Placement rotas and nursing students’ mental health: why self-rostering makes sense
The current system causes stress and makes academic, financial and personal planning difficult
The nursing student Twitter support network We Student Nurses often hears from students about the mental health challenges they face throughout their degree programme, so we recently held our first Student Nurse Mental Health Day.
One of the common themes that emerged from those who took part was the unnecessary stress caused by not having an advanced work rota for clinical placements.
Without an advance placement rota, how can students plan for commitments?
Nursing students have a lot more than placements to contend with: we have university deadlines and study days, and some of us also have part-time work, children or other caring commitments. The lack of certainty over placement rotas makes it difficult to plan ahead, which can have a negative effect on our personal relationships.
To explore this issue further, We Student Nurses developed a UK-wide survey to gather a wider range of views. The survey results were compelling – and alarming: 89% of the 616 students who participated said not having an advance placement rota was having a negative impact on their mental health.
Students are advised by universities to contact the clinical learning area in advance of their placement to introduce themselves and gain their working rota. But two thirds of those who responded to our survey said they were often told to turn up on their first day and staff would ‘try’ to sort the off-duty rota.
This is not always the case, and there are many examples of good practice where staff try to prioritise nursing students and ensure we have an advance rota. But students also report feeling like a burden and being spoken to rudely by staff when they contact the placement, who say they have too much work to sort the off-duty rota in advance.
Last-minute rotas can cause financial pressures and increased anxiety
Receiving a rota at the last minute affects many areas of students’ lives. Our survey respondents said it affected their physical health through weight gain or loss, insomnia or excessive sleeping, and decreased energy or fatigue due to the worry and uncertainty.
Students also said they struggled to find time for health-promoting activities, such as going to the gym.
‘Prioritising our workload would help us develop time management and leadership skills, and planning our own shifts would give us the opportunity to learn negotiating and conflict management skills’
The inability to plan ahead also means students cannot plan for paid work, which causes financial worries and can lead to high stress levels and burnout. Then there are the family events, parents’ evenings, nights out with friends, or events run by university clubs and societies we may have to miss, which can make us feel socially isolated.
So how do we fix this problem?
Almost half of the students who responded to our survey felt that four weeks’ notice of a rota was fair, with 18% saying three weeks would be sufficient.
Another solution is self-rostering – the preferred choice of 80% of our survey respondents – where students choose which shifts they work.
The advantages of students being able to self-roster
Self-rostering would give students more control over their learning needs: we could arrange to attend conferences to enhance our professional development and networking skills, shadow senior staff to broaden our knowledge, or follow a patient’s journey to gain more insight into the services provided and a better understanding of the value of multidisciplinary working.
Prioritising our workload would help us develop time management and leadership skills, and planning our own shifts would give us the opportunity to learn negotiating and conflict management skills.
The financial benefits of self-rostering should also not be underestimated: if students could arrange their own rotas, they could plan when they were able to work and earn money, meaning less debt and less stress.
Self-rostering would enhance our work-life balance, enable us to plan childcare and special events, and take account of religious days. Registered nurses are able to request days off in advance, so why not students?
Set criteria to manage a self-rostering system
Self-rostering is not without its issues, the main concern being the potential for abuse. A self-rostering system could encourage workday bias, meaning students may not gain a 24-hour experience of nursing. This could be mitigated, however, by ensuring stringent criteria are in place, such as students being required to work a set number of night shifts where applicable.
Concerns have also been expressed in relation to skill mix; too many inexperienced staff within the clinical environment could cause patient safety issues – but surely this could be addressed by thorough planning and effective communication, another core nursing skill?
Protecting the mental health of nursing students
We want to express our gratitude to the students who shared their stories with us and completed the survey. We have listened to you and your voice matters.
While we may be seen as ‘just the student’ by some, nursing students are human, we have lives outside our course, and we want to learn. We are proud to put on our uniforms and call ourselves nursing students, but our mental health needs to be protected. Otherwise, the UK will have high attrition rates and burned-out newly qualified nurses.
Let’s sit down together and look at the problem, listen so we can hear each other, and ask the tough questions so we can come up with effective solutions.
Natalie Elliott is a second-year adult nursing student at Glasgow Caledonian University