FINANCIALLY-STRAPPED STUDENT NURSES say the health system is putting them under financial pressure to work in multiple healthcare settings to earn money, despite the risk of Covid-19 cross-contamination and the potential danger it poses to patients.

Some student nurses, who are not paid for their university placements where they work up to 36-hour weeks, say they also do paid shifts in other healthcare settings – such as a hospital, rehabilitation centre or nursing home – because they need money for rent and travel.

The students say they are financially reliant on this work, often through agencies, because they are not paid for the placements in first to third year of their degrees, but the uncertainty about the propriety of these shifts is a cause of anxiety for them.

However, in a change to previous years, the HSE has said it ‘does not support’ student nurses working in multiple settings due to the risk of infection of Covid, leaving many students now torn between choosing to risk cross-contamination or jeopardising their own financial security.

Mary Hogan, a 21-year-old-year nursing student in University College Dublin, said: “The contamination comes from bringing it from one group to another, and that goes hand in hand with working in different environments.”

Aoife Toner, 21, a third-year student nurse said, “If we were paid for placement, I would 100% not be [doing agency work] because it’s such a risk.

“If I got [Covid-19] I wouldn’t feel as bad because at least it was me, but if I give it to someone who was vulnerable, I don’t think you could live with that kind of guilt.

“But at the same time I’m still put in a position where I have to be selfish and think of myself because in the long run I’m going to be the one who struggles.”

The government on Wednesday night voted down a motion brought forward by opposition TDs that would have seen student nurses and midwives get paid for their placements during the Covid-19 pandemic. Instead, student nurses can now apply for the Pandemic Unemployment Payment. 

‘Breaking point’ 

Hogan contracted Covid-19 while working part-time for a nursing agency alongside her college placement. She said that she feels she has to continue doing agency work now that she has recovered, despite the risks involved.

“I definitely wouldn’t manage financially if I wasn’t working,” she said. “The rent up in Dublin wouldn’t be feasible if I didn’t have some sort of part-time work.

“We’re at breaking point at this stage. We’re doing 36 hours a week in placement and then some of us do two shifts at the weekend, so that’s adding up to 60 hours a week.”

College placement involves students shadowing qualified nurses for educational training in hospitals and is unpaid; agency work involves students working part-time for nursing agencies in a range of health-related settings as healthcare assistants (HCAs). HCAs perform more basic tasks than are required from students on placement – such as helping patients with washing and dressing -  and they are paid for it.

After testing positive, Hogan had to take ten days off from her college placement to self-isolate.

She acknowledges the risk attached to the way she was working, and knows that “with special placements you could be in ICU or in paediatrics with very high-risk patient groups and obviously then it’s not advisable to be [doing extra shifts] on a general medical ward.”

Hogan and the other student nurses say the HSE has not addressed the risks associated with their financial reliance on agency work during a pandemic. 

In a statement to TheJournal.ie, a spokesperson for the HSE said that there is “nothing precluding the students from applying for any other post they are eligible for in the HSE including part-time work”. 

They noted, however, that due specifically to Covid, “we do not support the movement of healthcare workers through a number of clinical sites due to risk of infection during Covid 19″. 

Students interviewed for this piece said they have received no instruction from the HSE about combining their student placement work with their paid agency work. They say this is because student nurses are not registered as official employees in the health system and are overlooked as a group.

Many student nurses believe the healthcare system does not adequately oversee or supervise nurses working in different places.

“There’s no accountability,” Hogan says. “The agency will still put you on Covid wards, there’s really no account that you are on placement as well. So, it’s trying to balance that, being in with Covid patients, and then trying to see if you are a close contact or not.”

According to the Health Protection Surveillance Centre (HPSC), more than 11,000 health care workers have tested positive for the virus since the beginning of the pandemic.

Aimee Lanigan (20), also a third year nursing student in UCD, was working as a HCA, but took time off when she was on placement in a high-risk area.

“I’m working in Holles Street this week and obviously I don’t want to put little babies at risk, so I’ve taken time off work,” she said. “That puts me under pressure [financially].”

“I feel like I have to work for an agency,” she said. “I have no choice. I need the money and obviously we’re not getting paid for placement.”

The nursing agencies “just ask you to come in and don’t really care if you’re on placement,” said Lanigan. “I know myself if I’m on placement in a high-risk area, I won’t take a shift [in another healthcare setting].”

Phil Ní Sheaghdha, the general secretary of the Irish Nurses and Midwives Organisation (INMO) said: “Student nurses are not on a roster and identified with an employee number [so] they are missed in the contact tracing.

“Student training is governed by three separate bodies: the university, the clinical placement and the Nursing and Midwifery Board, and each one of those say [testing and contact tracing] is the others’ responsibility,” she said.

‘Why aren’t we getting tested every week?’

Katie, (21) a third year student nurse who wishes to keep her surname and college anonymous, is currently on placement. She tells a similar story: “I actually asked my clinical placement coordinator why aren’t we getting tested every week and she said: ‘Well, if you were getting tested every week we would have no staff’.”

Student nurses in first, second and third year are obliged to do unpaid clinical placement as part of their training. On average, third year general nursing students complete 740 hours of unpaid placement in the academic year.

Katie said that “altogether, on rent and diesel, it’s €1,950 for 12 weeks [of placement], and I’ll be getting from the HSE a travel contribution of €395. So I’m at a loss of €1,555 after the 12 weeks.”

Students working for an agency can earn up to €14.28 per hour Monday to Friday and this hourly rate can double over the weekend. The pay also increases depending on the nurse’s year of study.

According to some students, there is an over-reliance on student nurses to fill gaps within staffing shortages.

“The fact that the hospitals are so stuck for staff and you get the odd phone call asking you to come in, I feel they shouldn’t be so reliant on student nurses. They should have staff there to support them,” Lanigan said.

A fourth-year student nurse (22), who wishes to remain anonymous, said he felt as though he was being taken advantage of.

“Students are consistently exploited and treated like dirt on the bottom of someone’s shoe. I am annoyed but at the heart of things, I am disappointed that a system like this exists in this country and no one seems to care.”

He said that some clinical placements refuse students who also work for agencies. Left in limbo, he sought clarification from the placement coordinator.

He was then told to ask the university for clarification, who then sent him back to the placement coordinator – it was, he said, “kind of on a loop.”

In the end, the placement coordinator told him, “If you were in my boots, would you want a student to work in two separate healthcare settings?”

Still faced with their financial struggles and with little clarification on the matter, many student nurses have chosen to continue working at an agency for money.

The INMO has launched a campaign to end what they say is the exploitation of student nurses. They are petitioning the Minister for Health, Stephen Donnelly, for increased pay for student nurses and full health and safety protection to all students, including payment if they have to go on Covid-related leave.

At time of publication the petition has attracted 23,000 signatures.

Following Wednesday’s vote against paying student nurses for their placements, Minister for Health Stephen Donnelly has said that some students and midwives who would otherwise be relying on placement work for income would be eligible for the Pandemic Unemployment Payment (PUP).

“I think it’s very welcome news for anyone that couldn’t continue or opted out of their part time work, but for anyone who kept working … during placement it is really no benefit for us since we won’t be entitled to it if we are in employment” said Mary Hogan.

“Had this been offered earlier I think a lot of students definitely would have claimed it, just to lessen our risk of contracting covid and lightening the huge workload of placement, assignments and a job on top of that.”