From the sources of information regarding part-time programmes currently available, it would appear that the provision of part-time pre-registration programmes from English HEIs is limited The provision that currently exists is predominantly provided in ‘new’ universities and typically there is little or no marketing of the programmes. Despite some support for such programmes at a policy level, because they support policy objectives such as widening participation in higher education, the skills escalator and the NHS careers framework, it is unclear what material or financial support is being provided to encourage their further development.

 Despite the fact that the University of Surrey’s part-time pre-registration nursing programme is not apparently being actively marketed it would appear that there is strong demand in the Chichester locality as evidenced by the fact that five students had already registered early to commence the programme in February 2005. (However it is not clear if these students will enrol since the decision has been made to provide the programme at Chichester only for current cohorts).

 Many of the students who participated in the evaluation expressed their appreciation of the opportunities which the programme offered them as ‘non-traditional’ students and the support which tutors gave them which often extended into the latters’ personal time. Most students expressed commitment to the programme. However it is clear that students did not feel they received as much support as they felt they needed. Students felt particularly under supported in relation to the amount of timely one-to-one tutorial support available. Completion of portfolios was a particular source of anxiety for students for which they requested greatly increased support.

 Although attrition from the first student cohort appeared to be relatively high it is clear that attrition, in a comparable time period, (i.e. nine months into the programme) has been very significantly reduced in the 2004 cohort. As the programme commenced recently (in February 2003) it would be premature to make any definitive statements about the pattern of attrition.

 Although it was only possible to question five students who had left the programme it was clear from these respondents and the data collected from other stakeholders, including students currently on the programme, that the major drivers of attrition appeared to be (not in order of magnitude): changes in family circumstances; financial pressure; having to engage in paid employment as well as maintain programme and family responsibilities; a perceived lack of academic support; an inability to cope with the academic demands of the programme or an inability to cope with the demands of placements in clinical settings.

5.2 Support for students

 All tutors who participated in the evaluation were highly committed to the students and the objectives of the programme.

 Although many support mechanisms exist for students on placements (mentors, buddies, clinical placement facilitators, link tutors) students reported several cases of placements where they had no source of support available. The reasons given for

54 this included mentors being on holiday, the student not having the same shift pattern as their buddy or placement locations not being informed of their arrival.

 Students reported that they did not receive adequate notice of their placements and placement locations from the placement office at the Stag Hill Campus. Students also said they found it difficult to get adequate notice of the structure of the programme and in some cases this made it difficult for them to put childcare in place.

 Mentors who took part in the evaluation mostly reported that they had a good knowledge of the part-time programme and the needs of part-time students. However it is unclear whether this is actually the case. Students report many instances of mentors or other staff in their placement location being unaware of their status as part-time students and consequently receiving undue criticism for being absent on occasions such as handovers.

5.3 Contribution to policy objectives

Overall the programme is making a valuable contribution to policy objectives such as widening participation, developing a flexible healthcare workforce, the skills escalator and providing a model for flexible teaching and learning to support non-traditional students.

There are challenges to be addressed in terms of ensuring that the students’ unique needs for appropriate support are met.

6. Recommendations

The key recommendations to be drawn from the conclusions are as follows.

6.1 Recruitment and retention

 The recruitment strategy, which has been strengthened, should be consolidated and formalised to ensure careful design of the recruitment process in terms of the staff who participate and the information they give to potential / beginning students. It is essential that students' expectations of the programme are clarified and that they are given a realistic picture of what will be expected of them on the part-time programme. The programme organisers need to fully consider the students’ personal circumstances at the outset of the programme and make realistic judgements about the support required for successful completion.

 A feasibility study should be undertaken before rolling the programme out to any other localities. In particular there needs to be an assessment of transport links and journey times to the Stag Hill Campus from any locality where provision of the programme is being considered as well as an assessment of the academic and support facilities available in the locality.

 Where teaching staff from other HEIs are contracted to deliver teaching it is essential that regular channels of communication which may be available (such as module meetings with the University of Surrey teaching staff and programme management team) should be appropriately utilised and sustained. Existing channels of communication should also be regularly reviewed and publicised.

 The programme should be clearly marketed to take account of the local health economy and the local population in order to both respond to, and meet the needs of,

55 key stakeholders, including the Strategic Health Authority and the local market in relation to programme provision for ‘non-traditional’ students.

6.2 Support for and involvement of students

 Although key staff reported there were nominated student representatives from each cohort, it would appear there is a need for even more student involvement and representation in the management of the programme to take account of their requirements.

 Further student representation would increase agreement between staff and students about the aims, structure and content of the programme (for example in relation to the most appropriate dates for submission of portfolios) and also make staff aware, on a regular basis, of how the student body feels about the programme.

 Existing mechanisms for feeding data from module evaluation into the management of the programme should be fully utilised to ensure that concerns raised by students are acted upon.

 The date for completion of portfolios needs to be given careful consideration to avoid coinciding with their children's school holidays. The amount of support available to assist students to complete portfolios should be increased and they could be shown examples of successfully completed portfolios.

 It would appear that students who commenced the programme in 2004 onwards have been given a choice of two personal tutors thus achieving parity with the full- time students. This choice should be extended to the 2003 intake and maintained for all future intakes. This will ensure that one-to-one support is available in a more timely fashion and will also reduce pressure on tutors.

 Regular one-to-one meetings between students and personal tutors are planned and their early establishment is to be welcomed and supported on an ongoing basis.

 Consideration should be given to providing extra support to students who have children as well as being in paid employment during the programme as they are likely to be under the greatest pressure. The form of this support could be worked out in consultation with students or their representatives and might include priority access to academic or personal support.

 Although some opportunities for students to get to know each other are built into the curriculum, it would be beneficial to have more planned opportunities, early in the programme, for them to meet, socialise and bond, either on Campus or in an informal setting. This would facilitate the development of peer bonding and support for all students.

6.3 Other recommendations

It would appear that raising the profile of the part-time programme amongst all stakeholders, including tutors, mentors and the placement team would be beneficial in ensuring appropriate recruitment interviewing, induction, mentoring and liaison with the placements team. This could take the form of a regular newsletter, a dedicated web page or staff development seminars focused on part-time programmes. Approaches might include highlighting the aims of the programme, raising awareness of the profile of the students in terms of their support needs, and recognising the important contribution the

56 programme makes to the Department of Health policy objectives such as widening participation and developing a flexible healthcare workforce.

57 7. References

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Department of Health 1999, Making a Difference, London, HMSO

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58 Nursing Standard Editorial 1990, "Staff Shortages - Reforms Require 'National Strategy'", Nurs.Stand., vol. 4, no. 35, p. 6.

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Royal College of Nursing (2004), Full marks for part-time pre-registration, Royal College of Nursing. 2004. Web reference http://www.rcn.org.uk/news/congress2005/congress2004report/19.php

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59 8. Appendices

Appendix 1: Time scale and scope of evaluation

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