Student nurses at breaking point with unpaid placements

Just weeks out from finishing their degrees, nursing students say they are at breaking point.

Third year AUT students say they are under immense stress juggling 40-hour-a-week unpaid clinical placements alongside full-time study with no payment or compensation for expenses like petrol or hospital parking.

It comes as the nation faces a desperate shortage of health professionals and the government embarks on a raft of measures to bring more nurses and doctors into the country.

"My honest advice to anyone that was going to embark on a nursing degree would be: F*** no, stay away from it - don't even consider it," one said.

Although the finish line was in sight, Zoe* and other third-year nursing students have nothing left in the tank.

"We are students who should be excited about this new chapter of our lives and embarking on making change and helping people, which is the primary reason you get into this job, and we've got nothing left to give."

AUT's nursing degree covered everything from human anatomy to mental health science.

But Zoe said the university taught much of the content through 'self-directed learning' - which often meant watching a YouTube video, a previous year's lecture recording, or flipping through a textbook.

It made her feel unprepared for her clinical placements, which made up a crucial part of the degree, she said.

"When you walk into a placement where you've kind of taught yourself to the best of your ability how to do certain things, it's a: Embarrassing, and b: Completely unsafe practice."

And when she reached out to AUT for support, she found none.

"We've been told to basically get on with it, and that's AUT's ethos the entire time: If you haven't got the resilience or you haven't got the ability, or if it's too much for you, then this is the wrong industry - you shouldn't be doing it, and if you can't handle it now, you're never going to be able to handle it when you get into the real world."

Fellow AUT student Charlie* said the university assigned students to clinical placements with no input from the students themselves.

This meant a student living in Albany could find themselves on placement in Manurewa while those from Waitākere ended up in Howick.

Adding to the extra travel time was the stress of only finding out where the university was placing them, or what type of ward or clinic they were in, at the very last minute.

Meanwhile, university assignments and examinations did not stop during placements, and the pressure could mount quickly.

"I know a lot of students who have broken down because of the stress.

"The whole degree has a huge drop-out rate - I look at the class sizes now, and they've dwindled down to so little students compared to where we started."

Last year, almost half of the students in AUT's 2019 intake had not graduated.

Of the 497 students who started in 2019, just 250 graduated in 2021.

In 2020, about a third of the 288 students in the cohort did not complete the degree.

And in 2019, just 160 of the 300 students who began in 2017 finished their studies.

Unpaid placements cause financial stress

The Nursing Council required students to complete a minimum of 1100 clinical hours across the three-year degree - or about 10 full weeks of work each year.

But the placements are unpaid - in fact, students pay to complete them as part of their more than $8000/year university fees.

Financial support to cover the cost of uniforms, food, petrol, and hospital parking is hard to come by.

With an expected salary of about $60,000 a year once she was registered, AUT student Hannah* said she was not naïve about the prospects of working as a nurse in New Zealand.

But she said it had not helped that any concerns she took to the university - financial or otherwise - were met with deaf ears.

"It's been really, really rough.

"There is no empathy or support across the board from the school."

When some students pushed AUT for more assistance, they said the university told them it would investigate their suitability for the profession.

"It's crazy, because it's ingrained in us from the beginning of this degree how important a holistic approach to health is - you've got to look after yourself before you can look after others.

"Why is that only applied to the people we're looking after? Don't we have to be healthy too?"

New Zealand Nurses Organisation [NZNO] student unit chairperson Rebecca Dunn said a response like this was unacceptable from a university that was supposed to be preparing for a much-needed intake of new nurses.

"Every school needs to have mental health support available to their students.

"They need to have their students adequately prepared for the things that they're going to see when they go out into placement because a lot of it can be quite traumatic for people."

NZNO was pushing the government to support students with their placement costs, Dunn said.

The Nursing Council set the education standards for registered nurse programmes, including the requirement of clinical placement hours.

However, it said the support offered to students varied between education providers, as did the overall workload imposed on them.

AUT responds

In a statement, AUT said it took the mental health of its students seriously.

"We have a duty of care to students, but mental health and wellbeing issues do not preclude students from eligibility to register as a nurse."

The university said it advised students of their placement allocations by email and attempted to send students their allocations well before the start dates.

"Students are advised from the outset of the degree that placements are unlikely to be located in their neighbourhood, and as such, travel to placement is an expectation that is made very clear to students across the degree."

AUT said allocating placements was a complex process, especially given the number of nursing programmes across New Zealand - all of which needed to provide placements for their students.

"Final-year placement allocation includes some consideration of student location and preferences, and where possible these are included in allocations.

"Unfortunately, however, last-minute changes and disappointed students are unavoidable."

AUT said the nursing degree was intended for full time students.

The university said that where possible, it planned assessments to ensure enough time for student learning, with assessment dates carefully managed to accommodate students' need to complete clinical placements.

However, it said one challenge this year was the number of students working full or part time jobs and expecting to fit full-time study around their other commitments.

*Names in this story have been changed.