Sample 1

Critically analyse the nurses’ roles and responsibilities within care provision

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Nurses have a range of roles and responsibilities in order to provide society with the highest quality of care (Peate, 2016). The Royal College of Nursing (RCN, 2014:3) define nursing as the ability to ‘improve, maintain, or recover health, to cope with health problems, and to achieve the best quality of life’ for patients until their death. This essay will critically analyse the nurses’ role and responsibilities within care provision, discussing their role as a primary caregiver, a leader, advocate, educator, collaborator, practitioner, in addition to their responsibilities in line with professional codes of practice (Nursing and Midwifery Council, 2015).

The nurse has a role as a primary caregiver, adhering to succinct evidence-based practice in order to meet the holistic needs of every patient and their families through the use of clinical judgement and expertise (RCN, 2017). They show compassion and knowledge in order to provide direct care to patients within each setting or different environments (Masters, 2015). Illness prevention and the promotion of public health initiatives are also vital roles in nursing care (Joel, 2017). However, political and societal issues place strain on the nursing workforce, hindering their ability to adhere to their roles which can negatively impact on the provision of high quality care (Ryan, 2018). For instance, with the introduction of an English test by the Nursing and Midwifery Council following Brexit, the number of EU nurses has reduced by 89% (Tapper, 2017). Furthermore, the government has removed the nursing bursary, which in turn has led to a reduction in the number of nursing students, thus leading to nurse shortages (Adams, 2017). Many nurses have stressed that they find it difficult to carry out their roles and responsibilities as a healthcare professional (Tapper, 2017).

Nurses must act as leaders, coordinating care as members of multidisciplinary care teams, contributing to a collaboration of care (Crowell, 2015). This involves physical and psychosocial assessment, provision of education, support and diagnostic testing to navigate patients through appropriate care pathways (Crowell, 2015). The nurse coordinator is a key resource for patients and families who are an integral point of contact during their care (Weberg et al, 2018). Nurse leaders need to continually contribute to the development of other healthcare professionals, ensuring that they are educated and equipped with evidence-based knowledge in order to provide high quality care (Weberg et al, 2018). Different leadership styles can be utilised to carry out this role, primarily the use of a transformational style. A transformational style encourages and motivates other staff members to improve the provision of care, without dictating information (Marshall, 2016). However, a more transactional leadership style is necessary in time-sensitive, critical situations (Stanley, 2016). These aspects are considered within the role of nurse leaders.

Nurses also act as advocates and educators, ensuring appropriate information is relayed to patients, enabling informed decisions which are fundamental to maintain patients’ autonomy (Scott, 2017). This includes developing therapeutic relationships to support and empower patients (Stein-Parbury, 2017). The nurse must provide holistic care in order to meet unmet needs through professional intervention (Weberg et al, 2018). This is especially important if a patient lacks the capacity to make informed decisions and so the nurse is responsible for adhering to health legislation (McEwen and Wills, 2017). The Mental Capacity Act 2005 provides the framework in order to protect a patient who cannot make an informed decision. Nurses should carry out an assessment in order to evaluate levels of capacity, in an appropriate manner in which the patient can understand. If the patient is found to lack capacity, the least restrictive option should be chosen in order to provide care in their best interests (McEwen and Wills, 2017). Nurses must also be aware that capacity can change at any moment and so succinct clinical judgement is key in order to provide high quality and ethical care (Stanley, 2016).

Another important role of the nurse is as an educator, to patients, families, society, other healthcare professionals and students (Bastable, 2017). Within a hospital environment, they provide knowledge about illness and teach patients how to self-manage their conditions (Bastable, 2017). Emphasis and facilitation of self-care are vital components of nursing, especially as approximately 15 million individuals within England have one or more long-term condition (RCN, 2018). Furthermore, with the increasing concern of antimicrobial resistance, education and self-care are important, to ensure that antibiotics are taken correctly to uphold the health of society (RCN, 2018). Health education is a necessity and a key responsibility of nurses throughout the world (Bastable, 2017).

Nurses must ensure they collaborate with other professionals within multidisciplinary teams, remaining accountable with sound clinical judgement and excellent communication skills (Joel, 2017). They must appreciate the expertise of other professionals and learn from their experience in order to care holistically for patients (Bogaert and Clarke, 2018). This must include adherence to patient and family- centred care, with enthusiasm to work towards the best patient outcome (Finkelman, 2017). This role is grounded within professional and personal values, expertise, theories and practice that encompass innovative and evidence-based care, whilst complementing other healthcare providers (Joel, 2017). Patient-centred care is beneficial in that is ensures patients are treated with compassion and respect (Finkelman, 2017). Improvements are also witnessed in regards to staff performance and morale when patient-centred care is provided (Stein-Parbury, 2017).

Nurses have the responsibility to remain up-to-date with relevant evidence-based research in addition to adhering to professional standards of practice (Ellis, 2016). These standards are in place to create boundaries and a level of accountability (NMC, 2015). This will incorporate various aspects such as ethics, competence, knowledge, confidentiality, accountability and how evidence can be applied in a practical environment (Avery, 2016). Nurses are held accountable for every aspect of care, with continual documentation under the direction of management (Standing, 2017). Ethical principles are also adhered to, such as a patient’s right to autonomy, non-beneficence, maleficence and justice (Beauchamp and Childress, 2013). However, the individual self-perception of one’s role can differ, influenced by individual background, societal attitude, government policies and trends (Joel, 2017). Within contemporary nursing, role theory can be used to theoretically explain the role of the profession, with Brookes et al. (2007) noting three main perspectives that emerge from evidence-based research. They include; social structuralism, symbolic interactionism and a dramaturgical perspective. Social structuralism argues that a nurses’ role will differ in regards to different structures within society throughout time, whereas symbolic interactionism is in relation to a nurses’ environment. Dramaturgical theory notes a connection between time, place and audience (Brookes et al, 2007). However, quality assurance is expected of all nurses, within standards, legislation and society (Sherwood and Barnsteiner, 2017). These standards ensure that all professionals are providing care with utmost competence and the ability to apply evidence-based research within practice. The nurse has a responsibility to remain up-to-date and educated, as quality assurance standards across many different environments, countries and time are in a continual state of evolution (Brown, 2017).

Upholding confidentiality is an additional responsibility of a nurse, that is mandatory in order to provide high quality patient care (Tingle and Cribb, 2013). Privacy is a key aspect of legislation within the UK and throughout the world, as nurses are expected to maintain confidentiality, in terms of medical records and verbal conversations (Drury, 2017). It is discussed in detail within the Nursing and Midwifery Council Code of Conduct, to uphold dignity and to provide high quality care (NMC, 2015). However, from a critical perspective there are times in which this idealism may be breached, to uphold the health of the patient or society (Blightman and Griffiths, 2013). The legitimate exceptions to confidentiality rights are in relation to disclosures with consent, disclosures required by legislation and those made in society’s best interests (Blightman and Griffiths, 2013). The NHS has historically struggled to uphold patient confidentiality, which led to the Caldicott Report, outlining a succinct process in order to protect and maintain privacy (Peate, 2012). This includes the need to justify disclosure, utilise the minimum amount of information necessary, maintain anonymity when possible, access on a ‘need-to-know’ basis and strict adherence with the law (Herring, 2015). This extends to social media platforms in which patient information should never be disclosed (Blightman and Griffiths, 2013). Confidentiality and disclosure is also influenced by capacity and so nurses have a legal and professional duty of care to consider capacity when consent is expressed (Joel, 2017). This can be challenging if a patient is in severe pain which can impact upon conscious levels and so clinical judgement is a necessity (Griffith and Tengnah, 2017).

Nurses should also appraise their abilities, in relation to strengths, weaknesses and their preferences during the provision of care (Stanley, 2016). This should involve the process of self-analysis, to recognise one’s abilities in line with the care standard necessary, with realistic expectations to maintain high quality, safe care (Stanley, 2016). Nurses need to be able to recognise early signs and symptoms of illness, to take quick and appropriate action in addition to noting potential problems that could arise (Gulanick and Myers, 2016). This involves a succinct understanding and initiation of assessment, analysis, diagnosis, planning, an intervention and evaluation of the provision of care (Gulanick and Myers, 2016). Furthermore, these stages should be documented in a clear and concise manner, without the use of jargon or abbreviated terms in order to enhance patient-centred care and understanding (Monsen, 2017). During the provision of patient care, nurses are also required to remain self-aware, in order to evaluate personal strengths and an awareness of when to ask for help in line with personal limitations (Monsen, 2017). This upholds patient safety and the provision of high quality care (Stein-Parbury, 2017). Lastly, a nurse must be organised, with the ability to prioritise workloads in order to uphold their role (Monsen, 2017).

To conclude, the roles and responsibilities of a nurse have advanced within different spheres of practice, which will continue to adapt as healthcare within the UK evolves. As discussed, a nurse’s role is influenced by social structuralism, symbolic interactionism and a dramaturgical perspective (Brookes et al, 2007). The role and responsibility of the profession will change in regards to self-perception, influence of society, environment, time place and audience. Legislation also affects the role of a nurse, with ever changing political and legislative focus. However, there are aspects of the role which continue to prevail. For instance, the need to uphold confidentiality, dignity, competency and adhere to professional standards. Ultimately, the main role of a nurse is to provide high quality, safe care to all patients within society, with compassion, humanity, effective leadership and collaboration within multi-disciplinary teams to uphold good standards. This is in line with the Nursing and Midwifery Code of Conduct, which outlines the professional practice necessary to provide high quality care. Self-awareness is also paramount, to note personal strengths and limitations in order to uphold a sense of accountability, safe practice and protection against litigation. If nurses do not uphold the perceived roles and responsibilities of a nurse, they may be subjected to the legal implications which may impact on their ability to practice as a nurse.


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Sample 2

What is the Impact of Cutting down Nursing Student Bursary in the Future of Nursing Practice in the UK?

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This essay will critically explore the impact of cutting down nursing student bursaries in the practice of nursing in the UK. A brief description of what a student bursary entails will be provided to clarify its contribution to the practice of nursing. The negative effects of cutting down student bursaries will be explored. The new scheme that will replace it will be identified and its rationale provided. Ultimately, the aim of this essay is to provide an analysis on whether cutting down nursing student bursaries is beneficial or detrimental to the future of the nursing profession and the quality of healthcare services in the UK.

The nursing student bursaries form part of the scheme of the NHS Student Bursaries supplied by the NHS Business Services Authority (NHSBSA 2012). It essentially awards an annual payment from the NHS to help students studying medicine, dentistry, nursing, midwifery or other healthcare courses with their study and living costs (Gov UK 2016). As explained by Government UK (2016)

A full-time NHS student can get a bursary from the NHS which depends on the household income (e.g. student’s income, parents’ income or spouse’s income), a 1000 GBP grant from the NHS (for full time students or a reduced amount for part-time students) and a reduced maintenance loan from the Student Finance England.

The NHS pays the tuition fees directly to the university (Gov UK 2016). A student can even receive extra financial help if he/she has a long term disability, a mental health condition, a specific learning disability, children or adult dependents (Gov UK 2016).

From the above given characteristics of a student bursary, it is fair to argue that it is a big help for many students studying healthcare courses like nursing. It is safe to assume that the existence of a bursary helps encourage the entry of students to study nursing, and stabilise those who are already immersed with their nursing study. Ultimately, this helps to secure the future of the nursing workforce in the UK.


In line with the idea that student bursaries help encourage people to study nursing, it can also therefore be said that this same scheme is one strategy that helps combat the problem of nursing shortage. This is because it attracts people to study nursing because of the perceived lower financial burden when compared to studying a non-healthcare related course, and so naturally many more would prefer to study nursing, which would eventually increase the number of professional nurses available. Without the student bursary helping out numerous nursing students, the possibility of many discontinuing their nursing study because of financial constraints is a potential reality. This can ultimately contribute to the existing problem of nursing shortage, as fewer nurses will graduate in the future because students have shifted to another course or halted their studies. This emphasises that exacerbating the current problem of nursing shortage is one potential primary ill effect of cutting down student bursaries for nursing students. In line with this, a study conducted by Buchan and Aiken (2010) showed that one of the major causes of nursing shortage in the world is constrained resources that lead to the undersupply of new nurses. The Truth about Nursing Organization (n.d.) also highlights the inadequate resources for nursing education as one of the causes of nursing shortage.

Nursing shortage, whether local, regional, national or global, has a major impact on nursing practice inasmuch as it can lead to failure to maintain or improve the quality of health care (Buchan and Aiken 2010). In the UK for instance, the latest statistics show that 23,443 nursing vacancies exist which is equivalent to 9% of the entire nursing workforce, and to try to address this, 69% of UK trusts are actively recruiting nurses from abroad (Hughes and Clarke 2016). One reason for this high vacancy rate is that although the number of positions available have elevated, the number of trainees have not increased (Hughes and Clarke 2016). Cutting down the student bursaries available for nursing students will only worsen the problem because it will discourage prospective nursing trainees, and so instead of increasing the number of trainees, which is important to solve the problem of nursing shortage, it will only further reduce the number of people who want to study nursing.

Nursing shortage affects the quality of patient care in many ways. For instance, the lack of nursing staff in a hospital can lead to a heavier workload for the staff nurses present, which in turn can negatively affect nursing job satisfaction and contribute to a higher turnover and again lead to shortage (Duffield and O’Brien-Pallas 2003). This is a logical consequence because fewer staff nurses working in a ward means that each nurse will have to cater to a higher number of patients in order to effectively care for all the inpatients, and perhaps over a longer period of time. This can lead to work-related stress and burnout and therefore degrade the quality of care that they can render, and eventually cause them to quit.

A study by Nevidjon and Erickson (2001) recommended that increasing the funding for nursing education is a good strategy to address the problem of nursing shortage. A study by Keenan (2003) relates that subsidising training is another way to increase the number of registered nurses. It is safe to argue that the concept of student bursaries is a good example of increasing the funds for nursing education, particularly subsidising training of future nurses so that more nurses eventually graduate and enter the nursing workforce. This will ultimately result in more staff nurses working in hospitals. Based on all of the foregoing arguments, it can be declared that the student bursaries actually represent a very good initiative by the government in helping future nurses.

Bhardwa (2016) reports that the government has confirmed the removal of the student nurse bursaries, which will be replaced by student loans beginning in 2017. Since it was first announced, it has been opposed by several components of the health sector (Jenkin 2015). In fact, according to Johnston (2016) a coalition of more than 20 charities, medical and professional bodies and trade unions led by the Royal College of Nursing, the British Medical Association, the Royal College of General Practitioners and the Patients’ Association wrote an open letter to the prime minister essentially claiming that the governmental move to end bursaries for nursing and midwifery students is a very risky gamble. It could leave a nursing graduate with 50,000 GBP of debt, and this is enough to discourage people from studying nursing, which is a serious problem, especially now that the NHS is requiring more nurses to fill nursing vacancies (Johnston 2016).

Labour Party leader Jeremy Corbyn suggests that removing the bursaries and replacing it with loans is like punishing students (Merrifield 2016). Abrahams and Nash (2015) boldly relate that students paying for their own tuition fees is a bad idea, and once it is implemented, many students will no longer work on goodwill. Nursing students are a vital component of any ward and it is a rare sight to see a ward function effectively without the help and goodwill of nursing students (Nash and Abrahams 2015). Removing the bursaries will most likely deter prospective nursing students (Abrahams and Nash 2015).

On the other hand, the new scheme involving the replacement of bursaries with loans is expected to save approximately 800 million GBP in funding which is currently used to support the 60,000 student nurses, and which the government then intends to utilise to establish up to 10,000 new training places (Jenkin 2015). This is the primary reason why the Universities UK and the Council of Deans of Health support this governmental action. The change from bursaries to loans will actually remove the limit on the number of nursing students which the government can help support in their studies and therefore the number of prospective nursing students will increase (Jenkin 2015). This is because the presence of the student bursaries puts a cap or limit on the number of students which the government can financially aid (Jenkin 2015).

It is estimated that around 10,000 additional places will be created from 2017 and 2020, which means 3,300 places per year (Watt 2016). It is safe to argue that this increase in places can naturally allow more prospective nursing students. This is good because NHS employers will have a bigger pool of qualified home-grown nurses and therefore the reliance for oversees or agency staff will reduce (Gummer 2016). Dame Professor Jessica Corner, chair of the Council of Deans of Health, says that the replacement of the bursary with loans will not have a negative impact on the number of applicants, and in fact up to 10 applicants are vying for each of the 20,000 training places a year (Jenkin 2015). Aside from this, the change will also help universities to fund courses because currently many schools receive less than it actually costs to deliver training programmes (Jenkin 2015).

It can be declared that the government’s action to change the bursaries into loans does propose an advantage. The advantage is that it can create more training places, which would enable the system to accommodate the high number of people who want to study nursing, which under the current bursary system is limited because the funds for the bursaries can only support a limited number of students. There is however one flaw in this plan, and that is the fact that having more training places for potential nursing students does not immediately mean that prospective students will take advantage of these, because there is the consideration that they will no longer receive financial aid from that government and that they will have to pay for their own training and education. The loans which the government offer cannot be considered as a subsidy, since it is a debt which students will have to pay. This implies that the plan of the government to change bursaries into a loan system will also rely on whether prospective nursing students are willing and financially able to self-finance their studies. The large amount of debt(loan) involved is also not a laughing matter inasmuch as it can reach up to 50,000 GBP for every graduate. Aside from this, there are also other factors which contribute to the desire to study nursing. The Health Foundation (2016) states that factors like the perception of career opportunities after graduation and potential for high level pay are examples of long term factors that greatly affect prospective students’ desire to proceed to nursing.


verall, it can be said that the premise from which the government based its decision to replace bursaries with loans does present a potential advantage, but it is impossible to guarantee that there will still be a high influx of prospective nursing students once it is implemented. There is also the high risk that if the strategy of giving loans instead of bursaries does not work, there will be even less prospective nursing students and even fewer nursing graduates in the future, and this will only contribute to the current problem of nursing shortage in the UK. This in turn can negatively affect the quality of healthcare services. There is also the factor that those who are already studying nursing will be greatly affected once the change has been implemented, and it is logical to argue that some nursing students may even decide to quit or shift to another course because they will be unable to finance their own studies. With these arguments in mind, it can be said that cutting down nursing student bursaries and replacing them with loan grants can either positively or negatively impact nursing practice in the UK; however, the current benefits of the bursaries and the dangers of removing them far outweigh the potential advantage of the proposed loan scheme. Hence, it is no wonder why many sectors of healthcare oppose the new loan system.


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Bhardwa, S. (2016). Government confirms removal of student nurse bursary. [online]. Available at:

Buchan, J. and Aiken, L. (2010). Solving nursing shortage: A common priority. Journal of Clinical Nursing. 17(24):3262-3268.

Duffield, C. and O’Brien-Pallas, L. (2003). The causes and consequences of nursing shortages: A helicopter view of the research. Australian Health Review. 26(1):186-193.

Government UK (2016). NHS bursaries. [online]. Available at:

Gummer, B. (2016). Bursary reform is good for students, nurses and the NHS. [online]. Available at:

Hughes, D. and Clarke, V. (2016). Thousands of NHS nursing and doctor posts lie vacant. [online]. Available at:

Jenkin, M. (2015). Will scrapping nurse bursaries help or worsen NHS staffing crisis? [online]. Available at:

Johnston, C. (2016). Bursaries for student nurses will end in 2017, government confirms. [online]. Available at:

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Nevidjon, B. and Erickson, J. (2001). The nursing shortage: Solutions for the short and long term. The Online Journal of Issues in Nursing. 6(1)): Manuscript 4. Available at:

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