Extended Placement - A Student Midwife Training in Covid

Adapted from an article written for the Student Nursing Times.

June 2020.

When I last wrote for the Student Nursing Times (28/04/20) I mentioned how uncertain it was to be a third year in the final six months of a Midwifery programme (or indeed; anyone, anywhere on a Midwifery programme!) Since then, there have been huge changes both nationally and locally. Many universities have grasped these changes as opportunity with both hands, and I would like to take the time to reflect on that opportunity.

In April, Health Education England (HEE) announced that students on Nursing and Midwifery programmes in the last six months of their programme would have the opportunity to ‘opt-in’ to an extended placement; in order to finish their programme as an employee of the NHS. My understanding of this was that the initiative wasn’t to fill gaps of registered staff. My understanding was that HEE was stating Supervision of students under worst case circumstances, was a luxury that could not continue. In order to facilitate the completion of the programme – to the benefit of all parties - Midwifery students in their final six months would be offered the opportunity to complete extended placements in a non-supernumerary capacity. Due to the autonomous nature of the midwife (which is one of the key differences between nurses and midwives in the United Kingdom: Midwifery: An Autonomous Profession, non-supervised practice or early registration was not appropriate and therefore the extended placement was an attempt to fulfill both the aims of a maternity service in a pandemic and the need for final year students to finish and register on time.   

Some trusts and universities got on board with this immediately and put into place Inductions for ‘opt-in’ students from the start of May. While others may have hoped they could continue with planned placements without the need for contracts, this has now been negated by the highlighting of the need to provide remuneration for work performed in an emergency, such as: Death in Service, participation in the NHS pension scheme and the recognition that exceptional circumstances may impact placement experience. Therefore, if trusts want to continue facilitating planned placements for ‘opt-out’ students, these need to be done under contract (and payment).

I have chosen to opt-in to a trust closer to where I live, which meant a new workplace, new guidelines and new colleagues. I believe that my experience of opting-in has been an example of the opportunity the extended placement can provide for both employers and prospective newly qualified midwives (NQM). I now have the opportunity not only to finish my programme closer to home, to be paid for the work that I do; but also to upskill in preparation for registration. The Trust has welcomed us with open arms, has done everything they can to make us feel welcome and prepared, and to reassure us that they are aware we still have competencies and outcomes to meet.

I’m also aware that some old fashioned attitudes exist elsewhere in the country, where students are seen as a burden and told we should “be grateful” for the goodwill of trusts to continue to Supervise us. I feel this misses the mark, we are all in this together: students are the midwives of the future and we have stood up in a global health crisis and put women and children first, ready to support maternity services nationally. Terms of “gratefulness” indicate a complete misunderstanding of the symbiotic nature of student and teacher, and should be removed from local and national discourse.

What I’ve realised is that the extended placement is an opportunity for both the student midwife and the Trust. It essentially provides a structured bridge between student midwife and NQM, a bridge that has been found lacking historically. For employers, it enables them to kick-off recruitment for NQM posts and to upskill those prospective NQMs prior to Preceptorships starting. If the UK experiences a second wave of Covid-19 towards the autumn (a key period in national Midwifery recruitment) this will have been an even more advantageous move.

In addition, this move helps to close the gap between the cohort of students who are qualifying just before the new standards come in – which place greater emphasis on biomedical skills that will be built into pre-registration programmes – and those who will follow.

The experiences that opt-in students in supportive Trusts can gain during these final months of our programme may be the making of the 1709 students who have been able to take advantage. We are now a cohort divided between ‘opt-ins’ and ‘opt-outs’ and we still don’t know what the future will bring. For now though, I am proud of the opportunity I have been afforded by the Trust I have moved to, and I hope I can continue to stay healthy and serve women until I (finally) qualify.