Anne Rabbitte (Galway East, Fianna Fail) | Oireachtas source

I move amendment No. 1:

To delete all words after “Dáil Éireann” and substitute the following: "notes:

— the exceptional contribution that nurses and midwives, including students, have made to the Covid-19 pandemic response;

— that this was particularly important during the first wave of Covid-19 due to the high number of hospitalisations and workforce pressures;

— the associated move to temporarily suspend clinical placements with students becoming healthcare assistants and paid accordingly;

— the difference at the present time with lower hospitalisations coupled with a larger workforce allowing for the protection of educational clinical placements;

— recent positive developments for the nursing and midwifery professions, including:

— safe staffing framework;

— enhanced nurse/midwife role;

— review of placement allowances and stakeholder engagement;

— specialist practice roles;

— advanced practice;

— Expert Review Body of Nursing and Midwifery; and

— national foundation education programmes for graduates;

— the importance of continuing to protect undergraduate clinical placements;

— the existing supports for student nurses and midwives on clinical placements, including:

— clinical placement allowance for accommodation of €50.79 per week of placement;

— reimbursement of additional travel costs for placements;

— Clinical Placement Coordinators at Clinical Nurse Manager 2 level (senior grade) with ratios of 1:30 in respect of student nurses and 1:15 in respect of student midwives;

— student allocations officers in all clinical sites;

— trained preceptors on all clinical placements (one per student);

— a 36-week paid internship placement in 4th year, paid at the approved rate, that is €22,229 on an annual basis for psychiatric nursing specialism and €21,749 for all other nursing disciplines and midwifery; and

— four hours per week protected for reflection on practice; and

— the progress for student nurses and midwives on additional supports due to Covid-19, including:

— payment of the Covid-19 Pandemic Unemployment Payment for those working in the health sector who may have lost their employment as a result of Covid-19, including students in these circumstances;

— occupational health supports equal to those for employees/qualified staff;

— weekly oversight, at senior multi-stakeholder level, of clinical placements and any challenges arising;

— a review of placement allowances, inclusive of independent appraisal and stakeholder engagement;

— commitment to early agreement on any potential changes to allowances; and

— new opportunities for students to achieve learning outcomes across a variety of settings, including remote environments and telehealth."

I welcome the opportunity to address the House on student nurses and midwives on behalf of the Minister for Health, Deputy Stephen Donnelly. The Minister has advised that he cannot accept the Private Members' motion and accordingly, asked that I move the Government's amendment on the continued commitment to the education programmes for our student nurses and midwives.

I want to pay tribute to the nurses and midwives, and all their healthcare colleagues, who have continued to deliver care across the system during this unprecedented time. The past nine months have demonstrated, more visibly than at any other time in our recent history, the dedication, skill and commitment of our healthcare workers and I am acutely aware that this was not without risk, particularly for everyone on the front line. There are, as of 31 October, 39,608 whole-time equivalent nurses and midwives working in the system.

I want to explain to the House some of the notable differences between surge 1 and surge 2 of Covid-19, particularly in terms of the response required. There are around 280 patients in hospital with Covid-19, compared with around 900 in April and May. In addition, it is estimated there will be an additional 4,176 staff employed across the health service by the end of 2020, with 991 of them in additional nursing and midwifery posts. Also, the absenteeism rate for nursing and midwifery is currently around 5.6%, which is much lower than the 9% rate in the first phase, which led to a workforce crisis. These combined factors have made a difference in managing surge 2. Fewer senior nursing and midwifery staff needed to be redeployed. Therefore, those who facilitate the supervision structure for clinical placements have largely remained in their roles, providing appropriate levels of supervision in surge 2.

During the first surge of Covid-19, it was not possible to maintain clinical placements for undergraduate students safely. Given the emergency, the students were offered temporary healthcare assistant contracts as an initiative to provide much-needed support for the HSE's response to Covid-19. Given the late stage in the academic year of surge 1, it was necessary to ensure that all students progressed to the next academic year. A mechanism was put in place so that students could gain clinical hours if they worked as healthcare assistants in appropriate care areas. For example, they would work in a medical ward if medical learning was required for completion of a student's course. This was supported by the regulator, the Nursing and Midwifery Board of Ireland, NMBI, the HSE, the chief nursing officer, the higher education institutes and the directors of nursing in each area. Unnecessarily standing down clinical placements at this stage in surge 2, when it is still possible to provide them safely, would have a significant negative impact on the students and their ability to catch up and gain suitable clinical experience. Clinical placements are scheduled throughout the year for each student and with 4,505 students to accommodate in all required care areas, there is little room for flexibility.

Nursing and midwifery offer an exciting and rewarding career. There are many options across a range of specialties for nurses and midwives on completion of their undergraduate programmes. Recent developments in the professions in Ireland include a safe staffing policy with evidence of positive outcomes for patients, staff and organisations. There is also an enhanced nurse and midwife role. Today's graduate nursing and midwifery students can, after one year and 16 weeks of suitable experience, apply for an enhanced nurse or midwife role with a starting salary of €37,161. That does not include those allowances or pay premiums that are also available. I mention advanced and specialist practice, where the policy of the development of the graduate to advance nursing and midwifery practice provides a framework for graduate nurses to draw upon their undergraduate programmes and translate their broad-based experience and knowledge into action.

The recent commencement of the expert review on nursing and midwifery is also an exciting development. It is expected to report with recommendations in 2021 and will be an important milestone in the evolution of the nursing profession in Ireland. We should be proud of the standards of education and practice that exist in this country. We have an excellent educational and clinical infrastructure for undergraduate student nurses and midwives. The purpose of the registration education programme is to ensure that upon successful completion, the graduate is equipped with the knowledge, understanding, professional attributes and skills necessary to practise as a competent and professional nurse.

Student nurses and midwives are not paid for clinical placements in their first three years or in the first three months of their fourth year. This supernumerary status is critical for learning in complex environments and is the optimum clinical learning environment. This places students on the front line in a learning capacity, additional to the workforce and fully supervised, for certain periods during each year of their training. This ensures that students can safely learn, observe and take part in the wide variety of clinical skills acquisition required for qualification. The wording "clinical placement" does not adequately capture the essence of what is required or expected of the students. Clinical placement represents 50% of the undergraduate programme, defined by the regulator, the NMBI.

Placements are essential for the development of skills, knowledge, professional behaviour and attitudes, representing a key component in the undergraduate students' attainment of competence to practice as a registered nurse or midwife.

During each clinical placement, nursing students must achieve all domains of competence and all indicators at the stated minimum level. Levels of competence vary each year and move through a complex learning process, from novice in year one, learning through exposure and-or participation in clinical care under direct supervision, to year four, where students are achieving a level of advanced beginner or competent practice under distant supervision.

I now want to focus on some key benefits of the undergraduate nursing and midwifery programme which, as the Government amendment points out, is second to none. Our four year degree level programme is one of the main reasons that Irish nurses and midwives are in great demand throughout the world. The move to the graduate programme level has created opportunities for nurses and midwives to extend practices and provides the necessary sustained change to operate in advanced and specialist practice roles. To facilitate this, graduate nurses have access to educational programmes that are funded by the Exchequer at foundation, diploma, masters and PhD levels. Paid study leave is also available. New graduates can continue to develop and acquire new knowledge and skills, applying evidence-based practice to real-world situations. This creates an environment that supports expanding scope of practice and the available evidence has shown this results in greater job satisfaction, better patient outcomes and improved service quality.

This year, €2.2 million was invested in new advanced practice posts. This not only creates more opportunities for graduate nurses and midwives to work in integrated care environments, but it also assists in responding to the increase in the complexity of healthcare needs and service reform. Advanced and specialist practice are daily demonstrating important impacts and outcomes for patients, such as timelier access to services, reduced waiting lists, hospital avoidance and better integration of services through enabling nurses and midwives to practice to the fullest extent of their licence.

Earlier this year, in response to the emerging pandemic, health sector management and trade unions, including nurse unions, convened weekly engagements focusing on the matters arising from Covid-19. This collaboration has been key in addressing many of the evolving important issues that were of concern to our front-line health workers, including PPE, redeployment and occupational health and wellbeing. I want to pay tribute to health sector trade unions and management for this engagement to date and thank them for this important work. Covid-19 is still with us and the Department and I are supportive of management and unions continuing with this forum for as long as necessary.

In March of this year, the Department engaged with the nurse unions on the Covid-19 emergency that was impacting on student nurse and midwife placements due to take place between April and May. Following intensive engagement, the Department and the HSE put in place a temporary arrangement for student nurses to apply for healthcare assistant, HCA, roles while placement was suspended. This temporary measure ended in August. On behalf of the Government, I want to express my gratitude for the contribution made by these students in providing support to our health service in times of acute need.

Yesterday, officials from the Department completed a review of the current placement accommodation and travel allowances for student nurses and midwives. The Minister is currently considering the output from that review and will outline his approach to this matter soon. It is likely that further engagement with the trade unions will be required before this matter concludes. In conclusion, I want to be clear that I do not underestimate the difficulties that student nurses and midwives have experienced over the past nine months.

See this speech in context