Recommendation 187

Pre-degree care experience

There should be a national entry –level requirement that student nurses spend a minimum period of time, at least three months, working on the direct care of patients under the supervision of a registered nurse. Such experience should include direct care of patients, ideally including the elderly, and involve hands-on physical care. Satisfactory completion of this direct care experience should be a pre-condition to continuation in nurse training. Supervised work of this type as a healthcare support worker should be allowed to count as an equivalent. An alternative would be to require candidates for qualification for registration to undertake a minimum period of work in an approved healthcare support worker post involving the delivery of such care.

In its initial response to the inquiry, Patients First and Foremost, the government committed to a pilot programme, whereby every student who seeks NHS funding for nursing degrees will serve up to a year as a healthcare assistant.

The pilot is an opportunity for aspiring nurse students to get real, paid caring experience for up to one year as a healthcare assistant before entering undergraduate nursing education, to see if nursing is right for them and they are right for nursing.

In September 2013, Health Education England established the first set of pilots, and approximately 150 aspiring student nurses began working as healthcare assistants. Health Education England is looking to introduce further pilots in spring 2014. On completion the pilot will be evaluated to see how pre-degree care experience could be rolled out in an affordable and cost-neutral way, so that everybody who wants to train to be a nurse is able to get caring experience before they start their studies. The evaluation results of the pilot scheme will need to be considered in the context of the Nursing and Midwifery Council’s 2010 pre-registration nursing standards and their application across the four countries of the United Kingdom.

We believe that students will enter their nursing degree course with increased confidence that this is the career for them, along with a genuine and demonstrated aptitude for caring. In addition, all nursing degree programmes last at least three years and require that 50% of time is spent in practice learning and 50% in academic study. The first progression point cannot be passed unless the student undertakes a period of practice learning and assessment, and so nursing students will continue to gain experience in care environments throughout their studies.

Alongside this, work is on-going to make a career in nursing more accessible for those staff who already give care, as set out in the government’s Mandate to Health Education England.


In September 2013, Health Education England established the first set of pilots, and approximately 150 aspiring student nurses have now completed up to one year working as healthcare assistants, gaining experience of caring prior to starting their studies. In April 2014, a further 90 aspiring student nurses began work, with a further 160 healthcare assistants entering the programme in September 2014. Between approximately 250 and 400 further participants are expected by Spring 2015.