Health 23 February 2021 The shadow NHS: Student nurses left in limbo one year on from being drafted into hospitals After opting to join the front line pandemic response, student nurses now face intense workloads, financial strain and an uncertain future. Getty An NHS nurse enters the "red zone" of a hospital treating Covid-19 patients. Sign UpGet the New Statesman\'s Morning Call email. Sign-up Milly was never sure why she wanted to become a nurse, nor did she really know what to expect when she began her nursing university course in 2019. What the 30-year-old student certainly did not anticipate was that she and 25,000 other nursing and midwifery students across the UK would soon be drafted to join the Covid-19 front line. The sudden rush for student nurses to opt in was difficult for Milly and for her peers to process. “There were quite a few of us who weren’t really sure what we were going to do,” she reflects. Student nurses across the UK have had a year like no other. In March last year, as the virus spread through Britain, student nurses who were in their second and third years of study were told they could opt to drop their academic commitments and pre-planned placements to help the NHS in its pandemic response. It was a tough choice for thousands of trainee nurses across Britain, not least for Milly, who – on top of being apprehensive about her finances and safety – had learned that one of her lecturers had died from coronavirus, and had a young family to consider. “There were a lot of people feeling the same and there still are a lot of people feeling the same – it’s really hard to justify what you’re doing when it puts your family in danger,” she tells me. “When they called us up, quite a few of us weren’t sure what to do” Milly prematurely parked her studies last April during her second year and was catapulted into a 14-week placement on a cardiac ward in a major Welsh hospital in order to free up staff for the Covid-19 wards. The physical and mental impact of working through a pandemic has been tough. “It’s just sad. It does affect you after a while,” she says. “You see death as a nurse, you see life, you see all sorts. But the sheer number of people dying really takes its toll on your emotional well-being... Without wanting to sound callous, it was just depressing, it wears you down, because it just feels like all you’re doing is watching people die.” [See also: The shadow NHS: Outsourced hospital staff “on a knife-edge” without adequate protections] A lot of the patients on Milly’s ward were receiving palliative care. The sheer number of others falling seriously ill, coupled with a lack of staff, meant it was hard to give those dying adequate care. “If you haven’t got enough people to do it all then no matter how hard you try, things get missed or they don’t get done properly. One person can only do so much,” she says. “You want them to have dignity to die in peace, comfortable and happy. And sometimes that… just doesn’t happen because it can’t,” she says. “It breaks your heart.” Milly was so worried about catching the virus that she drafted a letter for her three-year-old daughter in case the worst happened. “It sounds really morbid and quite fatalistic, but that was where I was at,” she says. Milly finds people flouting lockdown restrictions, or questioning the severity of the situation in hospitals, particularly upsetting. “You kind of wonder why you’re doing what you’re doing,” she says, although she adds: “I love what I do, though – surprisingly!” Milly, who picked up her studies again after her placement ended in August and is now at the end of her second year, believes the health service is at a critical juncture. “Going forward, there are issues within the NHS that need to be addressed, which have needed to be addressed for years,” she says, pointing to what she calls the chronic underfunding of the health service. “[Coronavirus] might be the catalyst in which those things are addressed, or it might be the thing that destroys the NHS completely – we just don’t know yet.” *** Having given up part-time work, been worried about paid placements ending early, or been isolated from friends and family to help fight the virus, many students are unhappy about how they have been treated by the government throughout the pandemic. Incredibly, students who are on unpaid placements are not automatically eligible for the NHS and Social Care Coronavirus Life Assurance Scheme – introduced last July – which offers families of health workers £60,000 if their loved one dies after contracting Covid-19 at work. Though the Department of Health and Social Care says there is some flexibility around this, there is no guarantee that it will be offered to students on unpaid placements. “That was a difficult space for everybody, because we haven’t been in that position before where it [the risk of dying because of work] seemed to be a real possibility,” says Julie Bliss, a nurse and associate dean of practice learning at King’s College London (KCL). “Not opting in wasn’t an option for me” But even with the unprecedented risk and lack of support, a generation of student nurses has risen to the occasion. Louisa, a student nurse who took on a paid placement at Poole Hospital during her second year, relished the learning opportunity presented by working through the pandemic. “Not opting in wasn’t an option for me,” she recalls. “If I wasn’t willing to help the public at a time when they most needed it, I would’ve felt like I was going into the wrong profession.” She started her placement in the hospital’s emergency department (ED) and she says it taught her as much about her career as her studies had so far. “This is now where I want to work... I [previously] thought that going into ED as a newly qualified nurse would be absolutely crazy,” she says. While recognising the devastating effect Covid-19 has had, she’s glad to have found this clarity. “Had it not been for the pandemic, my degree might have ended up with me working in a completely different area [of nursing]. And so, in a weird way, I feel quite fortunate.” [See also: How Britain’s essential but most vulnerable workers were exposed as the virus spread rapidly] Of course, students weren't the only ones thrown into a completely new situation: universities and academics across the UK suddenly had to rally their students to join the front line. “It’s fair to say we were going into the unknown... There were moments when you thought, ‘How is this going to work?’” says Louise Barriball, the vice-dean for education at KCL’s Florence Nightingale Faculty of Nursing & Midwifery. “The planning level of collaboration across various departments was extraordinary. Everyone had confidence that our students can contribute positively to supporting the NHS – and our students did not disappoint.” *** In January, as the winter wave of the virus gripped the nation, the Health Secretary Matt Hancock with the support of NHS England wrote to the Nursing and Midwifery Council to ask for “special measures” to be re-introduced, allowing students to re-join the front line. This time, however, only third-year students had the choice to “opt in” to paid placements. This means second-year students such as Alexandria – who still have to go on placements to fulfill their training quota – are now carrying out unpaid work on wards for which they would have been paid during the first wave last year. “It’s a bit of a kick in the teeth really,” she says. “We know that the placements aren’t paid as part of the qualification… But to not actually get paid to do the job – because it is a job – is annoying.” “By the time I graduate, what state will the NHS be left in?” Having recently completed her placement at a children’s A&E ward in London while balancing her academic commitments, Alexandria and her peers are dealing with an intense workload without the support they had a year ago. “I’ve got all these work assignments and exams I have to plan for, as well as preparing myself for my next placement,” she says. “Even when you do have days off, you can’t go out and socialise with other people, or rant to your friend about how your day’s been – that was something that got us through last time.” [See also: How casual labour and lack of sick pay exposed care homes to coronavirus] Feeling “excited” yet “terrified” over the prospect of graduating, Alexandria, like many student nurses in the UK, will soon have to look for certainty in an NHS that has come under a tremendous amount of strain. “We’re all tired… there are a lot of things going on in your head,” she says. “No one can predict by the time I graduate what kind of state the NHS will be left [in] afterwards, and how burned out people will be. “Before, I had a bit of an expectation of what it would look like to graduate. Now, I’m not so sure.” › Why it’s not too late for the UK to pursue a zero-Covid strategy Harry Clarke-Ezzidio is a graduate trainee at the New Statesman. Subscribe For more great writing from our award-winning journalists subscribe for just £1 per month!