Healthcare placement tourism is becoming more and more popular but you should consider the ethical implications.
Not a day goes by on which I don’t hear about students’ excited plans of placements abroad, and get requests to contribute to fundraisers to pay companies arranging their placements to Ghana, Nepal etc.
I hesitate to call these placements voluntourism, as it is mostly is very much a paid for experience, which feel more like an exciting adventure for many students and is accompanied by safaris, excursions etc.
It would appear to be the ideal combination of work, learning, and play, with the added bonus of disadvantaged communities reaping the benefit of voluntary contributions from healthcare students.
But is it really a win-win? Perhaps not.
To get the most out of your placement and to understand the very deep-rooted issues that may accompany a placement abroad, here are some questions you may want to ask yourself and the company you are paying for your placement.
Why are you doing this placement?
Before making any arrangements you need to establish your reasons for wanting to volunteer.
Is it out of a deeply felt need to help others? Are you going to gain experience? Or are you going to gain insight into another culture?
You should also consider how your visit could benefit or impact your future practice.
Check out the numerous research studies on the subject of medical volunteering and international student placements.
Do you have the skills to meaningfully contribute to this community?
Do you have skills that you can meaningfully contribute to the community you are visiting?
Do you feel that you can competently manage yourself during difficult or emergency situations you may encounter – either in a healthcare, cultural or communication context?
Also consider if your presence could actually have a negative impact on the community. Would the patient or service user have a better experience if you were not present?
Are you very clear on what your role will be?
The company should be able to tell you exactly the work you will be undertaking – including how many hours a day and how many days a week.
Ethical Volunteering states that the biggest complaint for volunteers if that the work isn’t always what they planned, or paid, to do.
Does the company have good links with local organisations?
Companies should have connections with local organisations and be connected to the local community at a grassroots level.
Make sure you can be provided with contacts within the community you will be visiting.
Do you know where the money you have paid is going?
Many volunteer organisations charge a significant amount of money – but where does it go?
Be clear on how much is going back to the community which you are ultimately trying to improve, how much is going towards your food and accommodation and finally how much the company is taking as profit.
Does the company you are working with have an ethical policy?
Running volunteer programmes is ethically complex.
If you want to make a truly valuable contribution to the community you are going to work within, you have a responsibility to ensure that the organisation with which you travel has proper eco and ethical policies. Seek out organisations that have commitment to a community, employ local staff and have some mechanism for local consultation and decision-making.
You should bear in mind that consent and evidence-based practice are sometimes not usually high up on the list of priority in developing countries.
Do you know how much support and training you will get?
Organisations can offer wildly different amounts of support and training.
Aim to arrange your trip with a company who offers pre-trip training alongside having a training or support contact at your destination.
Traveling half the way around the world and entering a different culture can be lonely – ensure you will have the support you need.
Did you answer no to any of the questions?
If you have to answer any of them with ‘no’, more research on your part and exploration of your companies practices may help you to make a more informed decision on where, why and if to go on a placement abroad.
Another crucially important question to ask yourself too is whether you are absolutely happy for the ability of service users to consent to or decline your involvement in their care (even if the placement is only observational). Are you sure there is no coercion taking place (overt or otherwise) to accept your presence when service users are already living in the context of diminished rights and bodily autonomy with a backdrop of poverty when it comes to healthcare.
Having said all this, if you can truly answer all these questions with a resounding yes I hope you have a mutually enriching placement that benefits local communities as well as your personal professional development.
A lack of proper breaks is leaving tired nurses driving dangerously
Tired and overworked nurses feel they are putting their lives in danger just to ensure patients get the care they need.
The majority of staff admitted they often felt unsafe driving home.
Tired and overworked nurses feel they are putting their lives in danger just to ensure patients get the care they need, according to a survey by NursingNotes.
A survey of 2,660 healthcare workers prompted by the recent deaths of two nurses, sought to examine how safe staff felt driving home from their place of work after a night shift.
The majority of staff (73%) said they felt unsafe driving home. Over half (58%) said this was because they did not have the time to take their unpaid allocated rest break. When staff do take breaks, most staff (77%) said their employer did not allow them to sleep during this unpaid period. One respondent said; “When I drive home from a night shift I feel like I am drunk. It sounds odd but I feel dazed and out of it and have slower reactions.”
An overwhelming amount of staff (96%) admitted to feeling stressed or tired during the drive home and nearly all of all those surveyed said they were often forced to leave late because they still had patient care to provide – only further compounding tiredness.
Numerous respondents cited chronic understaffing and high patient acuity as the reason for leaving late.
Falling asleep at the wheel.
Respondents often described driving home after a night shift as like being on “autopilot” and the majority (80%) admitted to not always remembering how they got home. One respondent said; “I find myself drifting easily between lanes. A lot of my nights I run with very short staffing levels and get no breaks and I never remember driving home after these. I have almost drifted into cars in other lanes.”
Around two thirds (65%) of respondents admitted to being involved in one or more ‘near-miss’ while driving home after a night shift. Nearly a quarter (23%) admitted to being involved in at least one minor road traffic collision and twelve staff said they had been hospitalised as a result.
One respondent said; “A colleague of mine died in an RTC after a night shift,” adding “the coroner concluded she fell asleep and went headfirst into a lorry.”
A significant proportion of staff (40%) admitted having fallen asleep at the wheel with one nurse admitting; “I was driving back from work on the motorway after a stressful day and had an accident – swerved across the 3 lanes and the hard shoulder, somersaulted onto a trailer”. Another added, “the rumble strip has woken me up more than once”.
Driving tired is like driving drunk.
Dr Michael Farquhar, a Consultant in Sleep Medicine at Guy’s and St Thomas’ NHS Foundation Trust, said that while the NHS provides 24/7 emergency care “we all too often ignore the consequences on NHS staff themselves of working around the clock”.
He added; “Working long shifts, often under considerable pressure, inevitably leads to fatigue, especially when that work is being carried out overnight. Fatigue not only increases the risk of harm to our patients, but it puts every single member of staff driving home after a long nightshift at significantly increased risk of a road traffic accident – the levels of fatigue commonly seen after a normal NHS nightshift produce a similar effect on driving as if we are at or over the legal drink-drive limit.
“Driving tired is like driving drunk and when we ignore or forget that, we will continue to see NHS staff dying on the roads just trying to get home after a shift.
“A proper focus on regular rest and breaks during shifts, and strategies to reduce risk of harm when driving home after shifts, is essential, and every NHS Chief Executive has a responsibility to their staff and patients to do this.”
Employers must not normalise missed breaks.
Kim Sunley, Royal College of Nursing National Officer said: “Nursing staff are sounding the alarm on the dangers they face driving home from work after long shifts caring for patients. Staff say they are leaving work exhausted from being unable to take rest breaks and as a result are almost crashing their vehicles, in some cases with tragic and fatal consequences – this is an unacceptable position to put health and care staff in.
“Employers have a requirement to provide an uninterrupted break, however, in practice we know that staffing shortages can mean that health and care staff are unable to take breaks, eat or even or drink during their shift.“But despite the lack of staff, employers must not normalise missed breaks. This would not be acceptable in any other area where safety was critical and a lack of staff must not be used as an excuse for denying nursing staff the breaks they are entitled to.
“The corrosive effect of short staffing on patients and nurses has now never been clearer, but with a record 43,000 empty nursing posts in England alone it threatens to worsen. As well as employers upholding their duty give staff the break they are entitled to, the government must invest in the nursing workforce for the long-term and then change the law so that from the health secretary down, decision makers are held responsible for ensuring there are enough nurses to provide safe and effective care.”
Pushing exhausted nurses to burn out.
Jonathan Ashworth, Labour’s Shadow Health Secretary, said; “These two deaths are heart-breaking. We know that years of cuts, failures to address staff shortages and mounting pressures are pushing our exhausted nurses to burn out putting their lives at risk. It’s totally unacceptable.
“Our NHS ought to be the very best employer anywhere and that means caring properly for our staff just as much as they care for our loved ones. As a start we need to properly fund the NHS, bring back a decent bursary to train more nurses and midwives and invest properly in professional development.
“Ministers are taking our nurses for granted, it has to stop.
“My pledge is to be a champion for our nurses and midwives working together to improve care for staff and patients.”
It all starts with attraction: building the nursing workforce
While retention is clearly an issue, attracting new nurses into the profession is also a significant problem.
Six per cent of places on pre-registration nursing degrees across the UK are going unfilled.
When it comes to managing the nursing workforce the focus is often on retention, with recent figures from the Labour party revealing that more than 160,000 nurses have left the NHS for reasons other than retirement since 2010. This is undoubtedly worrying for industry leaders, with departing staff members adding to the strain on the health service from budget cuts and the ageing population.
While retention is clearly an issue, attracting new nurses into the profession is also a significant problem. The number of EU nurses joining the Nursing and Midwifery Council register since the UK voted to leave fell from 10,000 in 2015/16 to just 800 in 2017/18, which means that NHS trusts need to find nursing talent elsewhere in order to ensure that they can continue to provide excellent and efficient patient care.
Developing homegrown talent presents the most sustainable solution to the nursing numbers crisis, yet new data from The Open University’s Breaking Barriers to Nursing report six per cent of places on pre-registration nursing degrees across the UK are going unfilled – the equivalent of over 1,450 vacancies each year.
Barriers to nursing.
Despite many young people considering nursing as a potential career, there are a number of barriers that are deterring them from pursuing this route – and it is essential that educators and NHS employers work together to ensure that everyone who wants to become a nurse has the opportunity to do so.
The barriers to studying nursing are vast – and for most prospective students there will be two or more of these factors at play. The cost (and associated costs) of study is the most prevalent concern, particularly for those in England, but many are also put off by travel or entry requirements, workload, and even the advice made available at school or college. While some of these barriers are difficult to remove or reduce, there are a number of potential solutions that could help improve both recruitment and retention in the sector.
The removal of the nursing bursary in England has certainly made studying for a nursing degree a greater financial commitment, but the associated costs of studying – course materials, relocating, commuting – are problematic for prospective students across the UK. For many, this makes traditional nursing study prohibitively expensive, especially when the costs are compared to relatively low salary expectations.
One solution that could help to address the cost concerns faced by potential nursing students in England, and bring myriad benefits to the NHS as a whole, is the new Registered Nurse Degree Apprenticeship. The ability to earn while you learn is undoubtedly appealing, but it also provides a new route into the profession, offering a tool for continuous professional development to those already in the NHS workforce.
In addition to the cost of relocating and commuting, many prospective students struggle with merely the idea of this. For some, this can be an exciting opportunity, but for others the commitment is too much, especially for mature students, who may have other commitments or roots in an area.
With new technology, there is no longer any need for students to travel in order to study, particularly for the lecture-based portion of their degree. Through technology-enabled learning, educators can make course delivery more flexible, so that students can study wherever, whenever and however suits them. And because they have not had to relocate, fewer nurses will leave their training hospitals to return home upon qualification.
Furthermore, some universities’ entry requirements exclude many would-be nurses from entering the profession. The Nursing and Midwifery Council requires candidates to have just GCSE-level Maths and English (or equivalent) when they begin their course, but as it stands, nine in 10 Higher Education Institutions that offer pre-registration nursing degrees in the UK require the 96 UCAS points (equivalent to three A-levels at or above a C-grade) for entry. And grade requirement vary depending on where you are in the UK – in Wales all universities require at least 120 UCAS points at A-level (3 ‘B’s), while in Scotland half require only 64-72 points.
Remove unnecessary entry requirements.
These additional entry requirements limit an already diminished pool, and at a time when talent is in short supply, they represent an unnecessary barrier into the profession. These requirements also stand in the way of the NHS goal of widening participation and increasing diversity, as many of those who were not afforded good educational opportunities are effectively excluded, even if they have all of the other qualities required to become a nurse.
For some, it is not the practicalities of studying that presents the issue, but concerns about the career at the end. One in five of those who considered becoming a registered nurse were deterred because they were worried about the working hours and stress they might face. However, those working as registered nurses would argue that the rewards far outweigh any challenges – so it’s crucial that NHS trusts work with local communities and media to promote the benefits and counter any negativity, in order to bring in new recruits.
So, there are a number of barriers preventing prospective nurses from entering the profession, but there are also a number of ways in which industry stakeholders – educators and NHS employers – can start to address them.
By removing unnecessary entry requirements, promoting the positive, embracing technology-enabled learning and opening up new routes to the profession, we can develop a more sustainable pipeline of talent, which is essential for future-proofing the NHS, and ensure that it can continue to provide a safe service for years to come.
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