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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?
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.”