Lucy Hayes is a third-year student at the University of Birmingham studying adult nursing. She is the West Midlands student committee member for the RCN, academic officer for the university’s Nursing Society and on the @WeStudentNurse twitter team. You can find her on twitter @lucy_uo
On the 13th of January 2021 the Nursing and Midwifery Council (NMC) announced the introduction of new emergency standards in response to the Covid-19 pandemic. These new standards would allow struggling NHS trusts to ask final year nursing students to opt-in or out of paid placement. The choice whether to make this request would be decided between the trusts and the student’s universities. Universities were also given the option to put their first-year nursing students a theory only route, and to allow students on placement to be signed off by just one assessor (1). As someone who has a particular interest in nursing education this brought a number of thoughts to my mind, some of which saw the advantages of the new emergency standards, but many of which gave me fears for the education being given to current student nurses, and consequently, fears about the standards of nurses coming out of the cohorts which were affected by the pandemic.
The RCN have reported that nurses who had taken up paid placements in the first wave and since qualified felt less confident of their abilities as newly-qualified nurses (2). This suggests that education received during the pandemic has not been as comprehensive or of as good quality. Even before the pandemic students would report that they often felt they were not truly supernumerary, that they would be given jobs which are more traditionally health care assistant (HCA) jobs, and be used as an extra pair of hands (3). This has already been increasing during covid times (4) outside of emergency standards, at least partially due to worsening staff levels. Staff are also overworked, stressed, and experiencing mental health difficulties due to the pandemic (5; 6), this does not lead to the optimal teaching conditions.
My concern is that students who are also paid workers will have their learning stripped down in favour of function, because they are part of the numbers they will be given jobs which need doing, rather than jobs which add to their learning. This will also give students less ability to ask for tasks which assist their learning, because it come across as refusing to work. Whilst student nurses do still learn from doing tasks which both HCAs and nurses do, repetitively doing these jobs will not give a comprehensive experience. There is a difference between being helpful and being taken advantage of.
The removal of the nursing bursary has also meant that student nurses have to worry about money more than before. They have to take out student loans and pay fees. This means that student nurses will often have part-time jobs. This adds to their load from academic work and placement shifts- which are equivalent in hours to a fulltime nursing job. This makes a paid student nurse position very tempting, as it cuts down the hours they have to, whilst still giving them placement hours and a wage.
Those who choose to opt-out may also be put at greater disadvantage, especially those who opted-out in the summer. They are at risk of losing hours, and they do not have the pay, plus if opting-out is for health reasons they may not be able to do part-time jobs. This could lead to extra time being added onto their courses, or deferral, which in itself could give negative financial effects to student nurses.
I am also concerned about second-year students. These students are likely to carry on with supernumerary placements, unpaid. They will still have many of the same disadvantages that third-year opt-in students will have. They may find themselves given less in the way of teaching, but they may require more support. Most were pulled from placements during their first year. Yet they are being thrown into areas of high stress where they may not get the support they require. Whilst in normal times a second-year student might have been expected to work more independently, and to find their own jobs, or have their own patients, these students may not have the experience to manage this. They also may have been out of placement for an extended period which means they may be unsure of skills they have acquired in previous placements and need time to get back into the swing of working in healthcare. A lot of the reasons that I am concerned about second-years are also the reasons why I am glad that the NMC have allowed first-years to follow a theory only route as they may have no prior practical knowledge to help them on placement.
Students are really feeling the pressure, so we need to think about the support we are giving them, both on placement and off. The @WeStudentNurse twitter group carried out a survey which asked participants to give up to five words describing how they feel now. Common answers included ‘Overwhelmed’, ‘anxious’, ‘exhausted’ ‘stressed’ ‘scared’ and ‘forgotten’ (7). If this is a problem which does not get solved we are at risk of losing more student nurses, and compounding the staffing shortage which already exists (8) (9).
Student nurses need to be valued not just as a number, or an extra pair of hands, but as a member of the team with their own skills. They bring an enthusiasm to learn and care, they bring new insight into a team, they teach patients, other students, and even other healthcare providers. They may have more flexibility to build relationships with patients which give insights for their care. When students are given monetary value only in emergency situations this devalues them the rest of the time, but employing them risks their learning. The government needs to think again about what student nurses offer and the service they provide. To consider nursing as more than just another degree.
- NMC. Recovery and emergency programme standards. [Online] 13 January 2021. [Cited: 21 January 2021.] Avaliable from: https://www.nmc.org.uk/standards-for-education-and-training/emergency-education-standards/.
- Dawes, Dave. RCN Council on student nurses in paid placements. [Online] 19 January 2021. [Cited: 21 January 2021.] Avaliable from: https://www.rcn.org.uk/news-and-events/blogs/rcn-council-on-student-nurses-in-paid-placements-190120.
- Juliet, Jack, Thomas, Barbara A and Jinks, Annette M Resilience to care: A systematic review and meta-synthesis of the qualitative literature concerning the experiences of student nurses in adult hospital settings in the UK. Nurse Education Today, 2012. 32 (6).657-664
- Williams, Shaun. Student #Nurses, in England, do you feel that you’re supernumerary (i.e. not employed) and your learning is protected? via @Shaun_LDNurse [Twitter] [Online] 18 January 2021. [Cited: 19 January 2021.] Avaliable from: https://twitter.com/Shaun_LDNurse/status/1351201509472669696.
- RCN. Pressure on staff ‘unsustainable’ as nurse to patient ratios diluted to meet demand. [Online] 19 January 2021. [Cited: 2021 January 25.] Avaliable from: https://www.rcn.org.uk/news-and-events/news/uk-pressure-on-staff-unsustainable-as-nurse-to-patient-ratios-diluted-to-meet-demand-150120.
- Mahase, Elisabeth Covid-19: Many ICU staff in England report symptoms of PTSD, severe depression, or anxiety, study reports.. BMJ [Online] 2021 [Cited: 25 January 2021] 2021; 372:n108 (Published 13 January 2021) Avaliable from doi: https://doi.org/10.1136/bmj.n108
- WeStudentNurse. #WeStNs ran a mentimeter to see how you all felt, it makes for harrowing reading for us…. Tell Us what do you need to help? Is there anything as peers we can do? via @WeStudentNurse. [Twitter] [Online] 21 January 2021. [Cited: 21 January 2021.] Avaliable from: https://twitter.com/WeStudentNurse/status/1352254831558320128.
- RCN Staff safety at risk unless nursing shortages are addressed.. [Online] 17 September 2020. [Cited: 26 January 2021.] Avaliable from: https://www.rcn.org.uk/news-and-events/news/uk-staff-safety-at-risk-unless-nursing-shortages-are-addressed-170920.
- Ball, Jane. COVID has exposed a long-running shortage of nurses that is putting NHS patients at risk. [Online] 17 December 2020. [Cited: 26 January 2021.] Avaliable from: https://theconversation.com/covid-has-exposed-a-long-running-shortage-of-nurses-that-is-putting-nhs-patients-at-risk-150116.