Nursing students struggle to balance unpaid hospital placements with paid jobs

(Lillian Greenblatt/Ryersonian Staff)

(Lillian Greenblatt/Ryersonian Staff)

Fourth-year Ryerson nursing student Kinza Malik got a pretty good idea of what it’s like to be a nurse during her clinical placement at a Toronto hospital this year. She got to do nearly everything a registered nurse does, from monitoring patients after surgery to working their grueling 12-hour shifts. The only thing she didn’t get?

Paid.

Nursing students must complete a series of unpaid, academic clinical placements at hospitals, clinics and community health centres to graduate. Students perform tasks such as monitoring a patient’s vital signs and administering IV lines alongside a supervisor. These placements are meant to prepare students to work in their field by having them practice nursing in a real-world setting and with real patients. In reality, this free labour means many students must work paying jobs along with their shifts at the hospital, making them too exhausted to focus on their placements.

This, Malik said, puts patients in danger.

“It takes a lot of energy to work at a placement and more energy to work a part-time job,” said Malik, who is the official delegate of Ryerson’s chapter of the Canadian Nursing Student’s Association (CNSA). “Students will get burnt-out fast and that will directly affect their ability to care for patients. If they’re exhausted, they’re more likely to make a mistake.”

 

 

Malik said she experienced this exhaustion first-hand when she tried to juggle a part-time job with her shifts at the hospital. She lasted two weeks before she had to quit her paying job.

“I didn’t expect that to happen,” she said. “I didn’t think I’d have to quit. Typically, I have really good time management skills. But working a part-time job and a placement and doing homework for my classes – it was just all too overwhelming.”

Luckily, Malik’s parents stepped in to help her afford her tuition, but not all students have that option. Malik says she knows some students who were forced to drop out of the program because they couldn’t afford tuition, and working a part-time job alongside their placement was just too stressful.

“It’s not that they couldn’t do the job, that they weren’t good enough,” she said. “It’s just that they couldn’t afford to do the job.”

While non-academic unpaid placements and internships are illegal under Ontario labour laws, unpaid work is allowed as long as students are receiving academic credit. This does not mean that all academic placements are unpaid however. While Ryerson undergrads in programs such as nursing, social work and midwifery are usually not paid during their required academic placements, fully paid co-operative education is offered to students in other departments including engineering, business and most of the sciences.

 

 

To add insult to financial injury, nursing students must pay full tuition fees throughout all four years of their education, even during the last semester when they work full-time at their placements (as well as taking one class) and are rarely on campus long enough to use the facilities they’re paying for.

“I feel like it’s free labour,” said Betty Wang, vice president of the Ryerson Nursing Student Union. “In fact, we’re paying to do this free labour.”

Wang said that a consequence of this is increasing student debt. Since long hours at hospital placements don’t allow for part-time jobs, nursing students are heavily reliant on OSAP loans.

“It’s really not healthy for us.”Wang said.

Third-year nursing student Maryam Karimi knows this unhealthiness first hand. As a single mother trying to balance her responsibilities at her placement, she said her mental health and family life has been affected.

“Not only am I not working, but I don’t have time for my child,” Karimi said. “She comes to me and I have to tell her, ‘go away, go away, I have to study.’ She’s a strong child and she’s doing well, but as a mother I feel like I’m not doing much for her.”

The number of hours a nursing student must complete at their placement grows each semester. By their last semester, students must work 32 to 36 hours per week. According to the Registered Nurses’ Association of Ontario, if a student were paid the lowest salary of a starting registered nurse – $21.75 per hour – they would make $696 to $783 per week at their placement during their final semester, a sum that would likely pay off most students’ tuition fees.

The problem, of course: where would this money come from?

“Realistically, I don’t think there is enough government funding [for hospitals] to pay students,” said Leo Cho, a fourth-year Ryerson nursing student and member of Ryerson’s chapter of the CNSA. “As to Ryerson offering compensation, due to the huge number of students we have coming into nursing each year, I don’t see that happening any time soon.”

Nursing students have never been paid for their clinical placement work, said Gina Marasco, manager of Ryerson nursing’s Central Placement Office, and the government is unlikely to open their pockets to these students in the foreseeable future. While she believes that there should be greater public discussion over the fairness of unpaid internships and placements, she worries that turning nursing placements into paying jobs may pressure students into taking on responsibilities they’re not yet ready for, such as larger patient loads.

“Students do struggle. I know they struggle to try to balance all of their coursework with other parts of their lives,” she explained. “But we really try to be honest with students that however you manage it, you need to focus on your clinical so that you do well.”

 

 

For now, students are left to juggle their dreams of becoming nurses with the reality of financial instability.

“It’s not impossible,” Cho said. “There are obviously people who’ve already graduated and been through it and I think it’s all worth it in the end. It would just be nice if we were paid for the work we do.”

6 Comments

  1. And then there is the Level 4 BSCN student who is trying to balance being an RPN. I have cut my medicine unit working hours from regular part time down to casual part time and still have to balance it all while having multiple usernames and passwords for the same system and trying to remember what I can do as a RPN is different then a L4 student. Counting down till April !! Good luck to all the L4s out there!

  2. I have to disagree with much of what is said here, as it is extremely unrealistic and completely misrepresents what a clinical placement is.

    Clinical placements aren’t at all like internships due to the fact that you are almost constantly being monitored and taught until near the end of the placement, when you might be given some responsibility and have your work less thoroughly checked. When you start out, you can only watch because you know so very, very little. As you learn, you are then able to do things while being constantly monitored. The next step is doing things on your own, but then having EVERYTHING checked by someone working there to ensure that it’s been done properly.

    This teaching process takes months. Often it actually slows down the department’s workflow because of your work having to be rechecked and often fixed, early on. Even at the end of a placement, the person putting their name on your work is still legally reponsible for anything you do, so you’d better bet they’re going to still check even if you’re deemed near competent.

    While I completely agree that unpaid internships are bullshit, it isn’t at all reasonable to compare them to clinical placements. Clinical placements are an integral part of the health care training process, as it is important to make sure you can do the practical work before you are allowed to graduate. Good theoretical knowledge simply isn’t enough–no small number of students fail out of clinical placements or have to re-do them. Students presence at clinical placements also do not immediately benefit the facility. Of course, they can if they are hired later on AFTER they are properly trained and graduate. Even then additional training is required at the beginning of employment.

    TL;DR: It’s training and more school in a practical setting; it is NOT a job. Therefore it is unreasonable to expect to be paid. You can’t go into a program knowing you’ll have to do semesters of 36 hours/week of SCHOOLING and then call it unfair.

  3. It would be awesome if articles like these took into account other health programs as well.
    As a 4th (final) semester paramedic student not only do I continue to go to class two full days a week, I must complete 400+ hours in 4 months (unpaid), but I also pay a full tuition for the semester and pay an addition 1500 for the placement!
    Nurses aren’t the only ones suffering.

  4. I only just graduated nursing, and while the pay now is great, I still had to work parttime throughout my 4 years of school. I was a waitress several nights a week in between class, homework, and (unpaid) clinical days. My grades suffered. My health suffered. My life suffered. Thankfully I was able to pay my monthly living expenses through this though, but I still had to take out loans for tuition, books, and all the other costs (our program expects you do an out of town placement during your 4 years as well, all at your own expense). I know all of this made me stronger as a person, but I do not wish this experience on anyone. It is not fair that a student have to choose between seeing family during Thanksgiving, or working because they’re short on rent that month. I know that many other students would have benefited from being paid during practicum for all our hard work, even if it was less than minimum wage- at least then we would know that we could pay for groceries, and cover the cost of parking at the hospital. Truly, anything would help. And although because I worked I only incurred a fraction of the $40-50000 debt some of my friends incurred through school, I still wish there had been more help along the way, and can’t help but wonder what kind of nurse I would have been if I had had more time to study, instead of work.

  5. I went to school full-time and also held a full time job for a year while going to college. I had a dream and pursued it knowing that it would be worth it in the end. Stop crying, or asking somebody else to suck up the expense. Deal with it because it’s life and it’s going to happen to you until you die.

  6. Watching the difference in working co op my son as an engineering student, getting paid, and watching his older sister struggle to make ends meet and put food on her table, has been hard, I know in the early to mid seventies, the structure of the nursing programs changed from hospital led to college led. Hospitals paid and trained their own nursing students, housed and fed them. When that changed hospitals gained a source of income and lost and expense. But hey let some of the nurses in their, sixties or who are now retired speak up.
    PS my daughter is highly independant, she has kept a tab of all the monies lent her by her various siblings and her parents in addition to her student loans. She too has worked part time all the way through her nursing education she has maxed out her loans having already completed a ECD course before changing her educational goals.

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