Unpaid HCAs: the Future for Student Nurses

Being a student nurse is every bit as tough as you can imagine it being. What I did not expect was to be paying £9,250 a year to be in a 45-hour a week full-time unpaid internship.

Nursing students are a free workforce for the understaffed NHS Trusts all over the country and most of us out there on placements are fully aware of this. The NMC (Nurses and Midwifery Council) requires student nurses to complete 2,300 hours (19 weeks) in clinical practice (placement) over the three years of the course, as well as 2,300 hours in an academic setting. Shifts on placement can range from brilliant – learning new skills, interacting with patients and remembering why you decided to do this in the first place – to soul crushing. The later usually involves being a glorified unpaid Health Care Assistant (HCA) for the duration of a 12-hour shift. You make beds, sterilise equipment and fill out paperwork. Let me be clear, these skills are fundamental to what it takes to be a nurse, but when you’re carrying these skills out because there are staffing issues, the feeling of self-worth wears off quickly.

As of last August, all nursing students pay the same tuition fee as other disciplines; a wonderful £9,250 a year. This means that every nursing student is paying £27,750 to work for the NHS. There are no incentives to encourage young people to join healthcare; no NHS bursaries, no subsidies and very little financial support. There are two aspects to this that are very disturbing.

First, UCAS statistics show that the number of applications to nursing and midwifery courses drastically dropped last year. With the NHS funded tuition, universities were limited in the number of applicants they could enrol.  Without it, they are free to accept as many students as the university feels they can support. Despite vague promises that the removal of the bursary would have no real effect on the number of student nurses in the further education system, the reality was that there were only 305 extra places created for the 17/18 academic year. So, the hope that non-restricted numbers applying to universities would exponentially increase enrollment, has failed.

There is now significant pressure on nursing students to meet the expectations of Trust and the NMCs requirements. The Nurses and Midwifery Council decide which nurses practice; they can make or break a nurse’s existence.  The stereotype of a fresher having one or two lectures a week and getting drunk all the time doesn’t really apply to a nursing student – we simply don’t have the time to do that. On placement we work the hours of our qualified peers, whether that is days, nights, short shifts or long. We do this because the NMC requires us to experience the full range of shifts we can expect to carry out once we’ve qualified.

The second aspect of making student nurses pay full tuition is the government savings made. Not just on not paying out bursaries but in using students as an unpaid workforce. As stated before, current NMC courses require 2,300 hours on placement. Student nurses on placement do the equivalent job as a Band 1 HCA. Time on placement represents 37%, or 19 weeks, of a full-time employment (full-time employment being defined as 40 hpw). The cost of paying a non-student to do the same work at minimum wage – the lowest rung on the Band 1 NHS pay scale for HCAs – is approximately £5950.00. This cumulatively is a huge saving for the government of an estimated £15,200.00 per student. But, you can see why applications for nursing courses have dropped for the 2nd year in a row after the bursaries were cut.

The NHS needs new blood. We have an ageing population that needs health care and healthcare workers to replace our elders. All nursing students want is to feel appreciated in their role.

The NHS has been in a state of austerity for the last eight years and many of us within the system believe that austerity needs to end. Nurses were promised that the pay cap would last seven years and while Phillip Hammond claims this to be the case, it is clear that nothing has changed.

In the last three years, the national minimum wage for those over 25 has increased by 70p per hour; this is due to an effort to ensure that the amount people are earning is in line with the cost of living. It cannot be said that a rise in wages is a bad thing; but why are nurses missing out? Although, a Band 5 nurse earns more than minimum – around £11.32 in 2017– the wage per hour has only risen by 30p per hour – not 70p. The wage of a newly qualified nurse does not keep up with the rate of inflation meaning that many nurses are forced to work beyond their contracted hours in order to be able to take home an amount they can live on.

As a student, it is estimated that the cost of living in London is around £15,000 per year. This, I have to say is a low-ball estimation of the cost. According to the Office for National Statistics, the average London household spends 643 pounds per week – or £33,436 per year. This is significantly higher than the annual wage of a nurse starting out their career. Not only are there not enough nurses to supply the demand a functioning service needs, the nurses we have are expected to work above the hours other workers would be expected.

This usually comes in the form of ‘bank shifts’. Bank shifts represent the hours of work where there are not enough members of staff to run a service effectively. Off-duty rotas are provided anywhere between one and three months in advance, immediately showing the gaps. Staff registered to the bank can then request to be on duty in order to fill the gap – this is usually on a ward/department separate to that which they usually work. Although, there are well-documented cases of nurses taking their annual leave (paid holiday) from the department and then working the shift as bank, to fill in the gap made by their leave. Student nurses cannot do bank shifts during placement so there is no way to earn extra money during term time. Even zero hour contracts at Tesco’s are practically impossible as placements are 5-8 weeks long and the shifts are unpredictable.

So why do nurses take on these extra shifts? Aside from the need to eat of course. Well, usually it’s because a band five staff nurse usually gets paid more in order to work these extra shifts.

So rather than providing incentives for more people to join the profession, the government create incentives to work the already existing workforce to the point of exhaustion. We’ve seen time and again the mistakes that get made when a service and its staff are stressed to breaking point. The main example in mind would be the Mid Staffordshire Trust and the enquiry that followed the death of between 400 and 1200 patients at Stafford Hospital. Although there were clear systemic issues with the trust at the time, including failures with the most senior staff as well as the governing bodies (i.e the CQC), many of the major issues can be blamed on the staff being pushed to and beyond breaking point.

We cannot allow this to continue. Without nurses, the entire system collapses. I have lectures about inter-discipline cooperation and if I have learned one thing in my 9am daze, it’s that every role has to work their butt off or the whole system goes to hell. While I have focused on the nursing experience, I know that every role in the NHS is suffering at the hands of the government. As a student, you know that’s there’s support looking over your shoulder. Once you’re qualified, things get a lot scarier because suddenly you are the one ensuring patient safety and not your mentors.

So what’s the big question that is on every Britain’s lips? When Brexit happens, what will happen to all the EU nurses?

This is not an answer that can be fully answered at this time; there are far too many variables, namely that of Theresa May and what she negotiates over the next two years. What we can talk about is the effect the referendum is already having on the NHS. This is much easier to see, as with many things, there are statistics to show precisely what is happening. The number of EU nurses and midwives leaving the NMC register has been steadily rising for the last few years; from 683 people leaving the register in the period of 2010/11 to 1981 people leaving in 2015/16. Although this rise is massive it does not compare to the exponential rise that has taken place in just the last year. Since Britain voted to leave the EU, 3081 nurses and midwives left the register. We do not have precise data to suggest why these people left – there’s likely a fair amount who simply aged out and retired from work – but it’s fair to say that the jump in number in the last year suggest that Brexit has played a role.

This is a shame to say the least.

As a student nurse, I cannot speak for the entire profession. Most nurses would go so far as to call me a baby – a loving term I assure you – to show that I am fresh to this world, a little overly optimistic and not averse to crying in public when the time comes. That’s why I am leading you to the voices of others. The RCN published a report based on the experiences and comments of over 30,000 nurses working within the healthcare profession. If you don’t feel like listening to me, go ahead, listen to them instead.

Please read the report! https://www.rcn.org.uk/professional-development/publications/pub-006415




Florence N

Florence N is the "nom de plume" for those in the UK health care industry who wish to remain anonymous. Florence N does not represent a single individual or gender but may vary from article to article.

One thought on “Unpaid HCAs: the Future for Student Nurses

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    6th March 2018 at 9:08 pm

    Excellent article. A huge part of the problem is that caring professions – whether as individual carers for family members, nursing and other medical care, paid community care, childminding & nursery employment – the list is long – are simply undervalued. This is because they are professions largely populated by women and because we just do not value care and nurturing in this society. Both of these reasons require fundamental shifts in our societal structure and thinking to change.
    People have forgotten what it was like before the NHS provided care free at the point of need and cannot imagine what may happen to them if the NHS is destroyed.
    My hope is that the dedication and commitment of people like the author will delay this, but at what cost to them personally?


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