Shortly after 3.30pm on September 2nd, Taoiseach Micheál Martin sent an email to Minister for Health Stephen Donnelly.
He was following up on correspondence received from a student nurse who expressed concern about unpaid placements in hospitals during the Covid-19 pandemic. Martin wanted Donnelly to have the student’s points examined and to let him know what he found out.
That student nurse, like many others, had previously had a part-time job as a healthcare assistant, in this case in a hospice. However, given the potential danger of cross-infection between placement in the hospital and a role in the hospice, this arrangement could not continue.
The student told Martin that on making enquiries to “social welfare offices/citizens’ information” on the situation, it was suggested “that maybe I could take out a low-credit loan for the weeks I am on placement”.
“If there are no paid placements or financial supports available to student nurses this year, particularly because we are being expected to work on the frontline during a pandemic, I have pondered deferring my nursing career as financially I simply would not be able to put myself through a year of college and placement without a wage coming in,” the student said.
Ministers' offices receive representations on a very regular basis, and the Department of Health was at the forefront in dealing with the Covid-19 crisis.
However, the correspondence shows that while the whole row over student nurse placements and payments did not really ignite until weeks later, the issue had reached the top level of Government by September.
At the heart of this controversy are two separate but linked issues: the payment from the State during their hospital placements, and what student nurses are being asked to do while they are there.
Ironically, it was the Taoiseach who was centrally involved in establishing the university-based training system for nurses when he was minister for health 20 years ago. Up to that point an apprenticeship-style system was in place under which nurses were paid while they trained in hospitals.
Divide
Nursing students now divide their time between universities and hospitals. In the first three years they complete placements ranging from around nine to 12 weeks. Students in fourth year do a 36-week paid internship. They receive the equivalent of an annual rate of €22,229 in the psychiatric service and €21,749 in other nursing disciplines. Those in other years receive supports including an accommodation allowance of up to €50.79 per week, if they are away from home, as well as a refund of their travel expenses.
In April and May, 17 student nurses contracted Covid-19, a figure that would rise to 31 by November
However, unions maintain that the payment of these allowances is not uniform. Many student nurses supplemented these payments by working shifts, for example, in nursing homes. However, the dangers posed by Covid-19 effectively meant these arrangements had to stop.
Donnelly's predecessor in health, Simon Harris, last spring moved to strengthen the workforce by offering student nurses and midwives paid roles as healthcare assistants. For fourth-year students this effectively meant a pay rise as the healthcare assistant rate was higher than what they received for internships.
About 1,350 students in first to third year took on the paid roles, with the initiative costing €41 million.
In April and May, 17 student nurses contracted Covid-19, a figure that would rise to 31 by November.
However, by the late summer academic nursing courses were re-commencing and Harris’s initiative came to an end. It was at that point that many students realised they would be left without their part-time shifts in nursing homes while they would no longer receive the healthcare assistant pay. This was the backdrop to the letter sent by the student nurse to the Taoiseach on August 24th.
In mid-October, the Irish Nurses and Midwives Organisation (INMO) went public after unsuccessful behind-the-scenes talks with the Department of Health.
“Student nurses and midwives are being exploited during Covid,” the union claimed, adding that those on placement were being effectively asked to work as staff for no pay.
Revision
The department said on October 16th that it supported a revision of allowances paid to student nurses, “and expects to conclude this revision in the coming days”.
The INMO briefed Opposition parties about the student nurses; however, it says it was not involved in devising or co-ordinating their political strategy. Its campaign purposely featured student nurses telling their stories, while others separately used social media to highlight their experiences.
For the Opposition, the narrative of student nurses working for free in hospitals during a pandemic presented a golden opportunity to criticise the Government. Just as in the case of the Debenhams workers, who were fighting to secure the implementation of a better redundancy package that they had agreed with the retailer a number of years before it went out of business, the nurses' issue started with the trade unions but quickly became a political campaign.
First-year students are not meant to be treating Covid patients, and they are not meant to be treating patients full stop
Donnelly arranged for student nurses who lost their part-time jobs to avail of the pandemic unemployment payment (PUP). However, the story had moved on to what the students said they were being asked to do in hospitals.
Sinn Féin leader Mary Lou McDonald, Rise TD Paul Murphy and Richard Boyd Barrett of People Before Profit read testimonies of student nurses in the Dáil.
“We start our shifts at 7:30 am. By 8am, we are rushing around carrying out observations, helping patients with toileting and washes. This will bring us up to 10:30/11. Twelve o’clock comes and we do medications, blood sugars, feeds and toileting. After lunch we try and get some documentation done, call doctors, check blood results and other tasks. Teatime comes and we are back assisting with feeds, toileting and medication,” explained one.
‘Passed away’
Another said: “I have dressed and laid out babies who have passed away to be shown to their parents for the first time. I have cried with women who have been told that their baby has died while they are alone in hospitals with the current restrictions.”
Martin maintained strongly that no form of exploitation would be tolerated.
“First-year students are not meant to be treating Covid patients, and they are not meant to be treating patients full stop. Their education in clinical placements should be protected. If it is not protected, it is unacceptable.”
He said student nurses who were rostered for work should be paid and the personal experiences raised in the Dáil should be sent to the HSE and department for investigation.
The HSE said that at management level no complaints had been received. It is understood that the Minister wants a report to be drawn up into the claims by student nurses, but it is unclear if this will be carried out by the HSE or an outside reviewer.
An initial review of allowances paid to student nurses is to be completed by the end of December. A second examination of longer-term issues beyond the pandemic will commence early in the new year.
