Nursing studies

Nurse education: the COVID-19 response was the first step in treating students as equals

The five tests to assess commitment to change and ensure a new platform for students’ voices 
Picture of students on a video conference call. Students are getting involved in debates around the COVID-19 pandemic. Picture: iStock

The five tests to assess commitment to change and ensure a new platform for students voices

Nurse education has often been criticised for its slow response to the need for change.

But since the start of the COVID-19 pandemic, the healthcare education sector has shown a flexibility, agility and speed of movement which would have previously been unthinkable.

Online learning was just one of the changes for nurse education

Courses written for face-to-face delivery have been adapted to enable online learning, while dyed in the wool assessment strategies have similarly been amended.

Even more significant change has occurred in relation to practice learning. With placements suspended for first-year students, universities have had to find ways to facilitate entry to the second year without students having completed a

The five tests to assess commitment to change and ensure a new platform for students’ voices

 iStock
Students are getting involved in debates related to the COVID-19 pandemic Picture: iStock

Nurse education has often been criticised for its slow response to the need for change.

But since the start of the COVID-19 pandemic, the healthcare education sector has shown a flexibility, agility and speed of movement which would have previously been unthinkable.

Online learning was just one of the changes for nurse education

Courses written for face-to-face delivery have been adapted to enable online learning, while dyed in the wool assessment strategies have similarly been amended.

Even more significant change has occurred in relation to practice learning. With placements suspended for first-year students, universities have had to find ways to facilitate entry to the second year without students having completed a core component of the criteria for progression set out by the Nursing and Midwifery Council (NMC). 

Add to this the introduction of the online theory or extended clinical placement options for more senior nursing and midwifery students, and the radical rupture in business as usual is even more apparent.

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Nursing students have made a vital contribution to healthcare during the pandemic

Perhaps most significant of all is that – for the first time in over a generation – students are being remunerated for clinical practice. In Scotland, where the bursary is still in place, payment is in addition to existing arrangements.

It is not uncommon to hear students say they feel undervalued or unimportant, but the pandemic has shown that, while students may sometimes be under-appreciated, they make a vital contribution to health care.

This is evidenced by the speed at which university deans, chief nursing and midwifery officers and the NMC worked to agree on their deployment.

Concerns have been expressed about the decision to use students to strengthen the workforce during the pandemic. It may be too early to tell if these are justified, and judgement will depend in part on what happens in the weeks, months and years to come.

What we do know is that, over the past few months, new channels of communication and types of conversation have emerged between students, healthcare leaders, academics and trade unions.

Bringing student voices to the table in discussions on the future

Student leaders have been involved in discussions with the chief nursing officers of the four UK nations, as well as the Department of Health and Social Care, the Council of Deans of Health, the NMC and unions.

These discussions have extended to co-editing policy documents and driving discussions on protecting student learning, with students treated as important partners by powerful people.

Health Education England used webinars to give a platform to the student voice, with many universities also using webinars and online meetings to share progress with students as it emerged. Students were able to feedback their concerns and know their voices were being heard.

These interactions suggest a genuine desire on the part of those in positions of power to work in partnership with them and see them as equals. We hope this reflects a new type of relationship and engagement, one without the tokenistic paternalism of the past and that truly values the student contribution.

There is a lot to be optimistic about in the way leaders have sought to include students.

Five tests to assess commitment to change

If the improved level of engagement shown over of the past few weeks is to be used as a platform to deal with some of the long-standing problems students have reported, these changes must be sustained.

We have set out five important tests which could be used to assess this commitment to change:

Illustration of a nurse with a dripClinical placements

Despite many examples of excellence, some student placement experiences are poor. This may reflect an overstretched workforce in some cases, with staff not having the time to support learners, but it is clear that some of it is also a result of disinterest on the part of some staff, resentment and sometimes bullying. Students report problems with rostering, supernumerary status and lack of learning opportunities. Strategic leaders must take responsibility for addressing these issues as a matter of urgency.

Illustration of money.Student funding

Current models of student funding vary across the UK. None seem to have been able to address the fact that many students have to take additional paid employment while also undertaking a full-time course, which requires them to complete a minimum of 2,300 hours of clinical practice. Advocates of the status quo are few and far between and action is needed.

Illustration of figure balancing scales.Balance between theory and practice

For many students, the balance between theory and practice is puzzling. They reasonably assume that the requirement to complete 2,300 hours of theory and the same amount of practice to register with the Nursing and Midwifery Council (NMC) is underpinned by a firm evidence base, but this is actually mandated by an EU directive. A consultation should now take place between the NMC, higher education institutions and their partners and students to review this and agree a way forward.

Blended learning

We have seen how flexibility is possible in a system which has often been inflexible, and where institutional imperatives and regulatory requirements have often taken little account of student needs. A new era of online and blended learning with more flexible pathways through programmes would go a long way to demonstrate that co-production has superseded the old ways of doing things for – or to – students.

Illustration of white and black figures equally balanced on a scale.Cultural competence

The pandemic is not the only trauma to have struck recently. The disproportionate representation of black, Asian and minority ethnic (BAME) groups in COVID-19 mortality statistics, and the recent Black Lives Matter protests, have intensified discussion about institutionalised racism in the UK. The BAME maternal mortality crisis in the UK has also led to calls for cultural competence to be incorporated into midwifery education and for such curriculum changes to be developed in partnership with BAME students and service users.

 

Empowering the future workforce

The COVID-19 crisis has demonstrated how important students are to our health and social care system.

It provides us with numerous examples of how nursing and midwifery leaders, academics and students have worked together as equals, engaged in a common endeavour.

Not only must this work continue, it must be developed and built on. The sector must work hard to elevate the status of students. It is in all our interests to create an empowered future workforce that is confident and capable, and that knows its own worth.

For all the tragedy, perhaps this new deal for students could be a positive outcome from the COVID-19 crisis.


Joy O'Gorman is a second-year adult nursing student at the University of Plymouth 

 

 

Robin IonRobin Ion is senior lecturer in the division of mental health and integrated practice at the University of the West of Scotland 

 

 

Alicia Burnett is a third-year midwifery student at the University of West London 

 

 


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