Student: Patrinjei Bogdan Alexandru

TD. Anul II . Gr.II

Universitatea de Vest "Vasile Goldiş" din Arad

Facultatea de Medicina Dentara

Profesor : STANCUTA DIMA LAZA

The COVID‐19 pandemic has changed our perspective on a myriad of things as it
sweeps across the globe. One issue we are forced to pay more attention to is the risk
that COVID‐related care entails and the fact that nurses have tragically lost their lives
in this pandemic (Cook, Kursumovic, & Lennane, 2020). This loss of life has
included student nurses

The pandemic has put the nursing workforce under stress in many parts of the world,
and because of this, in some parts of the world, nursing students are being offered a
choice to undertake extended work in hospitals to bolster the nursing population that
is apparently required to deal with the (actual or predicted) vast increase in critically
ill patients.

Given this, the universities to which these students belong are having to engage with a
level of risk that is unprecedented. This is not to say that universities have been
neglecting the protection of their students—far from it. However, until the COVID
pandemic the concerns have been focussed on areas such as ensuring students are
protected from more existential threats, such as “microaggression” and advocating for
the provision of “trigger warnings” in lectures should the subject matter (potentially)
create anxiety. Now, these same universities are allowing, enabling and even possibly
encouraging their students to enter high‐risk health environments where some student
nurses have already lost their lives. A simply incredible volte‐face it would seem.

Many questions are raised when we contemplate this strategy. These questions are
complex and involve the consideration of many factors—factors that are individual,
location and service‐based. What is the evidence that students are needed? How many
students are needed? How can they best be deployed? Are some students more “at
risk” of harm than others? Will students from at‐risk or highly vulnerable groups be
kept safe? Will students who choose not to undertake extended placement in the
clinical environments be disadvantaged? What are the measures for ensuring the
physical and psychological safety of all students?

Reflecting on whether students are actually needed in this way, we have yet to see
robust and extensive workload data on this. One thing is clear—critical care nurses
around the world are engaged in the most stressful, difficult, risky work of their entire
lives. We recognise their skill, dedication and—in far too many cases around the
world—their sacrifice in responding to the pandemic. However, in many countries the
COVID‐19 pandemic has also resulted in a marked reduction in other healthcare
services. In many parts of the world, elective surgeries are suspended, outpatient
clinics are closed, day surgeries are significantly reduced and emergency
presentations have plummeted, meaning there is also a group of nurses who would
normally work in these areas who have seen a large reduction in their workload. How
have these nurses been effectively utilised by hospitals before looking to universities
to supply students as labour?

Nursing students move between sectors as a part of their studies. Over the duration of
their studies, they move between the university sector and the health sector and
occupy the position of learner in both. In the usual course of events, students’
placements exist primarily to meet student learning needs (rather than operational
health needs), and most universities and healthcare providers have various strategies
in place to enhance student learning when in clinical placement. Such strategies
include the use of mentors and clinical teachers, guided reflection activities,
prebriefing and de‐briefing. These strategies not only enhance the learning of the
student through helping them to draw meaning from events that happen in the clinical
environment, but also allow for the early identification and remediation of any
problems or issues that students encounter in the clinical setting. It is uncertain
whether these or similar strategies will be available to students opting to work
clinically in extended placement (and if so, what form they would take) in this current
environment.

Writing from the United Kingdom, Swift et al. (2020) have raised the issue of
students possibly feeling some pressure to enter the practice environment to support
the COVID‐19 efforts. This is very concerning and raises questions about how this is
being presented to students. Are some using emotive messages to put emotional and
professional pressure on students to enter practice? We have heard and seen messages
and tweets that suggest that students have a “duty” to undertake this work, that it good
preparation for qualification and also that—as they will be registered soon—this is a
responsibility they should take on now. We think that universities need to manage
their message—officially and unofficially—to ensure students do not feel pressured
one way or another. There also needs to be close monitoring of student social media
platforms to manage any attempts to unduly influence students to alter their
programmes and help with COVID‐19 care. This issue also needs to be addressed in
the longer term—is this response risking the creation of two cadres of nursing student
—the ones who did “help” and the ones who did not?

Clearly, universities are indicating they want to help in the face of the COVID‐19
epidemic—which is laudable and admirably reflects the civic duty of universities.
However, they also seem very keen to publicise these efforts on their websites and
social media—as if there is a need to be seen to be doing something. This could be
seen as virtue signalling in our minds, and we must honestly appraise whether nursing
students are or should be a part of this.

For those students who do opt to undertake this, very careful thought needs to be
given to student safety and welfare when redeploying them specifically to meet the
needs of the health service. These individuals are being redeployed purely on the basis
of their status as university students. It is important to remember that universities have
a duty of care to students. Contemplation of this fact raises questions that universities
must address. Are universities putting the right support measures in place? How will
universities monitor student well‐being? Whose responsibility will it be if a student
suffers damage to their health or death as a result of this university sanctioned
activity?

There is a considerable body of information suggesting that even experienced heath

staff can develop post‐traumatic stress and other undesirable sequelae as a result of
working in pandemics (Li et al., 2020), so there is a need to carefully weigh up
potential risks. Questions must be asked. Is there a heightened risk of students
experiencing harm? If so how will it be recognised and managed?

1. We suggest that a robust and appropriate support plan should be

in place for whenever student nurses are to be co‐opted in an
emergency situation such as a pandemic and recommend the
 following should be key elements of sFast and efficient occupational
health advice, including assurances that students will be provided with
adequate personal protective equipment at all times while on duty—and
suitable training in its use.
2. Clarity on the impact of extended work in hospitals on each student's training
and graduation.
3. A sound risk assessment of clinical environments before placing students,
with plans in place to rapidly identify, respond to and mitigate identified
risks.
4. Careful planning about how students will be placed and for how long,
together with clear evidence that they have given informed consent to enter
practice.
5. Formal strategies to monitor student well‐being—in the short and longer
term‐ with early recognition and intervention for any problems or difficulties.
6. Access to pastoral support while in placement and access to mental health
counselling and support from within the university
7. Support for the students who choose not to be co‐opted.
8. A register of events capturing and appropriately recording any and all
untoward or unforeseen events affecting students.
9. Support to develop a rigorous evidence base around the co‐opting of nursing
students in a pandemic or other health emergency.
10. Clarity on where the legal responsibility for ensuring the safety of health
students lies.

uch a plan:

The above 10 points should act as a basis for the current pandemic—and help shape
the response to future events of a similar nature. The COVID‐19 pandemic has
highlighted the fact that—unsurprisingly—many nursing students have a strong desire
to help during a health emergency. This is laudable and a sign of professionalism—
however, which does not remove the fact that universities have a moral and legal duty
of care to protect the health and welfare of their students. We will look back at many
things once this pandemic has passed we are sure—one question we will need to ask
is this; does the decision enabling nursing students to enter the COVID‐19 front line
represent a valuable intervention by universities to fighting the epidemic or a reckless
placing of nursing students in harm's way with little evidence to support the necessity
to do so?