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With the health system already under pressure, nursing students warn of a shortfall in graduates next year as Covid-19 hinders their ability to officially complete their placements and other course requirements. By Santilla Chingaipe.

Student nurses struggling to graduate

Nursing student Hope Mathumbu.
Credit: Supplied

Final-year nursing students at Australia’s largest provider of nurses, the Australian Catholic University (ACU), fear they will be unable to graduate this year, due to the impact of Covid-19.

Required to attend on-campus classes to complete their degree, despite state government advice prohibiting face-to-face learning, ACU nursing students have told The Saturday Paper they feel they’re being exposed to unnecessary risk during a pandemic. Yet, as Victoria’s healthcare workforce faces unprecedented strain, the prospect that nursing students may not graduate this year is itself cause for concern.

Professor Michelle Campbell, executive dean of health sciences at ACU, confirmed that practical classes are continuing on campus. Lectures and tutorials, meanwhile, have been moved online.

“The students need to complete a certain number of hours of practical classes as determined by [the] accrediting authority,” says Campbell. “The government has allowed us to keep going with those practical laboratories on campus.”

Campbell says the university has offered replacement classes for students who are concerned about attending these weekly sessions during the pandemic, and they can take those classes later in the year.

“I think what’s caused some of them to be perturbed is that we said we’re running the classes during the semester,” she says. “If you can’t come into those classes, we can’t guarantee that you’ll be graduating at the end of the year because make-up classes will probably go into next year … If Covid goes on and on with these restrictions, and those students still elect not to come, well, it’ll be up to them. The students cannot graduate until they complete the mandated hours in the practical laboratory.”

But Hope Mathumbu, a third-year nursing student at ACU, says she and many other students have spent the pandemic working in front-line roles, learning practical skills.

“As a third-year student, all of the learning that we’re going to be doing … is on the job,” she says. “There is nothing new that is being introduced except for clinical leadership subjects.”

Ineligible for government support, Mathumbu has worked in quarantine hotels and at Covid-19 test sites during the pandemic to support herself. “I know other students that work in aged care,” she says.

Mathumbu says the university should not require nursing students to attend face-to-face classes, particularly when so many are working in front-line roles.

Aaron McPherson, another third-year student at ACU, agrees. He has been working in the Registered Undergraduate Students of Nursing (RUSON) program, which allows hospitals to employ second- and third-year nursing students.

The 27-year-old says that, as part of his RUSON job, he’s been working on a Covid-19 ward at St Vincent’s Hospital. “They can’t wait for me to finish and start as a nurse,” he says.

“When you’re working on the front line on a positive Covid ward, it puts things into perspective – what’s important here? They’re telling me that if I don’t attend a mock simulation tomorrow at university – that they told me was originally cancelled – I’m going to fail the attendance.

“They threaten to fail us, and you go into the lab class and it’s something stupid like emptying a catheter bag on a mannequin and reporting how much fluid was in the catheter bag,” he says.

Another final-year nursing student at ACU, who asked to remain anonymous, says the way the situation is being handled is distressing. “I personally live with someone who is immunocompromised and I’m trying to take all the precautions I can to not have to put myself at risk,” she says.

Beyond the practical accreditation requirement for their degrees, student nurses are also required to complete a minimum of 800 hours of placement. But, says the student, “it’s really hard to find placements for people because of the current climate”.

Student nurses are not allowed to work in Covid-19-positive wards, and many hospitals “don’t want the increased people in the hospital that are deemed unnecessary because we are there to learn and we’re not independently working”, she adds.

“I still have 240 hours to complete,” the student says. She is concerned that she won’t be able to graduate this year.

Hope Mathumbu believes ACU, the Victorian Department of Health and Human Services (DHHS) and the nursing regulatory body, the Australian Health Practitioner Regulation Agency (AHPRA), are not being responsive to the situation.

“Some students have now had their placements cancelled before starting,” she says. “What does that mean for their hours? … AHPRA is still saying ‘we need your 800 hours’. Where is the give?”

In a statement to The Saturday Paper, the DHHS says it is working with health services to ensure “as many clinical placements as possible continue to take place for student nurses during the pandemic”. A spokesperson said that “students have been reassigned to other clinical areas to minimise their exposure to coronavirus”.

For nearly a decade, reports have warned that Australia’s ageing nursing workforce and poor retention rates in the profession will lead to a shortfall of nurses – potentially as high as 122,846 nurses, according to a 2014 report by the former federal government body Health Workforce Australia.

Aaron McPherson says the failure to address concerns raised by the students could also result in a shortfall of nurses in the midst of a pandemic.

“They do need to maybe reassess and think if we maybe don’t put an exception on these hours, we’re not going to have 2000 graduate nurses for next year, which is going to put another strain on nurses that want to retire or things like that,” he says.

McPherson says final-year students shouldn’t be penalised if they’re unable to fulfil the required hours, given the circumstances.

“I just think there’s bigger things going on in the world right now than to penalise us for [being] 10 hours short of our registration hours, especially when a lot of us are actually working in hospitals now,” he says.

Like many others, student nurses have been under financial strain because of the pandemic.

Third-year ACU student Jessica decided to rent an Airbnb during her placement so she wouldn’t risk exposing her immunocompromised mother to the pandemic. “I literally live in fear of killing her from Covid,” says Jessica.

“The difficulty is that [a] placement can get cancelled at any time,” she says. “So there was also a risk that I would lose all the money that I put in.”

Ineligible for government support, Jessica previously worked in retail and tutoring but says those jobs are now not available due to the pandemic. She worries she’ll soon run out of money.

“We don’t have a union to support us, we don’t have WorkCover, we don’t have an income like employed nurses do. We don’t have the benefit of having the care of a workplace,” she says.

Ella Weiser, another final-year student at ACU, says student nurses should be paid for going on placements. “If you do a trade apprenticeship, you get paid for your time,” she says.

In Britain, the government offered student healthcare workers – including student nurses – the choice of either postponing their placements to focus on the theoretical part of their coursework or registering as paid volunteers to support the National Health Service through the pandemic.

Health Education England said that during the pandemic unpaid placements for student nurses would be forgone “to recognise the special circumstances and as part of the response to Covid-19 these hours have been paid and will be until the end of summer”.

Neither DHHS nor AHPRA responded to questions from The Saturday Paper about the prospect of launching a similar program in Australia.

A spokesperson for the Nursing and Midwifery Board of Australia said support and advice are being provided to student nurses.

The ACU’s Michelle Campbell says such support is also available for international students. “We do have loans and grants available to the international students alongside those other government initiatives that are there for them,” she says.

But Vedavash Pradhan, a final-year nursing student from India, says there has been inadequate support for international students, particularly when it comes to finding work, given they are ineligible for government support.

“I’ve got some friends who have lost their jobs during this pandemic. They’re having a hard time … they’re desperate to find jobs,” he says. “It’s hard for their parents to send them financial support because even our countries are in lockdown.”

Pradhan says he is also worried about his career prospects in Australia. “From what I know, employers prefer locals first,” he says.

Mental health advocacy group Black Dog Institute recently revealed the pandemic is causing high levels of stress for healthcare professionals. But for these students, the uncertainty of whether they’ll even be able to graduate is also taking a toll on their mental health.

“It’s a lot of pressure to put on young people who often are straight out of school,” says Ella Weiser. “I’m a mature-age student, but a lot of kids in the course … they really struggle with it mentally because it’s a lot to put on young people.”

Weiser has called for a representative voice for student nurses that can advocate on behalf of students. “It’s really quite mentally draining. I find it frustrating because I don’t think there’s much of a student voice in the situation,” she says. Other students agreed.

For Weiser, the experience has made her re-evaluate how much she wants to pursue a career in nursing.

“I still think it’s the right career for me. I was always quite interested in health sciences and I’m a people person, so I think it matches with my passions. But I don’t know what my stamina will be in this career just because it’s already been so challenging and I haven’t even started.”

This article was first published in the print edition of The Saturday Paper on Aug 22, 2020 as "Nursing injuries".

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Santilla Chingaipe is a journalist and documentary filmmaker.