In 2016, Jeremy Hunt, the UK's health secretary announced that a disputed restructuring of pay for junior doctors would be implemented, without the approval of the British Medical Authority. The proposed changes involved reducing the rate of bonus pay a junior doctor would be entitled to for working 'unsociable hours', as well as massively restricting what constituted 'unsociable hours' for a doctor to work. Saturdays and late-evening and early morning shifts were no longer considered 'unsociable hours' and as such they would be without the benefits of Junior doctors were to be expected to work Saturdays, as well as starting earlier and finishing later on weekdays, without the benefits of bonus payment that they would previously have been entitled to. So, junior doctors took to the streets in one of the largest protests by medical professionals in the UK's history.
Thousands of junior doctors protested, and while, despite bringing a case to the High Court against Jeremy Hunt protesting the injurious effects the proposed changes would have on the NHS, they were unsuccessful in their attempts to block these changes being implemented, they had shown a strong and unified voice of opposition. They had shown that any future attempts to further burden junior doctors - simply, doing their best to prop up an already desperately stretched healthcare system - would be met with similar vehemence and acrimony.
In Ireland, there are signs of similar levels of discontent beginning to spread among student nurses, long forced to work in incredibly exploitative situations for free. An email written by Tara Nic Chormaic, a final year nursing student, addressed to Minister for Health Simon Harris has gone viral. In it she outlines the 'untenable positions' she, and hundreds of other student nurses, find themselves placed in throughout their degree. The whole letter can be read in full below.
The staffing shortages in the HSE, particularly with regard to nurses are well documented. Indeed, in the 2017 budget Simon Harris promised to create 1,000 new positions in the HSE for nurses. However, given that many hospitals utilised private contract-workers, many of these positions were simply transferring staff who were already working in hospitals onto permanent contracts. As such, the number of additional staff brought into the HSE was significantly lower than this figure in real terms. The solution that has increasingly been relied upon to make up this staffing shortfall is to have student nurses be put on more extensive, and more frequent, placements throughout their time in college. They are expected to do this work for free.
One female, third-year nursing student who got in touch with our page - and wished to remain anonymous - said that over the course of her degree so far, she has worked around 35 hours a week across 42 weeks of study, all without pay. Far from this time, some 1470 hours in total, being spent shadowing nurses, she says that she has had to "carry out all the same duties as a Healthcare Assistant and most of the duties of a staff nurse." She described being thrown into the deep-end even as a first-year on placement, saying that nursing staff have described the work done by her and other students as indispensable to the functioning of the HSE. The entire healthcare system has found itself in a position where many wards simply would not be able to function without the work done by these student nurses for free.
On top of this, many students have to hold down a secondary job to actually cover their tuition fees and pay their way through college. This can result in students, during weeks when they're one placement, having to work between 60-80 hours between their two jobs, all the while trying to keep on top of their studies; a situation that is evidently deleterious to both their morale and indeed mental health.
A key issue she also raised was the fact that, given so much of a student nurse's time is spent off-campus on these placements, their plight is often over-looked by their Student Unions.
We are at breaking point. We are part of the many, many students that they represent, and we seem to be forgotten because our presence isn't as strong as other courses' on campus, because we are doing a professional degree of 9-5 hour lecture and tutorial days.
After sending them a letter, this student's SU have pledged to raise the issue of the exploitative working conditions student nurses are forced to endures during an upcoming meeting. Evidently though, much more action is needed to bring attention to this issue within campuses and indeed nationally.
While final year nursing students are classed as 'interns' and given a salary of €14,150 for 36 weeks rostered work, the overtime and hours that these nurses end up working typically results in them earning less than the minimum wage. As such, there is something of a vicious cycle of under-staffing that has developed within the HSE. An Irish Nurses and Midwives Organisation survey conducted in 2017 revealed that only some 30% of final year mid-wifery students had been offered part-time or permanent contracts to take up when they finished their degrees. The number of Irish nursing students who graduate and enter into full employment with the HSE each year is shockingly low. The HSE has cemented itself as being a place unappealing to prospective employees due to its lack of staff, while being understaffed due to the lack of desire for many student nurses to end up working there, and a lack of funding available to take on even those that want to.
The poor career prospects, low pay - even when nurses are brought into the HSE as permanent staff - and understaffed working conditions in Irish hospitals, that has led to them being reliant on the free labour of student nurses in the first place - results in the majority of Irish nursing graduates looking to emigrate. In the same INMO study, 78% of final year students surveyed revealed that they are considering emigrating upon graduating. Indeed, far from being frowned upon, many Irish nurses are imploring their student colleagues to consider emigrating when they graduate rather than entering into a broken, incredibly stressful and unrewarding healthcare system.
Speaking to CollegeTimes.com, the same third-year nursing student described the wisdom imparted to her on placement by members of staff;
When I was on my second year placement I had the staff nurse on the ward take me aside and ask me was it too late to change courses, I told her it was and that this is what I wanted to do. She said if that was the truth then leave Ireland. There are no prospects for us here and we won't make enough to have a comfortable retirement. And that is what we hear from so many staff nurses.
Expecting student nurses to work in such strained, stressful conditions without any meaningful financial compensation is disgraceful. They are expected to be on the frontline, helping to make and oversee medical decisions that can be the difference between life and death. Maintaining a sense of optimism and motivation in such an environment would be difficult at the best of times. Yet, with evident reminders all around them that,when they graduate they will be working in similarly testing conditions - if they are even offered employment within Ireland, deployed in understaffed wards where they will themselves then be relying on college students, is it any wonder that student nurses feel like they've reached breaking point?
Tara Nic Chormaic's letter in full:
Dear Mr Harris,
I don’t know of any other undergraduate courses in Ireland, outside health-sciences, where one day your bringing life into the world, and the next holding the hands of someone leaving this world, comforting families who have been totally broken apart.
Nurses are glue. We hold teams, families, friends and patients together.
We try and stop people from taking their own lives, instil hope.
Many of us can’t do it for ourselves.
Why are student nurses going home crying at the end of a week of 39hours unpaid placements and a further 36 hours of their normal jobs to keep a roof over their heads, because student grants are just a drop in the ocean to helping with student debt?
Student nurses although officially “not counted in the numbers” are being counted in the numbers on wards - to the point without students the wards would collapse at times.
You keep talking about retaining nurses. If we don’t get treated well in training why would we think it’ll be any better when we qualify.
We see the stress qualified nurses are under to feed their families and keep a roof over their head as it is. Nurses sleeping in their cars.
New graduates not able to afford their rent and mortgages or even dream of ever getting a mortgage without moving away.
Despite this we go in day after day and care for everyone else when we can’t care for ourselves.
This week I had €6.49 to spend on food, more than normal, to keep me going for a week.
Not sure if you know, but nursing is a physically and mentally demanding job. You need energy. Energy comes from food and sleep. Two basics that I just don’t get, because I chose in the face of adversity to better myself. To do what I’ve always wanted to do and become a nurse. To help others.
I’m a Children’s and General Nursing student. Everyone tells me I’m incredibly lucky to be in such a prestigious course and how it’ll stand to me and be worth it in the end. €28,768 a year as a staff nurse. €2791 I earn extra a year for having dual qualification.
Four and a half years of studying and doing the same workloads as General Nursing students at the same time as covering the extra work, study, assignments, exams, placements and stress of doing the Children’s Nursing aspect for €2791 extra a year when I qualify.
That doesn’t even cover one years student contribution fee. That doesn’t touch the student loans I’ve had to take out because of the cost of living (and it’s far from a fancy life I live).
Student and Staff Nurses are burnt out.
The conditions and pay we are working under are beyond shocking.
The job we do is worth so much more. We are worth so much more. When will you see that?