Cash crunches and `tainted' tests make for a bleak prognosis

Nursing students fear that NHS cuts and suspect qualifications will harm job prospects. Nic Paton reports.

Nursing has never been a field that one enters for an easy life. The pay is not great (although it is much better than it once was), the hours are long and the work can be physically demanding and emotionally draining. But nursing has always promised a stable career - until now.

The funding crisis in the National Health Service and, to a lesser extent perhaps, the increasingly bitter lecturers' strike are starting to change all that. Nursing students face a potential double whammy this summer and autumn as the refusal of lecturers to mark and assess exams affects their chances of qualification and they face a harsher jobs climate when they do qualify.

In April, the Royal College of Nursing warned that thousands of trainee nurses might not get jobs this year because of NHS recruitment freezes and deficits. Anecdotal evidence suggests that half of all students qualifying between April and September will have no job to go to. One university in Hampshire reportedly told nursing students not to expect to get NHS jobs this year.

On top of this, it has emerged that the Department of Health is coming under increasing pressure to transfer the billions of pounds it spends on nursing education and training to the Higher Education Funding Council for England because of continuing uncertainty about the health service's fiscal situation.

Some universities, such as the University of the West of England, say they face big budget cuts, in UWE's case about 40 per cent, that may lead to some nursing courses being dropped.

Then there is the lecturers' pay dispute. The situation for final-year nursing students is perhaps less clear-cut than it is for other students.

Not all nursing academics are members of the two unions involved in the dispute, although some face higher workloads because they have had to mark essays and take on assessments that are normally carried out by striking colleagues.

As for students, many final-year nurses qualify in May, so they will have sat their exams and had them marked before the industrial action started to bite. The situation for those who graduate between July and September may be more uncertain if the action rumbles on, says Richard Cummins, chairman of the Royal College of Nursing's Association of Nursing Students and a final-year student at Sheffield University.

Grant Ciccone, a final-year nursing student at the University of Central England, says there is clear anecdotal evidence that those who are due to qualify between July and September are not getting their essays marked, which means they may not be able to get their registration processed. This in turn could mean they do not receive a personal identification number that proves they have qualified. If they cannot give a prospective employer a PIN, any job offer could be rescinded.

In addition to the problem of whether nursing students will qualify, there is the question of whether they will have been assessed properly, says Andrea Litva, a lecturer in medical sociology at Liverpool University's faculty of medicine.

"We have student nurses who are doing exams on areas of core competencies and many will be going on to the wards in the summer. But those exams are not necessarily being set or marked by the normal experts, so there is a question mark over to what extent those core competencies have been assessed," she explains. "Students are in an incredibly difficult position."

She says questions may be asked about the validity of the qualification and the true level of competency that they achieve. "They have used previous years' papers, and none of the experts was present when they marked the papers."

Worries about tainted qualifications only add to the fears of students who are also fretting about the recruitment climate, although the picture is not clear.

Health trusts are still hiring student nurses, says Foluke Ajayi, head of NHS careers at NHS Employers, which oversees workforce issues in the health service. The organisation has complained that media coverage of the jobs situation and deficits in the service have been "misleading" and that, in reality, few people are being made redundant.

"Most of the redundancies are isolated," Ajayi says. What is happening more often is that vacancies are being frozen.

"Student nurses may need to be prepared to be more flexible about where they find work. In the past, it has been relatively easy to find a job wherever you want to because there have been shortages. Now competition is stiffer, but we are not talking about no jobs," she explains.

Others are less optimistic. Paul Turner, executive officer of the Council of Deans and Heads of UK University Faculties for Nursing, Midwifery and Health, says the initial indications are not good. "We are seeing something like 1,000 vacancies at the moment, and we expect 25,000 students to qualify this summer." Students who would normally be able to get employment within a trust after their last long-term placement are getting signals that that may not be the case, he adds. Ciccone, who is also chair of the RCN's West Midlands Student Forum, says he has had 51 applications rejected.

Cummins concedes that recruitment is much slower than it has been for many years. "An acute trust in my area that normally takes on 100 students is taking on about 35." But he points out that because most trusts are very large organisations, they do not necessarily stop taking people on even when they are in deficit.

Advice to travel further afield or to consider other sorts of jobs will not work for all nursing students - particularly as the NHS has over the past few years made a great play of attracting into the service older people, who may have family or mortgage ties. "The private sector is another option for people, obviously, but it cannot soak up everyone," Cummins says.

On top of all this, there is another factor that weighs heavily on the minds of nursing students: debt. According to a survey by healthcare workers' union Unison late last year, more than half of nursing students had considered quitting because of the debts they incurred during training, and the number of those who are £10,000 or more in the red has doubled in the past two years. Ciccone works in Tesco to make ends meet.

In an environment of rising debt, a shrinking jobs market, worry over the future of some courses and questions over the validity of qualifications, nursing students will have to swallow some bitter pills, whatever the outcome of the lecturers' strike.