The clapping was lovely but an improvement in working conditions would be better.

Carrie Etchells, a 20-year old student nurse at City University, was relaxing in the spring sunshine when she received a call from an NHS Trust. They had finally managed to arrange her COVID-19 placement. “I was literally sat in a park sort of enjoying the sun and got a phone call, can you come in tomorrow? And I had to rush home and get ready!”

While confusion and uncertainty have been defining features of the pandemic for just about everybody, such experiences have been particularly acute for student nurses such as Carrie.

When the government realised that the NHS did not have enough staff to cope with the number of COVID-19 patients, they turned to student nurses for help. Instead of being allocated to their usual educational placements, student nurses were asked to ‘opt in’ to COVID-19 placements, for the course of which they would be contracted as NHS staff. Unlike ordinary educational placements, these would be paid.

But part-way through their placements, stories emerged that some NHS Trusts were terminating contracts early as the services of student nurses were no longer needed – effectively sacking them once they had served their purpose.

Communications around this were, to say the least, hazy. Health Education England eventually clarified that all student nurses would be fully paid until the ends of their contracts, but the uncertainty had already led, in the words of Royal College of Nursing student committee chair Jess Sainsbury, to “confusion and distress”.

This is far from the only injury which the students have been left to nurse. A series of communication blunders, inept interventions and callous decisions by the government have left this vital group of key workers feeling alienated and exploited. 

’Not providing a service’

Arguably mid-June marked the point in which relations between student nurses and the government disintegrated. In response to a letter from the student nurse Jessica Collins calling for more financial support for student nurses, the Minister for Care, Helen Whateley, declared that student nurses weren’t ordinarily paid because they were “not deemed to be providing a service.”

The statement was seen as betraying a deep ignorance about the degree to which student nurses make a vital contribution to the functioning of the NHS. “A lot of us were really angry with the statement,” says Carrie. “I felt quite hurt by that really, especially because it was when I was in placement, working really hard, and just for someone to sort of say ‘they’re not providing a service’, it was just a bit of a kick in the teeth.”

For Laura Hother, a 21 year old student nurse at the University of Liverpool who is involved in the NHS Workers Say No grassroots campaign, the effect was more than minor irritation. “It might sound dramatic, but I went to placement the next day, and I felt like absolute rubbish … I felt so demotivated and devalued, because I thought how dare you? Half the time we’re doing three people’s jobs because there’s not safe staffing on the wards.” 

Solidarity develops

However for some student nurses, the minister’s blundering intervention had an unexpectedly positive side-effect: the anger it generated tied qualified nurses and student nurses more closely together, strengthening the bonds of solidarity that had developed in the course of the pandemic.

“That statement came out, and at that point I was feeling very tired from placement, feeling a bit run down, and I thought gosh, why am I even bothering with this?” remembers Carrie. “But then I went into placement and the staff on the ward who had seen this as well were angry like me … and actually they made it very clear that they really value students.”

Helen Whateley’s statement wasn’t the only government intervention which helped to unite the workforce in a shared sense of injustice. The announcement on 21st July that the nurses the government had been so eager to portray as ‘heroes’ wouldn’t be receiving an early pay rise also stimulated a form of defensive solidarity that transcended any differences between qualified and student nurses.

“With the announcement that doctors and teachers and policemen were getting a pay rise, but nurses weren’t included in that, I think even us as student nurses, we felt very aggrieved,” says Carrie. “Nurses that I’ve worked with … were working way beyond their job and way beyond the scope of their training, and they just haven’t really been acknowledged for that.” This comes in the context of calculations by the Royal College of Nursing (RCN) that the average inflation-adjusted salary for a nurse has dropped by 8% since the Conservatives entered government in 2010. 

Laura recalls the aftermath of the announcement: dripping with sweat from her PPE, dehydrated, struggling with a migraine, her face sore from her protective visor: the foam had been cut out as it was deemed an infection risk. “A lot of us had – and we laugh about it now – grade 2 pressure sores on your head, and you had ‘Made in Thailand’ engraved on your forehead … It was horrible. To think we’ve gone through all that, and literally bruised and marked ourselves, and they said you don’t even deserve any kind of pay rise. It was just ridiculous.”

Tensions between qualified nurses and students has long been an area of concern for the profession – but repeated government blunders throughout the pandemic, as well as the bonds forged by working together on the front line, may have inadvertently helped to overcome it. “As a student nurse or a nurse, you feel like you’re connected on that, you have that same profession, and so when student nurses or nurses are being treated poorly, everyone feels it,” says Carrie. 

Empty rhetoric

Earlier on in the pandemic, camaraderie also appeared to be growing between the medical workforce and the general public – as was symbolically captured in the weekly Clap for Carers events.

The student nurses were initially touched by the public displays of support. “To start with, it was really lovely,” says Oliver Dilley, a 20 year old student nurse at City University. However they now feel disappointed by how the enthusiasm faded over time, by uncertainty over whether it has translated into any significant long-term change in the way the public view nurses and other care workers, and above all by the complete failure to back up the gesture with any tangible improvements in healthcare workers’ pay, working conditions, or treatment.

As such, a gesture which once felt filled with promise is now remembered as being as empty PPE stockrooms were in April. “It just felt a bit like, we’re clapping, but what are we doing about it, like is there going to be any change in the future? How long is this going to last? And clearly it hasn’t lasted,” says Oliver.

Carrie is worried about how the spectacle – and the expectations and idealisations attached to it – have been capitalised on. “Seeing the public’s appreciation of nurses has been really lovely … but I think what has bothered me is the way the government have been … really pushing the fact that healthcare professionals are heroes.”

She suspects that when government figures speak of NHS workers as ‘heroes’, the words aren’t simply hollow, but something more malign: a way of justifying their own mismanagement, and of laying the ground for further exploitation. “It’s almost … ‘oh, they are heroes, so it’s okay so that some nurses are actually dying on the front line, it’s okay that some nurses are working way beyond their training and their scope, because they’re heroes and they’re amazing.’” Laura views the rhetoric through the same jaded eyes. “They do that because, what does a hero do? They work for no reward.”

Taking a stand

Given the experiences of Carrie, Laura, Oliver and thousands of others, one would be forgiven for forgetting that 2020 is the ‘Year of the Nurse and Midwife’. And the travails of student nurses during the pandemic can be seen as part of a longer trajectory of neglect and mistreatment by successive governments, the culmination of years in which they’ve repeatedly been used and cast aside. “

The kind of people that are doing this now have had the bursary cut, now employed during a pandemic … and have had all of university to deal with as well. It just kind of feels like all the bad stuff has happened to us,” says Oliver.

Yet despite all the frustrations with the way student nurses have been treated, their abiding memories of the experience are positive ones, rooted in the solidarity that the entire medical workforce has developed with one another over the course of pandemic.

For Laura, the struggles student nurses have gone through have emboldened them in their demands for fair treatment. “It’s brought people together and actually made a lot of people decide to be active within their roles and their workplaces and fight for their rights a bit more, and be like, hang on, I’ve done all this, I deserve better. I think it’s made a lot of people realise their worth – it took a lot! – I think it’s added fuel to the fire.” 

The student nurses have since returned to unpaid placements. But with a second wave of COVID-19 currently intensifying, they could soon be called on again. Given the essential, ongoing role that student nurses play in keeping the NHS functioning, it may have been advisable – from a pragmatic standpoint, let alone a moral one – to have kept them on side. The government’s failure to do so hasn’t come as a shock to Laura, but her patience has finally run out. “They’re always promising, I’m not surprised that they’ve let us down again. But we’re saying ‘no’.”  

Sam Stroud is a Welsh social researcher and member of Hackney South & Shoreditch CLP. He would like to thank student nurse Maya Holroyd for being interviewed for the article.

Comments are closed.