To make ends meet, Laura Hother has to work two 12-hour healthcare assistant shifts a week on top of her 37.5 hours of unpaid nursing placement.
Then she has to find time to squeeze in her studies and assignments as a third year student nurse.
The physical effects of this routine, says the 22-year-old, are brutal.
‘It comes to my day off and I just want to sleep because I can hardly catch up,’ explains Laura. ‘I’m only just in my twenties and I’ve got back pain, hip pain and my knees are hurting.’
For a brief window last year, the pressure on Laura and thousands of other student nurses was temporarily relieved.
During the spring and summer of 2020, in the face of the extreme strain placed on the NHS by the Covid-19 pandemic, the nursing regulator introduced ‘emergency standards’ that gave second and third year student nurses the chance to opt-in to extended placements as paid frontline staff – meaning they were freed of the need to scrabble for extra paid work to keep them financially afloat.
It was an arrangement that ended last autumn, with student nurses returning to unpaid placements and Zoom classrooms – that was, until rapidly increasing Covid-related deaths started to spike again in the winter and the scheme was partially reintroduced for third year students in January 2021.
However, while the first introduction of emergency standards meant that any student nurses opting in to placement would be paid, this time around it only applies in England, and individual NHS Trusts and universities can decide whether or not to offer paid placements.
In any case, there are no plans to keep paying student nurses when the Covid-19 infection rate tails off and the emergency standards are withdrawn: once again, they will have only debt and limited bursaries to sustain them.
This week has already catapulted nurses and their pay crisis into the public eye, after it was announced that despite dealing with the biggest crisis the NHS has ever had to face, it was recommended that they receive just a 1% pay rise.
The controversial decision prompted the Royal College of Nursing to warn that large numbers of staff could leave nursing when the pandemic is over, with Ms Patricia Marquis, south-east regional director of the RCN, saying, ‘this slap in the face from the government really has just reinforced their belief that they are not valued by either the government or perhaps some of the public in the way they would want to be.’
Following a nationwide slow hand clap in protest to the decision – with another being organised for April 1, the day the pay rise is due to come into effect- it was announced that the rise could increase to at least 2%, but was still under discussion.
With such uncertainty at play, it leaves little wonder that in fear of what their future holds once they are actually eligible to earn a full wage, the calls from student nurses’ for better financial support are growing louder.
Oliver Dilley, 20, is a third year children’s nursing student in London. While he hasn’t been offered a paid placement this time around, his memories of the temporary taste of payment they received in 2020 persist.
Although his earnings of £10.09 per hour during his paid student placement fell beneath the London Living Wage, the money helped Oliver cover the cost of his bleary-eyed commute to work from his family home in Bedfordshire – a three hour round trip on public transport.
It also afforded him some fleeting financial security.
Since the paid placements ended, however, Oliver has had to return to his job as a customer assistant in Marks & Spencer, leaving him hardly any time to study.
‘It’s challenging,’ he admits. ‘Because of my shift pattern, I can often work five or six days on the trot, which means I only have a day to look at my assignments. It just leaves me with very little time.’
The strain of juggling all these commitments is difficult to take, Oliver adds.
‘You’re expected to be almost the same as a newly qualified nurse [in third year],’ he explains. ‘Then throw the assignments and the dissertation on top of that – it just feels like so much more pressure.’
Oliver isn’t the only one feeling this way: according to the Royal College of Nursing’s latest employment survey, 58% of student nurses say they are under too much pressure at work, and less than a third feel they are able to balance their home and work lives.
Given these challenges, Oliver can see why others would be deterred from training as nurses.
‘People won’t be going into nursing,’ he says. ‘Because they just won’t be able to afford to continue, whether that’s physically or mentally, because it’s just going to be so draining.’
Carrie Etchells is also a third year children’s nursing student and argues that allowing them to focus on their studies and placements, without having to worry about picking up healthcare assistant shifts or trying to fit in other forms of flexible paid work, is essential to their health.
‘I’d say you can’t really work on top of placement,’ says the 22-year-old. ‘I think it’s a really bad idea. Even if you’re in uni and you’re doing bank [temporary healthcare assistant] shifts, it can just drain you.’
Such concerns about the over-working of student nurses are particularly salient after a survey by the NHS Confederation released in September 2020 found that 90% of NHS leaders are concerned about the pandemic’s long-term impact on staff wellbeing.
A more alarming study released in January in the journal Occupational Medicine found that nearly half (49%) of nurses working in intensive care units (ICUs) were reporting symptoms of post-traumatic stress disorder, with nearly one in five (19%) reporting thoughts of self-harm or suicide.
Putting up with working unpaid, an arrangement which can feel unjust and exploitative, only adds to the pressures wearing medical students down.
‘Sometimes you get home and you just feel so exhausted,’ says Oliver. ‘You wonder, can I go and do that tomorrow? Because effectively I’m just being used.’
Student nurses have been calling for paid placements for years, but pandemic aside, the government have so far resisted the pressure.
One of the reasons for this, Carrie thinks, is the demographics of the student nursing community: overwhelmingly women, largely working class, ethnically very diverse, and with a high proportion of mature students – some of whom have families to support.
‘I just can’t help but feel like it’s a very deep-rooted issue in the fact that if the nursing population was majority white men, would the situation be the same?’ she says.
But why don’t the government offer any sort of wage? The central argument made against paying student nurses is framed in altruistic terms: being employed as paid staff would negatively impact their education.
In response to a recent petition calling for payment, the government said that the ‘supernumerary’ status of student nurses – which means that they are technically an addition to the normal nursing team and are therefore not paid to provide care – ‘ensures students have the time and support necessary to learn’.
While stressing the need for better funding for student nurses, Stuart Tuckwood, national nursing officer for the Unison trade union, raises similar concerns about the idea of paying them.
It is essential, he argues, that student nurses have ‘their status as students protected, and that their learning time is protected in practice.’
Stuart explains: ‘The concern about moving towards a model where student nurses are paid is that obviously employers are going to be wondering what they’re getting for their money when they pay the students, and it might be that students get moved around, or get asked to do tasks that aren’t necessary for their development into fully qualified nurses.’
Laura is unconvinced. For one, she found that being paid for placement, and so not having to pick up extra shifts, allowed her to concentrate more on her education.
‘I could focus more on my learning because I wasn’t exhausted, and I was fully invested in my placement because I wasn’t distracted by anything else. In fact, I felt like I learned a lot more,’ she says.
Carrie points out a further problem with the supernumerary status argument – the gap between the theory, in which students are an addition to fully staffed nursing teams; and the practice, with fully staffed teams very much the exception rather than the rule.
‘On paper it’s a great idea,’ she says. ‘But the reality of it is the wards don’t have the capacity to always be prioritising your learning. There are lots of times where you have no choice but to just run around doing what people are asking you to do.’
As of June 2020 there were a staggering 38,000 nursing vacancies in England – equivalent to over 10% of the nursing workforce – and research released in December by Nursing Notes and Nurses United UK found that 66% of all nurses feel that they’re working in unsafely staffed workplaces.
A further survey released last month by Nursing Times revealed that 86% of nurses had recently worked shifts on which they felt patient safety had been at risk due to staff shortages.
As a result, supernumerary status is a myth, adds Carrie.
‘If the wards were properly staffed and had enough nurses and healthcare assistants, then we could be supernumerary,’ she explains. ‘But they’re not: all the wards are understaffed. They don’t have enough beds, time, nurses or healthcare assistants.’
Student nurses therefore find themselves serving as full members of the workforce. ‘You’re doing the job of three or four people because you don’t have the safe staffing,’ Laura says. ‘So surely, if you’re doing that, you deserve to be paid well for at least doing the job of one person. I don’t think that’s an unfair ask.’
(Picture: Getty Images/iStockphoto)
A similar arrangement of unpaid student nursing exists in Ireland, and in December the Irish Parliament debated a motion calling for the payment of student nurses during placements. The motion was narrowly defeated, but the governing parties voting against it sparked outcry, and momentum there in favour of paying student nurses continues to build, with a further parliamentary debate taking place in February.
While the issue is yet to receive such political prominence here, the growth of grassroots campaigning organisations like Nurses United UK and NHS Workers Say No over the last year make Laura optimistic that the current model is on borrowed time.
‘With all the action going on at the minute, I think things will be changing,’ she says.
And despite his reservations about the payment model of funding for student nurses, Unison’s National Nursing Officer Stuart has no doubt that a change is desperately needed.
‘They need financial support that they can live on – whether that’s payment for their time on placement or whether we give that to them in the form of a living grant or bursary is up for debate. Certainly, we need to make sure that student nurses are looked after better because there’s really high levels of attrition. It’s a really, really difficult degree to do.’
Much like our professional frontline workers today, whether change comes or not, student nurses will keep on fighting their way through burnout, exhaustion, and trauma because they are committed to helping others.
Echoing the feelings of the thousands of nurses currently reeling from the news of their paltry pay rise, Carrie says that on top of the many downsides of unpaid placements, it is the failure to recognise this sacrifice which hurts most.
‘If I didn’t love nursing, if I wasn’t really passionate about working for the NHS, I would have dropped out after first year, because the training is so tough,’ she says.
‘But we stick at it because we really love it and really want to do it. It’s just absolutely heartbreaking to be told that the work that we do isn’t really essential and isn’t really to the same worthiness or standard as other paid professionals.
‘We’re simply not being recognised for the work that we do, and we certainly don’t feel appreciated.’
Do you have a story for In Focus? Get in touch by emailing claie.wilson@metro.co.uk
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source https://metro.co.uk/2021/03/13/in-focus-overworked-and-in-debt-why-nhs-student-nurses-want-pay-14210151/
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