“Last week I had to choose between petrol or groceries for my family. I don’t think anyone thinks that they are signing up for that when they apply for a nursing degree”. This is the reality of a second year nursing student attending a university in the South of England. When she asked a tutor at her University for advice on how to address her financial issues they suggested using a food bank.
She went on to tell us the impact the overwhelming schedule of a student nurse is having on her mental health, “I’m currently waking up and having a little cry before getting my children up, I arrive home [after placement], clean, cook and have another cry before bed”.
Other nursing students across the country told us of similar mental health issues. One first year said “My mental health has really taken a drop. I just don’t feel supported at all. The amount of people on the course I know who have mental health issues and have struggled is insane. Just an insane amount.”
In 2019, The Mancunion published an investigation regarding the lives of student nurses at the University of Manchester. Three long, pandemic plagued years later, we asked a number of current students for their experiences of nursing at UoM. We also spoke to a number of nurses from universities across the country who described a frightening picture.
One of the most challenging aspects of a Nursing degree is attempting to strike the right balance of study, placement, part-time work, and maintaining a social life. The most contentious aspect of the course for the majority of students we spoke to is the clinical placements.
Clinical placements are crucial for student nurses to improve their clinical skills and expand their knowledge in a practical healthcare setting. Each placement can be anywhere from 4 -12 weeks in length and located in a hospital or community setting across the whole of Greater Manchester.
A first year University of Manchester student nurse, who preferred not to be named, said, “You’re expected to either be in Uni or placement for five days a week and then you need to work on the weekend to pay the bills. You’re burnt out before you even qualify”.
This busy schedule often leaves this student nurse with very little time for anything else, “I work two 12 hour shifts on the weekend alongside my placement in the week, I have no time for a social life”.
2300* hours of unpaid clinical placements must be completed over the course of a three year Nursing degree. A typical “working” week for a student nurse is around 37.5 hours. This necessitates four or five 8+ hour days a week. Shifts can vary in length depending on the placement but can start as early as 7am and finish as late as 9:30pm. Student nurses can also be expected to work weekends and nights.
When asked for comment a University of Manchester spokesperson said: “The number of hours spent on theory and practice are set by our regulator, the Nursing and Midwifery Council.”
Burnout within the NHS is a major concern currently, in 2020 an NHS staff survey showed that 44% of staff reported feeling unwell as a result of work related stress.
Increased pressure from successive waves of Covid have also resulted in an increase in resignations across the NHS. Comparatively very little research has been conducted to gauge the effect staff shortages, the pandemic, and burnout is having on student nurses and doctors.
Financial concerns also add to the worries of student nurses. A first year nursing student at UoM was particularly worried about managing their finances. “I’m lucky that I live with my partner as without him I wouldn’t be able to afford to do the course”.
Another student agreed and said, “The financial side of being a student nurse is awful. Working 37.5 hours a week on placement (which you have to fund [travel] there and back) whilst on your maintenance loan.”
Student nurses are provided with an NHS Bursary in a bid to alleviate financial difficulties, but with the current cost of living crisis this often doesn’t go far enough. Two University of Manchester students said, “The [NHS] Bursary helps but it’s not enough. £5,000 over a year isn’t a lot when you think about it.”. Another agreed: “The Bursary of £5000 doesn’t even touch the edges”.
The NHS Bursary was re-introduced in September 2020 in an attempt to attract more “homegrown” nurses and hopefully alleviate the staffing crisis facing the NHS. Students are paid in 3 instalments equating to £5,000 over the course of the year.
In its previous iteration, before it was axed in 2015 by then Chancellor George Osborne, it was worth up to £16,454 a year (means tested) with a minimum of £10,000 for all students. The £10,000 would be used to cover tuition fees and student nurses would only need to take out a maintenance loan to help with living costs.
Technically student nurses now “see” more of the money from the bursary but are burdened with far more debt from student loans.
In response to our previous investigation in 2019, UoM suggested that nursing students experiencing financial difficulties can apply for additional funding through ‘The Manchester Bursary’. However, this avenue is no longer available to nursing students as an exclusion has been placed on access to the bursary.
The financial support page on the University’s website includes a caveat, saying: “Students won’t be eligible to receive the Manchester Bursary in any given academic year in which they’re entitled to NHS support, with the exception of Medicine and Dentistry students who receive a lower level of funding when they become eligible for NHS support beyond Year 4 of their academic programme”.
A University of Manchester spokesman explained that due to the funding provided by the learning support fund, student nurses exceed the threshold for the Manchester Bursary but said: ”The University has invested in one of the most generous support packages in the UK for students in financial hardship; approximately a third of all our undergraduate UK students will receive bursaries of up to £2,000 per year. This includes the University’s Living Cost Support Fund and more information is available here”.
This increased tension around finances has led many of the student nurses we spoke to question why they are not paid for placement hours. One student nurse said, “Where else in life are you expected to work so many hours for free? Even apprentices get something”.
Another UoM first year nursing student agreed with this sentiment, saying, “I think student nurses should get paid even a small amount on placement … I understand that we are learning, however I’ve been doing loads on placement just like the nurses do”.
A University of Manchester spokesperson said: “Student nurses were paid when they were deployed in the NHS at the peak of the pandemic. However, they are normally in an unpaid supernumerary role and do not replace paid staff. The aim of this part of their course is to learn the practical components of nursing.”
Financial worries, hectic unpaid placement hours, traumatic experiences whilst on placement and managing a myriad of other day-to-day problems can leave student nurses feeling overwhelmed and suffering from mental health issues.
In our 2019 investigation, UoM stated that there is a “very robust student support mechanism which does signpost students to a range of sources of support”.
A current student nurse suggested they weren’t told about these robust systems, “I’m not aware of a mental health support system, I don’t know anything about it. The University doesn’t prepare you for the difficult parts of the job like death and other traumatic experiences”.
A University of Manchester spokesperson said: “The University provides a comprehensive range of resources and support for students in relation to their mental health. All information about what’s available can be found here. The support includes a free and confidential Counselling and Mental Health Service that provides both psychological interventions and mental health assessments. In addition there is a 24/7 mental health support phone line that allows students to access support outside of core hours.”
The pandemic has affected all courses at the University of Manchester over the past two years and has resulted in the majority of course content being delivered online.
The 2021/22 academic year has been far more promising and seen an increase in lectures and seminars returning to in-person teaching, this however, has not been the case for nursing students. The majority of the first year student nurses we spoke to have been incredibly underwhelmed with their learning experience at the University of Manchester.
One student nurse, who preferred not to be named, expressed their frustration at the majority of their course being delivered online. “I feel as though we can’t get to know our peers because nothing is in person. It’s very divided and at the start of the year I got really lonely and I felt as though we should be having lectures in person for many reasons.”
They then went on to comment, “I feel more motivated in person and learn better rather than staying in all day and staring into a computer screen. It’s difficult for me to learn like that”.
The grievances of this student also extended to the perceived lack of organisation and last minute decisions by teaching staff, telling The Mancunion: “I don’t feel as though things are explained well at all and they don’t give much notice as to when holidays are [or] if lectures are in person or not so it’s difficult planning things in your personal life around university”.
This was echoed by another student nurse who was also bemused by the lack of in-person teaching. “There was a week scheduled for Practice on Campus clinical skills. It was moved online. How are you supposed to practice clinical skills online?”.
Their frustration was also made worse by the perceived lack of thought put into some of the online content, “Most of the online sessions were pre-recorded from 2019 and a few times sessions were just links to YouTube videos. It felt as if I was learning nursing from YouTube. It just seems half arsed”. This student began to question whether or not they had made the right choice of university, commenting “I may as well have gone to the Open University”.
A University of Manchester spokesperson said: “It is difficult to comment as we have not been given specific examples from the five students who were interviewed for this article. However it is important to stress we were not using videos as teaching aids in 2019, so we reject the suggestion that our staff are using pre-recorded videos from that time. It is also important to add that all the units in our curriculum are updated every year. Many of our students tell us they prefer a blended approach to teaching and learning which encompasses face to face as well as online teaching”.
Support from staff was also difficult to acquire, “Tutors would often say things like if you’ve got any issues I only work Monday and Tuesday so you can only email me on those days, so it felt like you can’t reach out for help or ask questions because you feel as though you’re inconveniencing them and you won’t get anything back for at least a week”.
In response a University of Manchester spokesperson said: “It’s difficult to comment without having specific examples from the five students who were interviewed for this article. However we are proud of the dedication and professionalism of our staff, who signpost students to alternative modes of support if they are not in work.”
The frustration felt by most student nurses is also exacerbated by the fact that last semester student nurses attending other universities in Manchester are thought to have had the majority of their lectures in person.
One Student nurse told us: “We seem to be the only Manchester university that has a pathetic rate of in person attendance. And some other subjects within our university seem to be able to go in for lectures and seminars so why not us?”.
This was corroborated by another University of Manchester student who was told on placement by a fellow student nurse that students at neighbouring Manchester Metropolitan University (MMU) had been in person for the majority of their lectures and seminars.
For most students, their years in university are life affirming experiences that are treasured for a lifetime. But for these student nurses, their three years have been filled with hundreds of unpaid placement hours, a lack of support from university, financial hardship and life altering mental health problems.
*This article was corrected on April 5th 2022 to state that student nurses undergo 2300 hours of unpaid clinical placement, not 2400 as was originally written.