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Jackson et al. (2020) have recently described the extraordinary times we face as a result of the COVID-19 pandemic. As we write, the number of cases and the associated mortality continues to rise. In the United Kingdom (UK), a number of “Nightingale Hospitals” have been constructed within large arenas. Clinical staff who have recently left National Health Service (NHS) are being asked to return to practice to support the rapidly escalating numbers of patients, and nursing students from year two of their degree programme onwards are being asked to opt-in to an extended placement working to further bolster the numbers of care staff available. This editorial has been written by academics and nursing students from a University in a large city the centre of England, and a senior member of the executive nursing team at a large NHS Trust. At the time of writing (April 2020), the COVID-19 pandemic is thought to be reaching a peak in the UK and unprecedented requests are being made of our student nurses. Nursing students have been largely unheard in the discussion around COVID-19, and we wanted to create a space for students to speak and be heard; therefore, the co-authored content contains some direct quotes from the students. The nursing students are following a 3-year programme that will culminate in the award of a bachelor's degree and registration with the UK Nursing and Midwifery Council (NMC), conferring the right to practice as a registered adult, children's or mental health nurse. The NMC requires that nursing students undertake a minimum of 2,300 hr of theory and 2,300 hr of direct patient contact. Students are not paid for these compulsory hours of clinical practice. While in the clinical environment, student nurses are closely supervised by registered nurses and must demonstrate appropriate knowledge, skills and attitudes. Students must pass all clinical placements and theoretical assignments to complete their degree. In the UK, the past 2 weeks have seen a surge of support from the general public for healthcare professionals in the “front line” who are caring for patients and putting themselves and their families at risk during the COVID-19 pandemic. University campuses across the UK have closed their sites and moved their teaching and assessment online to help slow down the rate of infection. The most junior nursing students have had their clinical placements postponed due to an imminent shortage of supervisory staff and rapid changes within the clinical environment. Student nurses in years two and three of their programmes have been asked by Health Education England (HEE) to sign up to undertake extended placements. HEE is a public body charged with overseeing the training of the health service workforce of the future. The students who take up the opportunity to undertake an extended placement will be remunerated in line with the salaries of nursing care assistants. Students will be deployed to health and social care organisations (Health Education England, 2020). The term “deployment” has been carefully chosen to describe the hybrid status of both a student and an employee. As such, both the NHS organisation and the Higher Education Institution (HEI) share a duty of care to students. Students who do not wish to undertake these extended placements will follow a “theory-only” route for the foreseeable future, deferring their clinical placements. This will mean that they must “catch-up” on required practice hours later, likely to lead to an increased pressure on the students and on the clinical areas, which have been struggling to build capacity for student learning for some time (Taylor, Angel, Nyanga, I worked hard to get the grades I got and I decided that I can always catch up clinical hours later and it would make me feel better if I could do my best on my dissertation and assignments I’m scared to do an extended placement because it might mean being isolated from my boyfriend and friends who are my biggest support network. Working should be balanced with fun & support. Without that balance I am worried about feeling depressed. This pandemic offers some students rewards and comes with risks and costs. There is a risk that the decision to go onto an extended placement is the wrong one for some. Their perception that offering to help is the right thing to do, the sense of failure caused by being unable to do that, and the costs financially and for their future learning demonstrates the complexity of the factors that they are currently balancing. It is vital that whatever decision these students make, either to go into practice, or to follow the theory-only route, that they are fully supported in their decision, and not judged. There is evidence through social media that students who have chosen to take the theory-only route are perceived to lack the courage required to be a nurse. 2020 is Florence Nightingale’s bicentennial year, designated the Year of the Nurse and Midwife by the World Health Organization. How apposite in the past few months. This pandemic has reflected the sheer determination, bravery and compassion of nurses across the country. From a student nurse’s perspective this has been inspirational. I have never been prouder of the profession that I have chosen to pursue, and I am proud that I will be part of the NHS. We must ensure that students are making a free choice. The student co-authors of this editorial have shared how they are weighing up a multitude of factors that will influence their decision-making. Individual students will be weighing many dissonant factors including their desire to help, their need to earn, their health, the health of their families, the fear of lighter-touch supervision, anxiety about the quality of the learning experience and a desire to complete their programme on time in the least stressful way possible. Regardless of the decision each individual student makes, health organisations and educational providers have a duty of care to ensure the physical and psychological safety of nursing students who are stepping up to the fight against this pandemic. At the time of writing, many students have decided to opt-in to the extended placement, and health and education organisations are creating networks of support for them in what we know will be a challenging time.
Swift et al. (Thu,) studied this question.