Students, like many other Australians, are feeling the effects of the rising cost of living. Many are dealing with this by taking on increasing amounts of paid work outside their studies and universities are doing their best to support students with everything from scholarships and bursaries to food banks and emergency housing.
Students who are expected to undertake substantial hours of unpaid placement work, in addition to paid work and study commitments, can quickly find themselves in “placement poverty”. Placement poverty occurs when the costs of undertaking placements, which are compulsory to graduate, push financially marginal students into poverty and sometimes out of their studies.
“Poverty placement occurs across several degrees, including education and social work, but there are some specific features of health placements that make health students, particularly nurses and midwives, especially vulnerable.”
Challenges for health students
Poverty placement occurs across several degrees, including education and social work, but there are some specific features of health placements that make health students, particularly nurses and midwives, especially vulnerable.
The hours of unpaid placements that student nurses and midwives must undertake are extensive—a minimum of 800 hours for nurses and 1,600 hours for midwives across the course of their degree. For nursing students, placements are traditionally undertaken in blocks of time, typically for 40 hours per week for two or more weeks.
Placements reflect a nurse’s roster and include night shifts, weekends, and for many students can be more than 100 km from their home. Student midwives carry the additional requirement of “continuity of care”, where they follow multiple women (up to 20 over the course of their degree) through antenatal, labour and postnatal periods.
Those placed in regional, rural and remote health services can find themselves carrying the cost of travel, accommodation (when it can be found) and food, while still paying rent on their primary accommodation. Even for those lucky enough to have a placement closer to their accommodation, concerns for personal security mean that some pay expensive hospital parking fees or the cost of an Uber to get them to and from placements at nights.
Midwifery student experiences
Midwifery students recognise the importance of placements in becoming health professionals and often undertake additional hours of work beyond the placement requirements to support the expectant mothers with whom they have formed a bond. While they are grateful that women let them in on such an important part of their lives, they are deeply concerned about the costs, and there is growing concern that a midwifery degree is becoming inaccessible for many.
Students need transport to placements for early morning or late shifts when public transport may be unavailable or feel unsafe. Those undertaking regional placements may struggle to find accommodation. A number talk about sleeping in their cars at hospital carparks.
Placements can be even more challenging for students who are parents themselves, particularly if they are paying for childcare and must forgo paid work. They may find themselves considering dropping out between first and second year because of the financial and workload burdens or worrying that they will be burnt out and exhausted by the time they graduate.
A student we spoke to said, “Something needs to change. If we want these great midwives to come out and serve our community … there needs to be a lot more support for student midwives”.
The role of universities and health care providers
Articulating the problem of placement poverty is far easier than combatting it. There is a role to play for a range of institutions.
Universities are not funded to cover the additional costs of living support for student placements, although some (including Griffith University) are trying to assist the neediest students with financial support, scholarships and bursaries. Universities already pay health providers substantial amounts to supervise their students on placement or provide (and pay for) supervisors directly. In areas such as nursing, universities already spend around a quarter of the income they receive per student on placements, which is disproportional to the on-campus learning required. In 2023, Griffith alone will spend approximately $14.8 million on health placements.
There are ways in which universities can try to make a difference, such as working with health providers to create options for students to undertake placements part-time, as Griffith has done recently with some health providers. This at least allows for students to continue with some paid work and eases pressure for parents around childcare.
The health care system is under enormous financial pressure at present and cannot be expected to pay students for placements without additional funding. Health care providers could, however, assist students by recognising and respecting the challenges placements create for them. With the current difficulties with finding accommodation nationally, particularly in regional and remote areas, hospitals and universities could work closer together to support students to find appropriate accommodation. Health students are not entitled to discounted staff parking, despite placement hours that sometimes make it dangerous to catch public transport. Even without paying students directly, a more thoughtful approach to issues such as these would be of real assistance.
The need for government funding
Despite these approaches, the reality will remain that some students will find the cost of placements too high and there is a role for government in remedying this.
The Australian Government has recognised the problems caused by placements in its recent White Paper on Jobs and Opportunities and has committed to undertaking “scoping work on approaches to mitigate financial hardship placed on tertiary students completing unpaid mandatory practicum placements as part of studies in care and teaching professions”.
There are a variety of options open to the Commonwealth, which might reasonably expect some support from the States, which have primary responsibility for the health system. One would be to provide financial support for all students for all placements.
Another is a more targeted approach to have a pool of funding that students in need could apply to that would assist in covering the cost of living, including a loading for placements that require a student to live away from home. Queensland recently announced a $5,000 cost-of-living allowance for nursing and midwifery students undertaking regional, rural and remote placements in their final year. While not a complete solution, it is a welcome step in the right direction. Existing funding from the Commonwealth Government to support regional health placements (through the Rural Health Multidisciplinary Training program) is insufficient to meet current demand and focuses primarily on medical and dental students, but an expanded version for all health students would be a great improvement on the current state.
Placement poverty compounds existing challenges our hospitals face across the country in retaining and recruiting nurses and midwives. Forcing health students into poverty to complete their degrees is not productive public policy, harming both individuals and undermining the future health workforce. It makes it less likely that cultural groups that are under-represented in our health profession will be attracted to studying. The Australian Universities Accord Interim Report provides an important moment in time to reconsider the role that government might play in combatting placement poverty and showing respect for those whose professional skills.
