Faced with high trainee drop-out rates, universities have overhauled courses

You would think that, with the amount of TV drama devoted to life in hospitals, most people would have a fairly accurate idea of the realities of nursing.

But it seems as though a significant proportion of people have ended up on nursing courses ill-prepared for what's to come, and as a consequence have failed to qualify. Recent figures revealed that, of the students due to finish nursing degrees or diplomas in 2006, 26 per cent had dropped out some time during their three-year course.

"I think some people are still coming in to nursing with the wrong idea," says Gill Robertson, student adviser at the Royal College of Nursing (RCN). "They think they are cut out to be carers, and don't realise that the job can be physically hard work and mentally very draining."

Kay Caldwell, head of the Institute of Nursing and Midwifery at Middlesex University, which trains nurses for a group of hospitals in north London, says that too many may be getting their idea of the job from watching Casualty. "But, of course, being a nurse is not like that at all."

To address this, Middlesex, where nearly 600 students start nursing courses every year, recently reconfigured its recruitment process. The aim was to drive home to applicants the realities of the job, before they embark on the three-year course.

"We now make it clear they'll be working unsocial hours, travelling across London to placements, and have no school holidays," explains Caldwell. "We also tell them that they might encounter aggression, and have to do tasks that might upset them."

In addition, Middlesex has changed its course structure to give more support to students during their first year – the time when drop-out rates are at their highest.

"We front-load their academic skills during the first year, helping them with note-taking, essay-writing and literacy and numeracy skills," says Caldwell. And the tactics seem to be working. Middlesex's drop-out rate has fallen by nearly 50 per cent this year.

With about half a million nurses needed to run the NHS, natural turnover creates a steady demand for large numbers of new recruits. Tens of thousands start training every year, most of whom are women, with an average age of 29. They embark on a degree or a diploma course – the former requiring A-levels for entry, the latter GCSEs – but both consist of 50 per cent academic work and 50 per cent practical training, at a hospital or other community NHS site.

All courses begin with a year-long common foundation programme, after which students may specialise in one of four branches of nursing: adult, children, mental health or learning disabilities.

The intense nature of the course, which contrasts starkly with the more relaxed lifestyle of "normal" students who enjoy long academic holidays, can come as a shock to recruits.

But most universities now appear to be getting better at dealing with this. At Sheffield Hallam, where about 800 start nursing courses every year, the drop-out rate has fallen this year to only 3 per cent.

"We've extended our induction period to three months and treat students like members of the family," says Jean Flanagan, head of nursing and midwifery.

"We notice if they're not turning up for class or struggling with their work, and put in support to help them."

There's a similar approach at Thames Valley University, where 1,000 students start every year, with an average age of 33.

"The first year is make or break," says Anne Garvey, deputy dean in the Faculty of Health and Social Care. "We do a lot to help with study skills, and prepare students to go on their first placement, where often what they most need is confidence."

Another source of help for students feeling the strain is the independent website, Student Nurse (www.studentnurse.org.uk), which has more than 6,000 registered members.

The site offers advice on choosing courses, organising finances and coping with study. A forum area enables members to talk to each other, compare notes and discuss problems.

Linda Luke, a nurse in Edinburgh, who set up the site four years ago, cites a number of factors that can cause students to drop out. "Some go in to nursing with unrealistic expectations; some students just aren't academic enough, and others struggle because large class sizes mean they can't get the individual guidance they need."

But despite all these hurdles, Luke would enthusiastically recommend nursing as a career.

"It's finding that you can help people and make their lives better. That can be really rewarding."