Nursing students do not raise concerns on placement because of fear of repercussions and stigma attached to speaking up, a conference has heard.
It comes as many nursing students continue to experience incivility from colleagues, as well as bullying and harassment.
“A safe and supportive learning environment is not just a privilege, it’s a necessity”
Divanshi Sharma
Student nurses, nursing lecturers and UK healthcare regulator representatives today discussed how students can be better supported to raise concerns while on placement.
The discussion took place at the Council of Deans of Health (CoDH) spring conference, being held in London.
Kicking off the discussions was Divanshi Sharma, an adult student nurse at the University of Roehampton, who said raising concerns on placement could be “really daunting”.
She said: “I know that students often hesitate to raise concerns, not because we don’t know how to do that but because of the fear of repercussions or the stigma attached to it.”
Ms Sharma, who has experience of raising her own concerns on placement, argued that some students were worried that doing so would affect their placement grading, or that staff might treat them differently.
She said: “I knew the reporting process, I knew who to contact, but the hardest part was to take that first step.
“I had to remind myself that I was a good student and my concerns were valid and I deserve a safe and supportive learning environment.”
Universtiites and placement providers “play a crucial role” in empowering students to speak out on placement, Ms Sharma argued.
She added: “We need to make sure that students have more than just policy.
Divanshi Sharma
“We need a culture where students feel supported in raising concerns, and raising concerns should not be connected to progression in the placement.
“A safe and supportive learning environment is not just a privilege, it’s a necessity.”
Meanwhile, Paula McLaren, senior advisor for advanced practice at the Nursing and Midwifery Council (NMC), formerly the regulator’s head of education and quality assurance (QA), said it was “clear there is more that we need to do” to support students to speak up.
She explained that the NMC was currently undertaking a review of pre-registration practice learning, to improve the experiences of both students and practice supervisors and assessors.
As part of the work, an independent report was published by the Nuffield Trust in partnership with the Florence Nightingale Foundation last year.
Ms McLaren noted that the report showed a “power imbalance in placements” and a “hierarchical structure” that was preventing students from raising concerns.
She added: “Students err on the side of caution for a variety of reasons.
“They have limited autonomy, insufficient support, fears of damaging their personal relationships and, of course, progression throughout the programme.”
The conference heard how the NMC had created several email inboxes where students could contact it to raise concerns.
Similarly, the regulator had published guidance and supporting information “to encourage students to speak up”.
“We must not only advocate speaking up, but also for listening up as well”
Hugh Tregoning
However, Ms McLaren noted how reports from students were low, with one of the inboxes only receiving 17 student concerns in the last 12 months.
This low number, she explained, could either reflect a system in which students were able to raise concerns with their workplaces or university, or that there was “a degree of underreporting”.
Future ambitions for the NMC to tackle the problem include sending the reagultor’s QA team to visit universities to speak to students about their experiences.
Ms McLaren said: “There are more opportunities for students to engage with us, for us as advisers at the NMC to go out and talk to students, whether they’re on placement, whether they’re in universities.”
Paula McLaren
Concerningly, she said she had heard anecdotally that some students had been told that if they spoke to the NMC it could result in them losing or not gaining their PIN.
“That is not what we want students to hear about the NMC,” Ms McLaren argued.
“We need to be seen as supportive and more accessible.”
The conference also heard from Hugh Tregoning, professional liaison consultant at the Health and Care Professions Council (HCPC), which regulates 15 health and care professions in the UK.
He said: “While most learners will have a good experience on placement, a significant number continue not to have a good experience.”
Mr Tregoning noted that insights from the HCPC’s data, as well as national data, showed that learners “continue to experience incivility, bullying, harassment and sexual transgressions and too often they feel powerless to stop it happening”.
He said good organisational culture was the key to enabling students to safely raise concerns.
He added: “If we are serious about improving patient care, safety, learners’ experience [and] colleague wellbeing, we must address root causes – silence, fear and inaction.
“We must not only advocate speaking up, but also for listening up as well.”
