As part of their qualification requirements, health students are required to do placements to gain practical experience with real patients.
These placements are intense and unpaid, and can require students to move to different parts of the country without any financial support.
Financial hardship contributes to the 25% dropout rate for nursing students, the New Zealand Nurses Organisation says.
That drop out rate increases to 40% for midwifery students and 45% for social work students.
Re: News spoke to health students about why unpaid clinical placements are financially unsustainable.
Isla*, who is using a pseudonym because she is worried about future work opportunities, spent the past three years on unpaid placement in a hospital in Christchurch.
Isla just finished her final year of medical school, where she attended placement every weekday between 8am and 6pm.
She was also rostered on for weekend, night, and extended day shifts.
In addition to that, she needed to keep up with her academic coursework and pass an exam at the end of each placement rotation.
After dealing with the “mental load” of each day and “traumatic situations” she encountered on placement, Isla says it was hard to maintain her finances.
“Money became one of my primary stressors, more than placement itself.”
Isla, 27, would get $320 per week in student allowance and $230 of that would go towards rent, leaving her with $90 every week.
To help cover basic costs, Isla had a part time remote job bringing in an extra $60 per week.
Every day, Isla would work her remote job from 5.30am to 6.30am, attend placement for ten hours, and return home to spend another hour working her remote job while eating dinner.
“I was always running at a deficit,” she says.
“There was no financial freedom… There would be times I wanted to go home for mental support but I couldn’t afford the flights home.”
She says working without pay for three years has “dramatically affected” her sleep and well-being.
Isla spent her sixth year of medical school on full-time placement, and her fourth and fifth year on part-time placement and part time study.
“It’s really hard when you’re working super hard and it feels like you’re not being rewarded.”
Before studying to be a doctor, Isla completed a different undergraduate degree that did not involve placements and she had plenty of time to do paid work.
Isla says student allowance should be increased for students on placements who don’t have capacity to do much paid work.
Isla says it will be a “big relief” to finally get paid for her work this year as a junior doctor.
Sarah Duncan has completed 840 hours at a variety of placements over two years.
Sarah is finishing up her Masters of Science, Nutrition and Dietetics and gearing up to become a registered dietician.
For 2023, Sarah says her full time placement and university assignments added up to 55-hour work weeks.
One of Sarah’s placements was located in Palmerston North and Sarah says she received no support finding accommodation and no help with moving costs.
For nine weeks she was forced to pay double rent to keep her flat in Auckland and pay for a flat in Palmerston North, which came to a combined total of $400 per week.
Because Sarah is a postgraduate student, she does not qualify for student allowance.
Her income came from $302 per week in living costs (which she has to repay) and $80 per week in accommodation benefit from StudyLink.
Sarah says her income barely covered the double rent and she was “so fortunate to have my family helping me pay for groceries”.
“People in my placements have changed their eating habits, they can’t afford meat anymore,” the 31 year old says.
Sarah says she’s encountered many extra hidden costs of being on placement, like having to pay extra to see a GP in Palmerston North as she wasn’t an enrolled patient there.
She also had to buy half-sleeve blouses for another placement that did not allow full-length sleeves.
Sarah says she wonders why she doesn’t get paid when she feels she is doing the same work as a first year graduate.
“Our healthcare system is so under-resourced, often we are picking up the workload of others and seeing patients independently.”
Sarah says because of increased expenses, decreased income and the workload being “astronomical”, she has noticed the field of dietetics isn’t diverse.
“You do need to come from a privileged background… it’s mostly white women,” she says.
Anastasia Kovelenko says she fainted from hunger while on placement at a vet clinic.
When Anastasia was studying Veterinary Nursing in Invercargill in 2019, she did placement at a vet clinic every weekend for over six months.
She remembers being tired and having stressful days assisting with things like euthanasia.
Anastasia’s weekly income was just under $300 and consisted of student loan and student allowance payments.
“I was scraping by… If I had my weekends free, I would’ve worked instead.”
“It’s conflicting because having the placement was great, I really enjoyed it,” the 22 year old says.
One busy day on placement, Anastasia says she fainted from a lack of eating.
After staying for her eight hour shift, there was an emergency case brought into the clinic so she stayed to keep working.
“I’d eaten like a bread roll and a banana that day, something ridiculous that I couldn’t sustain myself on.”
Anastasia says food was expensive and she had allocated most of her money that week to pay for fuel to travel to placement.
She says she wrote in her end-of-year review that students needed more support and says she’s “surprised to see that the situation hasn’t changed”.
Advocating for paid placements in Aotearoa
Bex Howells started Paid Placements Aotearoa (PPA) eight months ago as a movement to get students paid for their placements.
The PPA social media accounts are a platform for students to anonymously share their stories and collaboratively advocate for change.
Bex herself was previously enrolled to do a Masters of Applied Social Work but says she had to drop out after realising how financially unsustainable her unpaid placement hours would be.
Bex is now doing a Masters of Social Policy and her thesis looks into unpaid student placements across all sectors.
Bex, 33, says she felt “enraged” at how healthcare occupations are more accessible to students who can afford to work without pay.
In a press release from September, the New Zealand Nurses Organisation Kaiwhakahaere Kerri Nuku found that 33% of Māori nurses and 37% of Pasifika nurses drop out in their third year of study, mostly due to financial hardship.
While students can apply to hardship grants for financial support, Bex says it takes a lot of administrative effort for what feels like “a drop in the bucket”.
Bex says she understands placement providers cannot themselves pay clinical students because otherwise students would be considered employees.
So Bex is launching a petition in January 2024 to push for a yearly increasing stipend paid by the government through StudyLink.
“We have shortages across all industries with unpaid placements… we’re not making it easier to get more people trained in these professions if we ask them to do unpaid work.”
Bex says she thinks the government could also help by covering hidden costs such as immunisations, uniforms and travel costs to attend placement.
When students have to pay for these out of pocket, they’re “spending money from an empty bank account”, she says.
‘They are students and not employees’
Te Whatu Ora chief people officer Andrew Slater says it is supporting medical students by adding new medical school places and expanding health education in rural settings.
He also says Te Whatu Ora is supporting student nurses by continuing to increase the pay of registered nurses.
Te Whatu Ora runs some ‘earn as you learn’ education pathways but these are for current employees studying towards a health qualification, not for health students, Slater says.
Different tertiary education bodies set education standards required to become a clinical health professional, Slater says.
Slater says standards set by the Nursing Council of New Zealand do not allow paid hours in a health setting to count towards clinical learning hours.
“This is to ensure they have the time and space to learn, as they are students and not employees,” Slater says.
“Students are learning to apply the theory of nursing when they are on clinical placement; they are not working.”
Katrina Sutich, Ministry of Education (MOE) policy group manager says MOE appreciates the transition from studying to interning is “a significant and challenging time in a doctor’s training”.
MOE provides a tax-free Medical Trainee Intern Grant of $26,756 to each final year medical student working as an intern, Sutich says.
The stipend is given to medical students in their sixth year at the University of Otago and the University of Auckland, Sutich says.
Medical students start placements from their fourth year of study but do not get a stipend in their fourth or fifth years of placement.
“A key challenge for Government is to balance the costs of maintaining high participation rates and ensuring affordability for students, especially in the current environment,” Sutich says.