Some of the problems in our health service seem intractable. Baked into the system even before the HSE came into being in 2005. We have been talking about waiting lists forever. The 2001 health strategy promised “that no public patient will wait longer than three months for treatment following referral from an outpatient department by the end of 2004”.
Minister for Health Stephen Donnelly told us this week that 622,000 people are waiting for an outpatient appointment and 81,000 people are waiting on inpatient or day case appointments, 22 per cent more than this time last year.
Just because other countries in Europe are failing to care for their student nurses does not mean we have to follow their example
In January 2020, there were 556,770 people waiting for their first hospital outpatient consultation. Coronavirus simply exacerbated difficulties within the health system which have been present for a very long time.
Similarly, the issue of paying student nurses and midwives (and indeed, student radiographers) has been driven to the forefront of our consciousness by coronavirus. However, the issue has been simmering since 2004, when nursing moved from an apprenticeship model to a degree programme.
Last year, when student nursing placements were cancelled, temporary healthcare assistant contracts were offered instead. Some second- and third-year students found themselves directly responsible for a number of patients when they arrived to take up their placements in nursing homes. The numbers of infections were so high among nursing home staff and indeed, in hospitals, that the gaps had to be plugged by inexperienced students. That is understandable in a global pandemic but not at any other time.
Allegedly, the issue is that student nurses are being educated, which is not the same as working.
Let’s be clear. Student nurses work.
I was speaking to a student nurse who has just started a placement consisting of 39-hour weeks with exhausting long days. She is in fourth year. Her course is a 4½-year degree in children’s and general nursing, so she is not entitled to a paid internship until May. She will be doing exactly the same work as her friends who are doing a four-year degree and who are being paid.
Officially, a placement is meant to allow a student to develop key skills under the guidance of a preceptor, a registered nurse who guides, supports, monitors and assesses the student. In reality, hospitals are busy places where there has been chronic understaffing for many years. Some students complain that they are de facto healthcare assistants. While the skills of feeding, washing and caring for patients are an important part of nursing, they are supposed to be honing their skills in specific disciplines in each placement.
Other students are given too much responsibility and feel overwhelmed. How well students are looked after varies from hospital to hospital and even within the same hospital. Some students report wonderful experiences on placement.
If it were you, would you not prefer someone who isn't suffering from burnout and who is earning a reasonable wage or stipend to be caring for you?
Nevertheless, they are working, and working hard. Donnelly has said that stringent EU regulations mandate how many hours must be spent on placements and those hours cannot be paid. Nonetheless, the HSE already pays salaries to a small number of healthcare assistants who opt to retrain as nurses or midwives. It is possible to pay some student nurses. He has also said that no one has been able to find anywhere in Europe with a degree model of education where student nurses and midwives are paid better. German students are paid well but they have an apprenticeship model.
But just because other countries in Europe are failing to care for their student nurses does not mean we have to follow their example.
The obvious answer would seem to lie in bursaries and generous help for students, which are available in some places in Europe. Instead, students here face high fees and, now, the inability even to supplement their incomes by working part time in care facilities due to the risk of cross-infection. There are many mature students who have families to support and many more younger students from families who struggle to support them for four years or longer.
Healthcare assistants, particularly in the private sector, are another group who do work that often involves hard, physical labour. (No matter how well trained you are in lifting, moving an elderly, heavy helpless person is demanding.) They, too, work long hours, sometimes for minimum wage.
Given that there are so many intractable problems in our health service, it would seem to make sense to tackle one, proper remuneration, which would help with two others – the perennial problems of recruitment and retention.
We often boast about the calibre of our healthcare education. The net impact is that those skills often end up in countries which show more care and respect for healthcare workers.
Given that most of us are going to need to be looked after by healthcare professionals at some stage when we are vulnerable or elderly, why do we not prioritise those who do that work? We would hope that in those circumstances, we, or those whom we love, would be cared for with kindness and respect.
If it were you, would you not prefer someone who isn’t suffering from burnout and who is earning a reasonable wage or stipend to be caring for you?