When Minister for Health Simon Harris announced this week that student nurses and midwives on placement would receive a wage for their work, many celebrated.
The move means hundreds of unpaid, or supernumerary, students around the country won’t have to work on the frontlines of the health service – in the midst of a terrifying pandemic – for free.
But for many final-year nursing interns, it felt like a kick in the teeth. “We’ve just been forgotten in all of this”, says Kate Brennan, a final-year nurse on an internship in Tallaght University Hospital. “I hope we can learn from this, because we’ve just completely fallen into no-man’s land.”
Brennan has been on an internship – for which she’s paid €10.47 an hour, nearly €4 less than qualified nurses on the lowest rung of the pay scale – since January.
Internships are distinct from the unpaid placements Harris addressed: most nurses and midwives undertake them between January and September in their final year. Now, supernumerary students – who have far less experience than interns – are set to earn nearly €5 more per hour than interns.
I hope we can learn from this, because we’ve just completely fallen into no-man’s land
Nursing interns are used to fighting for answers, Brennan says. Often, they feel as though their College sees them as hospital workers, while their parent hospitals argue they’re students. Many nurses say they frequently fall between stools, with hospitals directing questions to Trinity, and Trinity turning them back. It’s hard to get clarity.
But over the last two weeks, the situation has taken on a new, frightening, dimension. Now, the academic and professional questions that student nurses face are bumping up against a health service battling to stave off an all-out crisis.
The result, nursing interns say, is a scenario where they’re going to work every day with “ferocious mental stress” hanging over them – and without clear direction on their circumstances.
Interviews with seven fourth-year nursing students – all of whom are participating in internships in either Tallaght or St James’s Hospital – reveal a cohort struggling under the stress of a litany of issues. They’re unsure about whether they’ll have to repay time lost in self-isolation, and they’re battling to fulfil their academic requirements while on the frontlines of a national crisis.
And, they say, none of the stakeholders that make the rules are giving them the explanations they need.
“This is not a time for ambiguity”, says Megan O’Connor, off-campus officer and education officer-elect of Trinity College Dublin Students’ Union (TCDSU). “These organisations have the opportunity right now to stand up and say: ‘We appreciate the position you are in. We are going to do all we can’ – even if they don’t have all the answers.”
We all want to graduate on time, so you’re kind of being told to isolate, but that could be sacrificing your degree
“Nobody’s looking for a miracle”, adds O’Connor, who’s currently on an internship in Tallaght. “We understand better than most people what is going on right now – we’re stuck in the middle of it. But even if there was just a line of communication, I think it would be so appreciated.”
Georgia Gilligan, a fourth-year nursing intern in St James’s Hospital, had to take a number of days off work after she showed cold and flu symptoms. “I contacted my GP and they said that I was between a rock and a hard place”, she says.
As an intern, Gilligan is only entitled to 55 hours sick leave. Anything beyond this she has to make up if she wants to complete the programme, unless she has a doctor’s certificate. So far, this ruling, which predates the coronavirus, has not been changed – despite the fact that hospitals are expressly instructing nurses with symptoms to stay home.
Gilligan’s GP “couldn’t give me a cert”, she says, “because GPs were told not to see anyone with any kind of cold or flu symptoms”.
She ended up getting an online GP to give her a certificate. The result, though, is that she “might have to repay the place at the end of the block, at the end of the internship”.
“It’s just not helpful for anybody to stress about missing time”, Gilligan says. “Obviously, we all want to graduate on time and stuff like that, so you’re kind of being told to isolate, but that could be sacrificing your degree. And you’re not being told that you won’t owe the time back.”
If I get covid19, I have no sick leave to take. I cannot miss any more time or I have to repay it
She’s far from the only one facing up to the implications of taking time off work.
“A full nurse goes to work – she’s not worried about failing”, says Jenny Kass, another final-year intern, working in St James’s Hospital. “We are. We could lose everything if we get sick.”
“The College and the hospitals have not given us any indication as to what is the scenario should we fall sick”, Kass says. “If we miss two weeks because we’re isolating – and if we get sick, obviously, it’s going to be a lot longer than that. And none of us know where it leaves us if we are.”
Prof Anne-Marie Brady, the head of the School of Nursing and Midwifery, wrote in an email statement to The University Times that an “intern student’s placement hours, inclusive of absences, are reviewed individually in association with the student’s respective Health Service Provider to ensure that the student meets the Nursing and Midwifery Board of Ireland’s (NMBI) Standards and Requirements for Nurse/Midwife Registration”.
“This currently requires students to achieve an internship of 36 weeks inclusive of annual leave”, she said.
At the time of publication, the Nursing and Midwifery Board of Ireland had not provided a statement in answer to questions about whether intern nurses will have to make up the hours they lose if they’re self-isolating due to the coronavirus risk. The HSE had not responded to the same questions, posed by The University Times.
There are individuals that could get really really sick if they catch this, and they have to choose that risk between graduating
While they wait for answers, intern nurses are going to work, and praying they don’t have to self-isolate. But for some, the situation is harder still.
Lisa McDonagh is an intern nurse in St James’s Hospital. She’s six weeks behind the rest of the year, having taken six weeks off in September to care for her nine-month-old son, who had heart surgery last summer.
“I have used most of my sick leave already because I am struggling to get my son minded”, she writes in an email. “If I get covid19, I have no sick leave to take. I cannot miss any more time or I have to repay it. I cannot miss more days or I risk failing the year. If suspected of covid19 I cannot wait 7-10 days for a test, I cannot take 14days off to self isolate.”
McDonagh adds: “I am putting the health and welfare of my child and my family at risk, for 10.50 an hour for an internship that has shown me no respect, no protection and no compassion.”
O’Connor says that “if you miss time, it’s terrifying. There are individuals that could get really really sick if they catch this, and they have to choose that risk between graduating”.
“It’s just not fair”, she says.
But missing time isn’t the only worry intern nurses face – there’s also the matter of their academic requirements. This week, the School of Nursing and Midwifery cancelled an assignment due in April. O’Connor says this “was a great show of support from the school, and I think everyone really really appreciates that”.
We come home, we’re exhausted, we’re emotionally and mentally drained – and we’re frightened to go back in
But nursing students are still expected to hand in a 4,500-word literature review in April. They’ve been given a two-week extension, but most say it’s not enough.
“We’re literally in the middle of a pandemic”, says Naoise Brennan, a final-year nursing student working in St James’s. “You know, we’re still working. All the other students, they have their goals from College, they’re getting their online stuff done, and we’re still like basically in a full-time job.”
“We are quite literally working on the front line, and we have to come home and write some lit review – it just seems trivial”, says O’Connor. “All of us are really struggling to pay attention to something that just seems so unimportant at a time like this, while it holds such a weight in our final degrees, and our graduation, and us actually achieving what we’ve set out to over the last four years.”
“Giving us a two-week extension on our thesis isn’t enough”, says Kass. McDonagh writes that a “small extension was given but this does not reflect the circumstances of our country at present”.
“Given the circumstances, it really would be appropriate for them to see, if at all possible, if it could be further extended to sometime in May”, says O’Connor. “If they could be more lenient, it definitely would be most appreciated by all members of the School of Nursing and Midwifery in their final year.”
For now, though, the uncertainty looks set to continue for student nurses – at a time, Kass says, when they’re facing “ferocious mental stress”.
“We come home, we’re exhausted, we’re emotionally and mentally drained – and we’re frightened to go back in, because none of us know what’s going to happen on any one day”, she says.
Kate Brennan says that “I’m a very junior nurse, and I’m being put in this situation that even the most experienced and veteran nurses are quivering at. I don’t want to come across prissy, and I don’t want to come across precious, because I know we’re all struggling. But on a very personal level, it’s the most horrific way to end your final year”.