Abstract
Background: The World Health Organization estimates a shortage of 4.5 million nurses by 2030. In England, traditional nursing degrees cost ~£9,535/year, while apprenticeships are salaried, but take longer and currently have fewer places available. To better inform policy and workforce planning, it is crucial to understand the factors influencing entry into nursing. This study aims to explore factors influencing decision-making processes of prospective nurses, with particular focus on pathway preferences.
Methods: Qualitative semi-structured interviews (N = 40) were conducted online with 10 prospective nursing students, 10 current nursing students, 10 recently graduated nursing students, and 10 training providers. Participants were identified through policy partners, educational institutions, and snowball sampling methods. Thematic analysis was conducted, structured using the Framework approach.
Findings: Six themes were generated: 1) The role of professionalisation, identity, and stigma in shaping educational decision-making; 2) Balancing life, learning, and livelihood in the context of consumerist attitudes to higher education; 3) Preference for practical learning and embedded experience; 4) Career aspirations and progression opportunities; 5) Support systems and student experience; 6) Course delivery challenges. Stigmatised perceptions of educational pathways, with apprenticeships typically perceived as less prestigious than traditional degrees, appeared to contribute to a vocational-versus-academic divide, and differential delivery approaches (concurrent-versus-sequential delivery of practical and theoretical learning) also appeared to influence choices. Negative media portrayals of nursing post-COVID reportedly discouraged recruitment. Financial stability and family commitments were considered key factors in educational choices, with the financial structure of apprenticeships perceived as preferable for mature students with children. Apprenticeships were considered to have more robust support systems, facilitating positive educational experiences and mitigating academic confidence issues, with peer support and camaraderie highly valued across both routes. However, some younger students questioned their readiness to enter the workforce and reported their desire for a more traditional university experience. Providers reported apprenticeship delivery as more costly to educational institutions due to additional regulations and administrative load, and many noted a dichotomy in learning types between pathways, meaning integration of teaching across pathways would need careful consideration.
Conclusions: Addressing the shortages in applications to nursing courses in England requires a multifaceted approach. This may include national awareness campaigns to improve perceptions of nursing careers, enhanced financial support for degree students, and regulatory simplification for apprenticeship expansion. A more integrated approach to nursing education, balancing accessibility, workforce needs, and student support, may help to address current shortages in the nursing workforce.
Methods: Qualitative semi-structured interviews (N = 40) were conducted online with 10 prospective nursing students, 10 current nursing students, 10 recently graduated nursing students, and 10 training providers. Participants were identified through policy partners, educational institutions, and snowball sampling methods. Thematic analysis was conducted, structured using the Framework approach.
Findings: Six themes were generated: 1) The role of professionalisation, identity, and stigma in shaping educational decision-making; 2) Balancing life, learning, and livelihood in the context of consumerist attitudes to higher education; 3) Preference for practical learning and embedded experience; 4) Career aspirations and progression opportunities; 5) Support systems and student experience; 6) Course delivery challenges. Stigmatised perceptions of educational pathways, with apprenticeships typically perceived as less prestigious than traditional degrees, appeared to contribute to a vocational-versus-academic divide, and differential delivery approaches (concurrent-versus-sequential delivery of practical and theoretical learning) also appeared to influence choices. Negative media portrayals of nursing post-COVID reportedly discouraged recruitment. Financial stability and family commitments were considered key factors in educational choices, with the financial structure of apprenticeships perceived as preferable for mature students with children. Apprenticeships were considered to have more robust support systems, facilitating positive educational experiences and mitigating academic confidence issues, with peer support and camaraderie highly valued across both routes. However, some younger students questioned their readiness to enter the workforce and reported their desire for a more traditional university experience. Providers reported apprenticeship delivery as more costly to educational institutions due to additional regulations and administrative load, and many noted a dichotomy in learning types between pathways, meaning integration of teaching across pathways would need careful consideration.
Conclusions: Addressing the shortages in applications to nursing courses in England requires a multifaceted approach. This may include national awareness campaigns to improve perceptions of nursing careers, enhanced financial support for degree students, and regulatory simplification for apprenticeship expansion. A more integrated approach to nursing education, balancing accessibility, workforce needs, and student support, may help to address current shortages in the nursing workforce.
| Original language | English |
|---|---|
| Article number | 105306 |
| Number of pages | 12 |
| Journal | International Journal of Nursing Studies |
| Volume | 174 |
| Early online date | 1 Dec 2025 |
| DOIs | |
| Publication status | Published - 1 Feb 2026 |
| Externally published | Yes |
Keywords
- Decision-making
- Healthcare policy
- Nursing education
- Workforce expansion