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A glimpse of nursing student life in China

Toni Bewley discovers what nursing student life is like in a north eastern city in Daqing, China.

When Toni Bewley first arrived at Harbin University in Daqing, north-eastern China, she was intrigued to discover that students do not undertake any clinical placements during their three-year degree courses. 


Toni Bewley with students on campus at Harbin University in Daqing

The senior lecturer in children’s health at Edge Hill University in Lancashire, was there to teach in a two-week slot. It was a trip organised as part of the university’s enrichment programme and involved three team members from Edge Hill, including senior lecturers and nurses, teaching first, second and third year students for two weeks between September and November each year. Following the Chinese curriculum, they delivered 96 hours of teaching in English.

Zero

Clinical placements at Harbin in years one to three

In contrast to the UK, nursing students in China do not go into practice to obtain their nursing licence until year four of training. Whereas UK children’s nursing students have assessments, presentations and clinical exams, the Chinese students at Harbin undertake a theory-only degree.

Unusual

‘It is considered unusual for undergraduate students to go on placement. At the end of their three-year degree, if they decide they want to apply to sit the state exam for their nursing licence, they have eight months in clinical practice to consolidate the skills they have learned,' says Ms Bewley. After that, the students determine what area to specialise in.

Ms Bewley delivered sessions in children’s health immunisation and on the paediatric early warning scoring tool but she says, while Harbin students learn about these areas, they have no practical experience beyond simulated clinical assessments such as wound care and intravenous infusions.

‘They don’t do any type of experiential learning so when we go over, we introduce the nursing faculty to different ways of teaching. We do group work, scenarios, debates, and different types of objective structured clinical examination sessions which are all very new to China,’ she comments.

Because the university students are only taught theory, clinical skills training is undertaken and carried out by other women from the area – the unemployed and older women. As there are insufficient nursing homes and China’s one-child policy has led many children to move away and to seek employment in other areas, the women who are left are trained in basic community skills to support people in their own homes. 

'Unquestioning'

For Ms Bewley, the starkest difference between students in China and the UK is their lack of critical questioning. ‘They’re knowledgeable from textbooks, but they certainly don’t question anything as that’s not what they’ve been taught to do. You don’t get the enquiring mind.’

40%

Pass mark for Edge Hill students

She says this extends to the hierarchy of the hospital. ‘It’s very much a medical model. They respect people according to rank so you wouldn’t get a nurse, even once they had their licence, question a doctor – even those that are of a higher level in the hospital. If the doctor says do it, they will do it without question.’

This differs to students at Edge Hill who are free to critique services: ‘We give students the chance to look at service improvement, design it and find evidence on why it should work and present it to senior colleagues,’ she says.

Moreover, involving families effectively in consultations in all aspects of children and young people’s health is something senior staff from Harbin are considering implementing. ‘A parent may be with a child but they are not consulted in the same way we would consider a child to be about their care. Staff were thinking about how they might involve service users in every aspect as they are a long way away from that at the moment.’

What then can UK children’s nursing students learn from students at Harbin? Ms Bewley points to the students’ rigorous schedules and work ethic. Their day starts from 7.50am and finishes at 4pm – but the day is far from over. Students will go onto other classes, such as English or Russian language, and every 45-minute lesson is followed by a 15-minute power nap. Students must be back in their halls of residence by 9pm. At 10pm teaching assistants patrol and switch the lights off. Homework is completed every day in English and the pass mark is 60% compared to the UK pass rate of 40%.

60%

Pass mark for Harbin students

Ms Bewley also points to the sense of unity and pride that the Chinese students have in their university. ‘When my colleagues were there and the new students started, there was a stage performance for the university. They depicted nursing through the ages as well as performing traditional Chinese, Indian and contemporary street dance.’ She adds that the Edge Hill faculty was particularly interested in Chinese traditional medicine such as acupuncture and cupping.

For now, Harbin University are looking at undergraduate clinic placements which Ms Bewley says will be a new concept to them.

Graduation exams at Harbin University

Students complete a graduation exam and do a written closed book exam with two types of practical skills examination:

1. The written exam: marks are achieved in two parts:

Before graduation: the fundamentals of nursing make up 40%, internal medical nursing makes up 30% and surgical nursing makes up 30%.

Before graduation: the main assessment is the student’s mastery of clinical nursing knowledge and ability to analyse and solve problems.

2. Practical skills assessment:

Each student will be randomly assessed on three skills: intravenous fluids, various types of injection methods, of which one is chosen, and evaluation of vital signs.

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