With one of incoming Education Officer Sarah McGrath’s campaign promises being to promote equity across college placements, the University Observer has sought clarity on the issues face by healthcare students across the board.
While the paper did seek to speak to students across as many disciplines as possible on the issue of placement standards and supports, a recurring theme among student who did speak to us was a concern about coming forward at all. This concern was along two counts, the first being a concern about protecting the anonymity and privacy of patients and coworkers. The other was a fear of potential reciprocity if they were known to be speaking negatively about their placements. For this reason, anonymity has been extended to all students who spoke to the paper for this piece.
Nursing students, however, unlike most other medical placements, begin their placements almost as soon as they start their undergraduate degree. Jill* a current Nursing student, started on placement when she was still 17 years of age. With these changes incoming, Jill’s issues with the current placement system have a different focus.
“A lot of the issues I would see would be about dignity and respect. Then issues around compensation for placements. So, we hear a lot about people lobbying for student nurses to be paid for their work on placements, and people as ‘Oh why should student nurses be paid and not other healthcare students?’ and I think it goes back to the history of nursing as a degree, like it only became a degree in the early 2000’s and before that for their training programme they were fully paid throughout it. And we do a very similar kind of work on placement that they would have been doing when they were paid, full salary, and we also do like eighty-one weeks of practice placement across our degree, working full time hours.”
However, Jill’s main issue with student placement is the treatment of student nurses by patients and staff. “With issues of dignity and respect, they’re some of the issues you would hear about the most from Nursing students, in their stories from placement of things that have happened. Oftentimes on placement, it’s kind of like any issues that you have around patients themselves or other staff are kind of like, swept aside for nursing students.
“Because it’s something that’s so normalised within nursing, that these things are always going to happen and that you’re looking after vulnerable patients, patients with altered mental states, that these issues are always going to be there so there’s no point, like, speaking out against them. And, it’s even harder I’d say for, like, in my experience the student nurses, because you don’t want to be the student nurse who makes a fuss because something happened, because the hospitals that you’re training in may be the hospitals that you work in and the nursing staff that you work with may be your future colleagues.
“I’d say every single female student nurse has been groped on placement.”
“Coming from patients, you’ll have so many stories of - I’d say every student nurse I know has a different story, especially female student nurses, of being verbally or physically assaulted on placement. And it’s just seen as so normal. Like a lot of the times when you’re working with patients with dementia, they can get aggressive, they can get very hypersexual, and they can say things that are very, like, mean, or degrading, to the student nurses. And even patients who don’t have dementia sometimes - it’s a very stressful situation for patients to be in, to be in hospital.
“I’d say some examples of things that have happened to me are, just like, verbal assaults about my size, my weight, my age, my looks, like, your intelligence - even though they don’t really know you as a person they just will choose anything. And then like, I’d say every single female student nurse has been groped on placement. Like that’s true. It’s happened to me, it’s happened to everyone, like I was helping an elderly man with dementia and then he just, you know, groped me. And like, it happens to everyone. And it’s such a strange issue because you’re not sure how to deal with it because it is a vulnerable person? And when you tell nurses a lot of the time they’ll just say ‘Oh, that happens.’ There’s just not the support there for student nurses when it happens.”
Jill does highlight that student nurses do technically have support staff they can contact, but are often too busy, or too worried about about becoming an issue, to do so.
“And then from the other side, from staff, issues happen all the time, with people being disrespected because they’re a student. Like I’ve personally had, when I was in the operating theatre, the consultant surgeons would be quite degrading to student nurses. Asking ‘why you’re in nursing’, ‘you’re only going to be a nurse’. I had a consultant surgeon who took off his gloves in theatre and threw them on the floor, and said ‘Student nurse pick them up, that’s your job in the theatre.’ Which it isn’t, and maybe also learn my name while I’m at it, I told you my name. I’m not ‘student nurse’, I’m Jill.”
“the first day I was there there was...yeah, 28 beds and two nurses”
“And just, a lot of times with other nurses can just also be quite degrading to students. I’ve heard of students whose Preceptor, that’s the nurse you’re assigned to work with for the day, or however long your placement is, [said] they don’t want to work with students. Which, they’re entitled to not want to work with students but like, you have to do a Preceptorship course to become a Preceptor, so why are you doing a Preceptorship course if you don’t want to work with students, like it’s optional.”
“They’ll say, I don’t have the time to work with students today, can you go with the Healthcare Assistants (HCA) and do washes. And we find that frustrating, not because we don’t want to work with the Healthcare Assistants, like they’re our colleagues, we want to help them out as much as possible. It’s because we’re there to learn to be a nurse. [...] We don’t mind doing washes, doing feeds, whatever, but it’s just so annoying [...] I’m there as a student to learn, not just to work.”
“A lot of the time, it’s really the little things, like when you go onto a ward and the nurses say they don’t have time for you, or there’s a 12 to 1 patient ratio - so a safe patient ratio would be somewhere in the margin of 6-8, to have for one nurse. And then the nurse you’re assigned to has 12 patients and you’re just running around all day, and then when things happen it makes it even worse for you. In my first placement, the first day I was there there was...yeah, 28 beds and two nurses. [...] I’m trying to think of what stories I have, there’s just so many. I’m trying to separate my work stories, because I also work in the hospital, so they’re work stories and don’t count.
“and he just said to me, ‘I want to hire a prostitute that looks like you.’”
“On my first placement I was 17, because I skipped fourth year of secondary school, and I was giving a bed bath to a patient, who was compos mentis - in the sense that he didn’t have dementia or any cognitive impairments - and it’s always when you’re doing personal care for some reason - and he said to me and to a Healthcare Assistant who was in his 40’s, and he just said to me, ‘I want to hire a prostitute that looks like you.’ And I didn’t know what to say, because I was 17 and it was in my first week of placement ever. I was just like, shocked, and then the Healthcare Assistant didn’t say anything, and we just continued and that was it, and then I was just thinking about it for the rest of the day. Because it’s just so degrading, because I’m there to help you and you just say something like that.”
Jill estimates that around 75% of student nurses would have second jobs to support their education and placement costs. “I would say that everyone in my friend group also has a part time job.” Jill herself works in the same hospital she does placement in, as a HCA.
Rebecca*, a Radiology student, speaks as well about the lack of respect for the job being done faced by students in healthcare placements. Rebecca, being in a placement with minimal supports, found her biggest issue being the lack of respect for radiology students working, to her eye, a full time job.
“From September to December I was on clinical placement outside of Dublin. So, we were basically an hour and a half commute from where we lived, it was me and my friend, and there was only two of us going to this hospital. [...] Dark, winter weather, and you know, it’s full time placement, and we have three modules to study for on top of that, with assignments and exams and stuff. So, it was full on. So, the two of us stayed in a mobile home for the first month and a half. We had brown water, we couldn’t use the shower, couldn’t drink the water, so we would have to go into the hospital, early morning, to shower. And this was primarily because the two of us work in a clinic, and we had to come back on the weekends to work, to be able to afford the petrol and the food costs that it would take for us to be able to afford to drive down to this hospital.”
“The mobile home park closes at Halloween, so we moved into my family friend’s son’s summer house, thing. They built it themselves, so there was gaps in the wall where you could see outside. There was no insulation, no heating, no Wi-Fi, which meant that we had to stay in the hospital to do our assignments, even after a full day of placement. We would have placement from 9-5, but there was a day where we had an exam at 8pm, so we can’t go home [...] because that was the only place that had Wi-Fi.”
“We didn’t have a day off for the entire three months, and we were in scrubs the whole time, working.”
Rebecca also highlighted that in her work in the clinic on weekends, she was doing the exact same work she was doing on placement, except her placement provided no pay, and no financial support.
“It was very long and financially burdening, and also exhausting, in terms of 9-5 placement, 6-9 working in the clinic, and then squeezing in - on our lunch breaks, the two of us would open up our laptops and just try to do as much work as possible.”
Sarah McGrath, a Radiology student and incoming UCDSU Education officer, has said that on the topic of Radiography specifically, that the Department of Health are unwilling to extend further supports as the placement is “Observation only”, a statement which many Radiology students find contrary to their own experience.
Speaking to the University Observer in her capacity as the current Health Science’s officer, McGrath said of the current placement system, “So there’s just a huge disparity between courses in what they are given, and what they can claim, and what they can’t claim and where they go, and how far away it is, and things like that. It just creates a lot of disparity between students in healthcare before they’ve even entered their profession when they’re qualified. It’s a big problem for students, even in multidisciplinary team work between Health Science students, [because] then you’re on placement and you’re both doing the same work but you see someone who’s being put up in a hotel with their meal vouchers, and you’re not getting any of that and also working as hard. It just kind of pits them against each other for no reason.”
“the only thing you can claim for is one return bus ticket there on the first week”
“From talking to class reps and constituents in Health Science this year, there’s a huge disparity in the supports that students are given across the different Health Science degrees. So, for instance, Medical students are, depending on where their placements are, they’re normally in their earlier clinical years sent to Vincents or the Mater, and then as they progress through later years get sent on specialist rotations in different hospitals, which can be further outside Dublin. They pretty much get fully supported financially for that in terms of being put up in hotels - for some GP placements I know people who have been put up in hotels if they’re further outside Dublin, and they have meal vouchers they can use in the hospitals. So they are well set up in terms of their placement.”
“Typically nursing placements are kept to Dublin, like based on the colleges associated with the one hospital, and then for specialist placement they can go a little bit further afield. And then in Physio they’re also mainly kept in Dublin but not given any supports, but then in Radiography you’re sent all throughout the country. So the placements are...there’s I think five Dublin hospitals, five or six, and then the rest of the hospitals are all outside around the country. And you don’t get any supports for that. So in terms of financial supports, we have a three month placement block, and the only thing you can claim for is one return bus ticket there on the first week, and the bus ticket back at the end of the three months. So that’s the only financial support that you can get.”
Nursing Students are also due to get additional support following the findings of the McHugh report, including, quoted from gov.ie:
- an enhanced Travel and Subsistence Scheme for student nurses and midwives in years 1 to 3 of their studies will see each receive €500 per year as a targeted measure to contribute towards meeting the extra costs of meals associated with practice placements outside the student’s core placement site
- a new rate of €80 for overnight accommodation, along with an increased weekly cap of €300, for those students who require accommodation away from their normal place of residence while attending practice placements.
- student nurses and midwives can also avail of, on a vouched basis, the reasonable cost of uniform laundry services during periods of overnight accommodation pay will be re-instated at 80% of first year staff nurse/midwife pay scale, for internship students two additional uniforms for student nurses and midwives at the start of their internship
*Names have been changed to protect the anonymity of those interviewed