By Bethany Dawson, Chloé Meley and Julie Ngalle
All names used are fake in order to preserve the confidentiality of respondents.
Final year healthcare students are experiencing life under Covid-19 on another plane from their peers. Whilst students from non-healthcare courses have the privilege of turning off their push notifications and ignoring the barrage of news to get some headspace; that option does not exist for students working on the frontline.
Walking through the doors of their workplace is a harsh reminder of the magnitude of Covid-19; “don’t underestimate how scary it can be walking into a ward, having to change into your uniform at work as to not put anyone in your house at risk” notes Sam, a recently qualified paediatric nurse. As the UK death toll continues to soar, having become the highest in Europe on the 5th of May, healthcare students are grappling with unabating anxiety. Talking about the fear of contracting the virus, Avery – a final year adult nurse – said: “it went from ‘if I get it’ to ‘when I get it’ to ‘I hope I don’t die’, we are just all kids trying to deal with this.”
The mental health difficulties that these times are bringing to healthcare students do not respect the boundaries of hospitals, but they seep into every part of life, with final year paramedic Joe telling us: “I would wake up every day crippled by anxiety and stress of firstly not being able to see my family, and secondly due to the uncertainty surrounding the degree. I couldn’t focus on anything, and all the while I had to complete exams and a dissertation.”
Healthcare students have been hit with an all or nothing scenario: either temporarily suspend your studies or work on the frontline, which one final year adult nurse describes as a “warzone”. Avery describes the situation as “being blackmailed into either going into the emergency register or being forced to take a year out.” This places students in an impossible position, battling the decision whether to jump onto the frontline and risk their lives, or suspend their studies and postpone the service they’ve been training for years to provide.
On the contentious topic of joining the emergency register, Sam told us: “students are finishing their training six months early and those last six months [are formative for] a nurse, you have your final 12 week placement to make sure you are competent and safe, and now this has been taken away.” The choice to practice is therefore nothing short of anxiety-inducing.
The evidence base shows that students aren’t alone in their unease and apprehension. A recent survey on the experiences of nursing staff in the early phases of the pandemic shows that one-third of respondents reported experiencing severe or extremely severe depression, anxiety or stress, with 74% saying they felt their personal health was in jeopardy in the pandemic due to their clinical role, while almost all (92%) were worried about risks to their family members.
“The guilt of putting my family at risk by possibly bringing the virus home is one of the worst feelings” says Tara, a final year paediatric nurse. In order to minimise the risk that NHS staff may pose to members of their household, the University has made rooms on campus available for key workers. However, neither Avery nor Lucy, two student nurses, had been made aware of it. Thankfully, neither of them required access to those rooms, but as Lucy said: “I was not aware that this was a possibility, and if I needed accommodation I would have not known where to turn.”
Although it seems communication has been somewhat lacking in that regard, healthcare students note that the University has been getting progressively better at supporting them over the course of the crisis. The University has arranged with Health Education England for Lucy to do a placement in her home county of Lincolnshire, on the basis of a six-month contract that will set her on the path towards becoming a registered nurse, once she has completed a set number of hours and passed all her exams. She will be paid for the hours she works and will not be a supernumerary, meaning that she will be more independent and may be entrusted with more responsibilities. Although she was disappointed by the lack of advice and help provided by the University during the early days of the pandemic, Lucy acknowledges that they’ve been very supportive during her transition to a different working environment. She notes particular gratitude to her tutors, who she says have been very reliable and have facilitated her adjustment to new circumstances and guidelines.
However, even with adequate support from the University, the situation remains uniquely stressful. Jobs are changing on a daily basis, with priorities switching away from building a rapport and bedside manner to dodging the ever-growing threats posed by the pandemic. For those working with children and pregnant women, it has been particularly difficult to adapt. “Something as small as a face mask means that these children can’t see whether you are smiling at them … knowing that children can’t see your smile is hard”, said Sam.
Kiera, a student midwife, noted: “we have always been taught about creating trusting relationships with our patients, the art of reassurance and unique care tailored to each woman as she goes through her journey of motherhood. During this crisis, it feels it has all gone out the window as we are minimizing the time we spend with each woman to protect staff and the people we are caring for … I never expected to be turning away partners who are bonding with their baby, or not have a mother see the smile under my mask as I coach her through her labour.”
For student paramedics, work has “changed dramatically”, as one student puts it. Their final year has been turned on its head as they are no longer working in ambulance placements, having been allocated alternative placements within hospital A&E’s and minor injury units. Paramedic student Emily says this is “extremely saddening”, and has had a “massive impact on [their] wellbeing.” Describing these alternative placements, Joe notes: “the shifts were long and at times gruelling, but I always came away thankful to have been given the opportunity to help out during such a difficult time for the NHS. I felt proud to be a Surrey student helping out when people needed us the most.”
This blend of exhaustion and pride, of suffering from the intensity of the situation whilst feeling honoured to be able to help, seems to be shared amongst healthcare students. Emma, a second-year student nurse currently working as a healthcare assistant in different wards, notes her personal wellbeing has been negatively affected by a mixture of general uncertainty, working night shifts, and having to care for end of life Covid-19 patients. Although having to deal with dying patients isolated from their loved ones is emotionally challenging, she feels privileged to be “able to care and love these patients like they’re my own family when their own family can’t.”
Emma is harnessing the anxiety she is currently experiencing to become a better nurse, having used the present circumstances as an opportunity to learn more, prepare herself for the realities of the job, and build her confidence in the face of self-doubt. “I actually feel very privileged to work and of course it’s scary but I would rather be working than sitting at home feeling helpless”, she says. She does however recognise that her approach to the situation is not shared by everyone, and that her ability to cope better than most is due to the fact she does not have to deal with financial pressures or worry about putting vulnerable members of her family at risk. She also acknowledges that younger student nurses, who have not had as much experience, may also feel more anxious.
Although many have been unjustly endangered and not given the adequate support, Emma is adamant about one thing: nurses are not helpless, naive victims of the current situation. “Part of being a nurse is putting yourself at risk and advocating for others”, she argues, and young healthcare professionals are perfectly aware of that. Echoing this stoic attitude, Joe adds: “we adapt and thrive in the face of uncertainty for the betterment of our patients, and we will ALWAYS find that glimmer of humanity’s light in the darkest of times, even in pandemics.”
But even though healthcare students accept that the present situation is something they have been training for and have to face dutifully, they also denounce the lack of protection and assistance they have been given in rising up to such a challenge. Lucy, among others, believes that the government should refund nurses’ tuition fees, at least for the second semester. She was still required to attend placement in the few months before Easter whilst coronavirus was spreading across the UK, and was therefore putting herself at risk dealing with Covid-19 patients during that time. “I should have not been put in this situation without warning”, she argues, claiming that she did not receive the appropriate amount of support or guidance from the University at the start of the pandemic.
The class of 2020 are putting themselves at risk to save the lives of millions. A sure fire sign of a broken, or at least breaking, system is one that requires the mass action of students before they are ready to leave university. And not only are they taking this heroic course of action: most of them are paying to do so. Indeed, the students serving on the frontline are the same students who were the first to have the NHS bursary removed from their studies. One anonymous student told us: “they are putting their lives on the line alongside nurses with years of experience, the least we can do is thank them, thank them by clapping every Thursday, by random acts of kindness, but the ultimate thank you being, scrapping their student debt. While our nursing students are fighting the pandemic, we need to fight for the scrapping of their student debt.”
Many students noted the growing level of awareness for the invaluable service provided by healthcare students as a silver lining to this situation, with Sara, a final year paramedic, telling Incite: “the public have now acknowledged just how difficult our job can be and that other university students now realise just how tough it can be for students undertaking healthcare programmes.” We will always be indebted to these students and their phenomenal work. They should not be indebted to Student Finance England for the pleasure of risking their lives in a pandemic.
As the majority of students have adapted to working from home, our friends and colleagues from the School of Health and Medical Sciences are adapting to a life of risk and heroism. The care, passion, and dedication of these students should not be regarded as a freakishly unexpected part of their studies, but rather an act of unprecedented valour they ought to be compensated for.