Let’s quash the criticism of nursing students opting for theory-only studies

Those continuing their studies online amid COVID-19 need support, not judgement

Nursing students who are choosing to pursue the theory option during the COVID-19 pandemic, rather than doing an extended clinical placement, sometimes face criticism from those who think they have made the wrong choice.  

‘I’ve spoken to lots of students who feel guilty, ashamed and embarrassed, and are having to justify themselves when they shouldn’t need to,’ says second-year adult nursing student Brian Webster.

Nursing students are being made to feel guilty for choosing to continue studies online

Such criticism of this group has driven Mr Webster to set up the website ThinkTheory19 to support the UK’s nursing students, particularly those who have selected the online theory route.

In responding to the pandemic, the Nursing and Midwifery Council (NMC) decided that rather than the usual 50-50 split between theory and practice, second-year nursing students could choose to spend 80% of their time on placement, with 20% in theoretical learning. 

‘Students who have chosen paid placements should be commended. But while everything has been very positive towards them, there wasn’t any recognition for those who couldn’t or wouldn’t go out on placement,’ says Mr Webster, who attends the University of Dundee and is the nursing school’s student president.

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Those who aren’t joining the front line are being treated differently, he says. ‘It’s as if we are not professional, not future nurses and shouldn’t be commended,’ says Mr Webster.

‘For me, there was such uncertainty, not just about the virus itself but what the decision might mean for my education, degree and the future,' he adds. 'My concern was the impact the decision would have in the longer term.’

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Website was set up as part of a student leadership programme

The new website is part of Mr Webster’s project for 150 Leaders, the Council of Deans of Health’s student leadership programme, which aims to promote and develop leadership skills among future nurses, midwives and allied healthcare professionals by working with first and second-year students. It involves conferences and events, coaching and an online community.

‘I wanted to be part of these programmes,’ says Mr Webster. ‘It will give me the confidence and experience to be able to have the voice that’s needed so much in nursing.’

Alongside health and well-being, education and clinical resources, news and blog posts, the website also includes inspirational video messages from leaders in nursing and healthcare. This includes Health Education England chief nurse Mark Radford, Foundation of Nursing Studies chief executive Joanne Bosanquet and Scotland’s chief nursing officer Fiona McQueen.

‘They are saying it doesn’t matter what you’ve chosen, you’re still respected,’ says Mr Webster.

Online survey will assess the impact of the project

To ascertain the project’s impact, he has developed an online survey to find out how students felt before it started. Eight questions explore issues such as pressure on students from peers or their university and whether that influenced their choice, how they felt making their choice and other factors that influenced it.

It also asks about their feelings about the next stage of their course, having not had as many clinical hours as planned.

‘A lot of students who have opted out have felt almost inferior and worry that they won’t progress with their studies, rather than thinking they could learn something different’

Heather Bain, academic strategic lead for academic programmes, Robert Gordon University, Aberdeen

Mr Webster will repost the survey in the future, to check if people feel better than they did and to see if the project has had an impact. ‘I want to gather an evidence base to see if there was a need for the project,’ says Mr Webster. ‘If this ever happens again, we need to consider the impact on everyone, not just those on the front line.’

Other ideas include teaching clinical skills online, and approaching specialist nurses to help deliver this.

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‘As a nursing student, you have a gut feeling that you should be out there doing something,’ says Mr Webster. ‘But it’s important to remember that we are doing something, and we will be able to relieve all the students when the pandemic is over. We will be a fresh cohort.’

ThinkTheory19: aiming to end criticism and judgement

‘Whether you have opted into theory or practice, you are still going to be one of our amazing future nurses,’ says University of Nottingham associate professor Stacy Johnson, who is supporting Mr Webster’s project.

For her, one of the initial attractions of his work was the focus on choice of words. ‘Brian asked us to use language that is less likely to make people feel blame or guilt,’ she says. ‘Opting out suggests you’re doing something wrong.’

Professor Johnson wants to see all nursing students supported – no matter what decision they have made about their degree.

‘People are going into practice for lots of different reasons,’ she says. ‘They are healthy, feel able to contribute on the front line, and their personal responsibilities allow them to make that choice. Others don’t have the same freedom. What we don’t want to do is set people up so they feel pressured to make a decision that puts their own health or their family’s at risk.’

She hopes the project will end others’ criticisms and judgment. ‘I’m hoping that bad comments, such as those we’ve seen on social media, will stop because they will not be tolerated, and leaders defend students who are doing theory. I hope attitudes change and that it is visible.’

Mr Webster’s coach for the 150 Leaders programme is Heather Bain, academic strategic lead for academic programmes at Robert Gordon University in Aberdeen. ‘We bounced around a few ideas for a project but kept coming back to this,’ she says.

‘A lot of the students who have opted out have felt almost inferior and worry that they won’t progress with their studies, rather than thinking they could learn something different.’

Leadership programme gives students confidence and improves communication skills 

Her support has been invaluable, says Mr Webster. ‘She’s pointed me in the right direction and provided suggestions on how to do things,’ he says. ‘It has given me the push to realise this is something I can do.’

• RELATED: Developing the personal qualities required for effective nurse leadership

Dr Bain sees her role as facilitatory: ‘It’s not my project, so I’m not saying this is the way to do it. Brian is very independent and approaches people himself, including the chief nurse for Scotland, who responded. He is confident about targeting these leaders and engaging with them, which is great to see.’

Being involved is also personally gratifying, she believes. ‘There’s something quite special about identifying students who have such potential for the future. You’re giving them additional tools to help them develop.’ 

Lynne Pearce is a health journalist

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