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Nursing Education

Dáil Éireann Debate, Tuesday - 3 November 2020

Tuesday, 3 November 2020

Ceisteanna (89, 97, 117, 121)

Gino Kenny

Ceist:

89. Deputy Gino Kenny asked the Minister for Health if he will clarify the position of student nurses in the health service; if they have been offered healthcare assistants' contracts and work; if while on placement they will be offered similar payments as in March 2020; the supports that will be in place on an ongoing basis for student nurses serving in the public service given the risks of Covid-19 infection; if he will increase the current allowance of €50.79 a week; and if he will make a statement on the matter. [33542/20]

Amharc ar fhreagra

Richard Boyd Barrett

Ceist:

97. Deputy Richard Boyd Barrett asked the Minister for Health his plans to ensure student nurses are paid for the work they carried out in the fight against Covid-19; the details of the regime for the testing of these students when they are going on placements; and if he will make a statement on the matter. [33558/20]

Amharc ar fhreagra

Alan Kelly

Ceist:

117. Deputy Alan Kelly asked the Minister for Health when student nurses will be paid in full for the work they carry out; and if he will make a statement on the matter. [33476/20]

Amharc ar fhreagra

Peadar Tóibín

Ceist:

121. Deputy Peadar Tóibín asked the Minister for Health the reason student nurses have not been paid for the front-line placements in which they have taken part during the pandemic despite suggestions to the contrary. [31370/20]

Amharc ar fhreagra

Freagraí ó Béal (10 píosaí cainte)

The position of student nurses in our health service is very important. There is a lot of exploitation where student nurses work on the front line. They feel they are being exploited and are not being recognised for their work.

I propose to take Questions Nos. 89, 97, 117 and 121 together.

In my earlier response to Deputy Cullinane, I dealt with some of the issues raised by the Deputies, and I would now like to deal with the additional matters. Concerning fourth year nursing and midwifery students, the HSE continues to fund the internship employment of those students who are on rostered work placements. This includes those scheduled to commence in the coming weeks and those due to commence rostered work placements in 2021. These fourth year student nurses on rostered work placement are paid at the approved rate of €22,229 on an annualised basis for the psychiatric nursing specialism and €21,749 for all other nursing disciplines. I am open to examining what other measures can be put in place to protect and support student nurse and midwife education and welfare at the present time. My priority is to ensure that placements continue so long as it is safe to do so. In that regard, my Department is engaging with the HSE and the higher education bodies on an ongoing basis. Separately, and for the longer term, my Department is reviewing the accommodation and travel allowances for students on clinical placements that should apply from the academic year commencing in autumn 2021. This review is expected to conclude at the end of this month, and I look forward to examining the outcome of this review in due course. Regarding the testing of students when they are assigned to a placement, the testing regime follows the national system that the HSE has in place.

Two weeks ago, representatives from the Irish Nurses and Midwives Organisation, INMO, were before the Joint Committee on Health. The INMO's submission was extraordinary. It said that 3,400 students are on placements in Irish hospitals. Covid means they are in a vulnerable position. The failure by the HSE "to remunerate them amounts to exploitation". That is awful. The statement also notes that 50 nurses are infected by Covid each week. Student nurses feel very let down, unrecognised for their work but also financially. The Minister has to address that.

To follow up on that, the Minister said earlier on this that it was education not work so we should not pay them. We should be clear that this departs from what the Government was forced to do in March and April when it had to acknowledge they were actually working and pay them at the healthcare assistant level.

The idea that the student nurses who are on placement at this time are not working is a nonsense, when there are 500 to 600 healthcare workers out for more than 14 weeks with long-tail Covid, of whom the biggest cohort comprises nurses and midwives. Nurses and HCAs make up the largest cohort of workers being hit with Covid infection and they are working in a highly dangerous environment from an infection point of view. There is no question that the student nurses are working. In fact, they are being exploited and our hospitals would not be operating without them. The idea that they are exclusively on some sort of educational placement is not accurate. Their placements are part of their education but they are working. Indeed, they are being exploited because they are not being paid as they were earlier this year.

I endorse everything my colleagues have said on this matter. I have one additional point to make. Unless there is some capacity to distinguish between the risk of getting Covid for a nurse who is working full time and a nurse who is a fourth-year student, then this is an utterly disgraceful action and the Minister is putting students at risk as they strive to complete their education. The Minister cannot distinguish what he is doing now from what was done earlier this year. This is blatant exploitation and it is completely and utterly wrong. The Minister is underestimating this as an issue and he needs to do the right thing. These are front-line workers who are saving lives and putting themselves at risk the same as every other front-line worker. They deserve to be treated appropriately.

I thank the Deputies for their contributions. To pick up on the wider point, Deputy Boyd Barrett is absolutely right that nurses, midwives and HCAs throughout the system are doing extraordinary work. We often, rightly, talk about the amazing work teachers have done to make our schools safe places for children to be. There is not enough talk about the equivalent work nurses and midwives are doing to make hospitals safe places for patients. The Deputy is right that there have been a lot of Covid cases among healthcare professionals right across the board. I agree that nurses make up the biggest group of those who have been infected. That needs to be recognised.

Where I have a different view is in emphasising that for student nurses in the first, second and third year of their training who go out on placements, those placements are educational and make up part of their degree. This aspect of training was one of the components of moving the nursing qualification to a professional degree and it is a critical part of their education. I have a concern I wish to articulate in this regard but my time is up. I will return to it in my final reply.

The world we used to live in prior to Covid-19 seems like a very different world from the one we are living in now. In former times, many student nurses could take up other jobs in nursing homes and so on, but they can no longer do so for all sorts of reasons. Financially, this has left them out of pocket. Living on an allowance of €50 a week, with the responsibility that is entailed in their roles, is having a hugely detrimental effect on their well-being. Nursing is a very hard job and the people working in the profession are extremely dedicated. However, some are fearful of the nature of the business they are in. It is very important that the Minister for Health should recognise the contribution of student nurses, whether in first, second or third year. Of course their placements are part of their education. I know that because I used to work alongside them. However, it is really important that they are recognised, financially as well as educationally, particularly in the context of the Covid-19 crisis.

I raised this issue with the Taoiseach on 20 October. It might be of interest to the Minister to know that the video of that engagement has been watched 250,000 times, which is very rare for any video of proceedings in this House in which I am involved. That was the scale of the response from student nurses. In that engagement, the Taoiseach said the following:

...I will engage with the HSE and the Minister for Health on student nurses working on the wards in the current context. As they were earlier, they should be paid in accordance with the agreement arrived at earlier in the year. I will follow up on that.

When we put the points to him regarding the situation of the student nurses, he agreed that they should be paid at the previous rate. For the reasons Deputy Gino Kenny outlined, they cannot get other jobs. There is no question that they are working, in a context where they are replacing the hundreds of nurses who are down with Covid. That is why they are working. The Minister can call what they are doing an educational placement - it is, in a certain sense, education - but he cannot deny that they are also working. They cannot engage in any other work and they must be paid, not exploited, for the work they are doing.

There is a real issue for the Minister to deal with in this regard. Many of us have had student nurses and their parents contact us to tell their stories. Their health is at risk when colleagues go out sick with Covid and they have been thrown in at the deep end, being told to go into situations they did not expect to go into, sometimes with only a day's notice and certainly no more than a week's notice. The Minister needs to put them back on the HCA rate. It is completely and utterly unfair not to do so. I have spoken to two student nurses who are finishing their training and who told me, quite bluntly, that they intend to leave this jurisdiction because of the way they are being treated. They do not have any other means of getting an income and they have loans and other borrowings. Like many others did in the past, they are making the decision to leave. This is happening because the Minister is not making the right decisions. We know that the competition for staff nurses is extreme throughout the world. The last thing we should be doing is creating circumstances that lead to our student nurses deciding to leave the country when they graduate.

I assure the Deputies that I hear what they are saying. We all recognise the work of our qualified nursing and midwifery professionals throughout the country, in community healthcare and in the hospital system. Do students nurses make a valuable contribution while they are on their educational placements? Damn right they do and they work extremely hard. Those students are part of a clinical group whose members are funded for their educational placements. Are we looking at increasing that funding in a time of Covid? We absolutely are and we are engaged in doing that. However, I have a genuine concern that if we were to replicate what happened in the first wave, it could come at a risk to the educational element of those placements for nursing students in their first, second and third years of training. The placements are, first and foremost, part of their degree. Can we and must we do more for them? Absolutely. At the same time, we must protect their education. We are engaged in ensuring that we do both those things at the same time.

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