With ongoing shortages of some 40,000 nurses and a 26 per cent drop in applicants to nursing degree courses in the last two years the staffing crisis in the NHS is set to get more acute.
There is the backdrop of strikes, the legacy of Covid, low pay, the costs of studying along with the cost of living crisis.
It is, perhaps, little wonder that around 12 per cent of nursing students in England fail to complete their degrees – twice the average undergraduate drop out rate. As health students tell us, “there are times when the NHS is not a nice place to be.”
The constant cycle of coursework and clinical placements is “a treadmill, hard graft.” Students talk about feeling isolated, particularly during placements.
The pressure to succeed and the fear of judgment from peers and professionals over not being able to “tough it out” can get in the way of students accessing support. The emotional toll of the work, coupled with the expectation to maintain a brave face, leads to compassion fatigue, burnout and a sense of depersonalisation.
“It’s not,” students tell us, “what I thought it would be.”
The resilience narrative
Of course, the notion that healthcare is inherently tough and that only the most resilient can survive is not new. In fact, it’s something of a badge of honour.
As one student told us, “there is this echo chamber. Students all telling each other about how tough it is, about the pressure, the volume of work, how it is non-stop and overwhelming.”
But tying students’ worth to their ability to withstand adversity, that it is up to them to make up for something lacking in themselves instead of focusing on their capacity to thrive and grow, can be disempowering and debilitating.
It’s time to change this corrosive resilience narrative, to bury the notion that it is the student who is somehow coming up short, who needs fixing. Resilience is not about survival and just getting through. It’s about coming back from set backs and thriving. It is about learning and growing. And it’s about something that is fostered within a supportive community rather than an ordeal endured alone by every student.
So resilience becomes about putting in place support, about gathering what you need to be a success instead of simply finding a lifeline in a crisis.
It is community that becomes a building block of resilience: the pro-active building of strong networks among students that enable and encourage them to support each other; building a wider support network of academic staff, supervisors in placements, of family and friends. It is here you find fresh perspective, the space to come back from setbacks.
A midwifery student describes the: “WhatsApp group to keep in touch, check in and support each other. We’ve got a real sense of community;” a nursing student talks about how “it turned out that other students were just as terrified and felt like they were starting from scratch with every new placement.
Sharing our feelings and experiences really helped normalise them;” and the medical student who suddenly “realised that everyone else was struggling. I wasn’t the only one who didn’t have confidence in themself and their abilities.”
And by challenging negative interpretations of themselves, the “I can’t do it”, “I don’t belong”, “I’m the only one who’s struggling,” students begin to see new choices. Resilience becomes about developing the sense of agency and the confidence to respond differently, to challenge, to get the support you need to navigate towards your own definition of success.
What matters
So, to be resilient also means making the space to reflect on what truly matters to you when the norm, as a health student, is to focus only on the patients.
Our medical student talks about how:
…I spend a lot of time focused on looking after others and have seen myself as a low priority. This lack of self care used to result in things building up to breaking point. I needed a place to reflect, away from all the academic pressures. A time to focus on myself.
It can take courage to do different, to do what is right for you rather then what people expect you to do. It takes courage not to join in with the prevailing culture when it doesn’t work for you. So resilience is also about bravery.
The midwifery student again:
I’m stopping negative experiences being the be all and end all of my experience.
Disruptors and modellers
What we’re talking about here is a cultural shift, about redefining the resilience narrative so it is about enabling students to discover their strengths and navigate their challenges with confidence.
The role of staff is critical – as disruptors of the prevailing narrative in healthcare; in modelling behaviour; and re-inventing their everyday interactions with the practitioners of tomorrow.
By using coaching tools and techniques, those of whose job it is to support students can:
- Create a supportive environment that mitigates against self-stigma and provides students with permission and opportunities to be proactive in disclosing needs and unconditional reassurance that they feel they will be heard and valued;
- Work in relationship with the whole student, supporting students to reflect on who they are and where they are going, and to make courageous choices;
- Foster a sense of community to create a more supportive and effective learning environment
We know there are places where this work has already getting results.
A Clinical Skills Tutor describes how this approach:
…has made me rethink my relationship with students, opened me up to working with students in a way I’d not thought about. I’ve seen how empowering it can be. I’m much more effective at making sure they get the support they need.
Empowering students to redefine “resilience” on their own terms makes it a platform for learning and growth, rather than a burden to bear. There are more likely to succeed in their studies and will be better prepared for the challenges in their professional lives.
As our student nurse puts it:
“Grit turns your thinking on its head. I’ve been happier, calmer, better able to cope. I ask for help and support when I need it. I don’t bottle things up to breaking point. Things just don’t get to crisis point any more.
