Clinical placement

Redeployed on placement: how short-staffing due to COVID-19 changes everything

If supernumerary status it vital to learn and practise, it must be upheld, even in a pandemic

If supernumerary status it vital to learn and practise, it must be upheld, even as the NHS copes with the pressures of the pandemic

Students on placement in a clinical setting, all wearing masks due to COVID-19
Picture: iStock

From the start of our nursing degrees, we are told that our learning needs are paramount during clinical placements.

Students should be at the centre of the placement learning experience, says the Nursing and Midwifery Council (NMC), so they can be supported to learn and practise skills safely.

Protected learning status is eroded

To enable this protected learning time, the NMC says students must be considered supernumerary, meaning ‘they are not counted as part of the staffing required for safe and effective care in that setting’.

However, maintaining supernumerary status during COVID-19 has been a struggle for nursing students, with many redeployed to other areas to help out during the pandemic.

Nursing teams have been under immense strain since March 2020, with many clinical areas experiencing increased staff sickness levels. Figures published by NHS Digital in September 2020 show that in April just over a third of all sickness absence for nurses and health visitors was related to COVID-19.

As nursing students, we fully understand the need to play our part to keep services running and patients safe during the pandemic. But when we are moved out of our placement setting to other areas, we are effectively being counted in the staffing numbers and our protected learning status is eroded.

Pressures and placement moves due to short-staffing

Students at my university have become increasingly concerned about this, with members of my cohort voicing frustration and confusion over the amount of redeployment we are experiencing in practice.

One student I spoke to was asked to provide one-to-one care for a patient requiring enhanced observation, even though first and second-year students are not supposed to provide this level of care. Another was asked to move wards by the charge nurse, who became frustrated with her when she declined.

While on a placement in theatres, I was asked to assist on the wards. As much as I understand the pressure ward staff are under, I’m unsure how we are supposed to meet our learning needs if we are constantly being moved around to make up the staffing numbers.

It seems a change in culture is needed, where students’ supernumerary status is appreciated and protected so we can focus on our learning.

‘With staff shortages still rife and students being used to plug the gaps, our supernumerary status feels like a distant memory’

During the peak of the first wave of COVID-19 in April 2020, emergency standards introduced by the NMC meant students from all four UK countries had the choice to ‘opt in’ to an extended clinical placement, forfeiting their supernumerary status in return for monthly payments.

The scheme was suspended in September 2020, but a plea for help from health and social care secretary Matt Hancock and NHS England chief executive Sir Simon Stevens in January saw it reintroduced by the NMC for final-year students only.

No return for paid placements in Scotland

Fiona McQueen, Scotland’s chief nursing officer
Scotland’s chief nursing officer Fiona McQueen said students’ priority on placement should be learning Picture: Mike Wilkinson

However, in an open letter to all nursing and midwifery students in Scotland, chief nursing officer (CNO) Fiona McQueen said there were no plans for another opt-in scheme here, and that the priority was for students ‘to retain their supernumerary status and their position in the clinical area as learners’.

As commendable as this reasoning is, it caused a lot of unrest among students in Scotland, who feel that their supernumerary status has not been upheld during the pandemic.

In response, final-year students at the University of the West of Scotland wrote an open letter to the CNO, along with members of the Scottish Parliament and deans at the university, to voice their concerns.

Nursing staff have been dealing with the pandemic for almost a year and are mentally and physically exhausted. With staff shortages still rife and students being used to plug the gaps, our supernumerary status feels like a distant memory. So why were we not offered the choice of taking up a paid placement?

The CNO has echoed past messages of contacting lecturers for advice and support, but we need more than this. Governments need to collaborate with universities to produce national guidelines to secure students’ working environments and protect our learning.

Nurse leaders can help ensure ‘supernumerary’ is upheld

Effective nursing leadership is also required if we are to foster a culture of learning and teaching in the practice environment, with staff accepting that students are there to learn.

I have seen some great examples of this, with nurses advocating for our learning and understanding the importance of students remaining in the named environment, but this is not across the board.

Nursing during the COVID-19 pandemic has been extremely tough, and of course nursing students want to help. But this cannot be at the expense of our learning needs.

Without our supernumerary status and the focus on learning, we cannot gain the minimum required hours we need to register with the NMC.

So when university staff, healthcare professionals and government ministers say ‘students are not counted in the numbers’, they should mean it, and act on it when students say this is not the case.

Craig Brown, a third-year nursing student at the University of the West of Scotland