Nursing Students Are Being Treated As Healthcare Professionals, McGill ISN Students Say

Undergraduate students in McGill’s Ingram School of Nursing report high pressure and overwhelming expectations during the pandemic

*all names have been changed to protect anonymity

Since the beginning of COVID-19’s spread in Montreal, undergraduate students in the Ingram School of Nursing (ISN) have been facing a far different educational experience than they originally anticipated. Unlike most other faculties at McGill, the ISN did not extend the winter reading break – classes continued online, and in-person clinical placements began again in the summer. Since then, Nursing students say their Fall semester has been marked by uncertainty, poor communication, and a discouraging lack of support.

“Nursing never actually stopped classes,” Jamie*, a U3 Nursing student, tells the Daily. “We knew even less about COVID back then and we never got a break.”

Jamie, along with several other nursing students who spoke to the Daily, identified major issues with how the semester unfolded. Despite the fact that they are barely halfway through an education that they are paying the university for, McGill is treating nursing students as paid professional healthcare workers – minus the security of a union.

“We’re still students; we’re adults, but we’re undergraduate students.”Jamie, U3

“Begging” for information

In August of 2020, when most other McGill students were preparing for their first full semester online, ISN students were “begging to be [told] if clinicals were going to happen in person or if there would be any required presence on campus.” Mass emails sent by McGill administrators contained little to no information specific to the ISN program, leaving nursing students without answers, several told the Daily. Eventually, lower-year Nursing students had their schedules grouped into four “blocks,” allowing for smaller clinical cohorts in compliance with COVID regulations at teaching hospitals.

Students described this randomly ordered block structure as jarring and stressful. Rather than having 4 classes a week throughout the semester, students had to complete one class at a time during each block, separating theory and skill-based classes from hands-on, in-person requirements. Students were made to complete three blocks online, and in the remaining block were assigned to units in hospitals where they would complete their clinical hours 5 days a week. The Daily’s sources explained that this schedule required Nursing students to both finish their courses in a shorter period of time than usual and spend much more time in the hospital consecutively than ever before. The semester’s structure left students feeling unprepared for accelerated clinicals and overwhelmed with their coursework – factors that are all exacerbated by the stress of the pandemic.

Example U2 nursing student schedule

Because theory-based courses and lab blocks would be held online, whereas clinicals placements continued in person, each students’ presence on campus would be required during one of four possible periods. Though this ensured that students would be able to complete their full semester while adapting to the pandemic, it also meant that students were unsure if, and when, they would be needed for in-person clinical placements. “Students didn’t know if they had to return to campus or not until the very last week of August,” Jamie explains.

“[Most of] the emails over the summer […] didn’t really apply to us because we are in a very different situation,” Maya* (U2) tells the Daily. “But then the emails sent by [the ISN] were equally vague. They sent us the email that we were going to be in person, what, two or three weeks before school? It was pretty short notice. It all felt very rushed and not totally coherent, just very vague.”

These unclear, last-minute emails made it difficult for students living outside of Montreal to find a place to live and plan for their return in advance. Laura* (U2), was one such student; before she was told that her clinicals would start in November, she had already signed a lease and booked a plane ticket back for earlier in the fall. “It was very uncertain – things were kind of last minute and I feel like it’s a bit unfair, especially for people who are not from Quebec,” Laura tells the Daily.

Structural changes reveal difficulties

Nursing students also reported frustration with the structure of the semester itself. “It seems like the main point of our degree has kind of been taken away,” Maya tells the Daily. “All of our classes are really very interaction-based, like we do a lot of group work or working in teams. Last year we were always […] talking to lots of different people we don’t necessarily know, and getting to work with them was probably what I liked best. Clearly that’s mostly been taken away, which is not the fault of the administration. It’s no one’s fault, it’s how it has to be. But [it’s] just such a big drastic change in how so many of our classes look, and I think that’s been the most difficult thing for me.”

“I do worry that I’m going to graduate with skills that are not comparable to others,” Jamie says, expressing concern that she will not be able to retain what she’s learned this semester. Talia* (U2) echoed this sentiment. “Learning the material myself has been really challenging, and I feel like I’m just doing the lectures to have them done. I’m really worried about when the information comes up again later in the degree or in my career that I’m going to be like, ‘Oh, wait, that was from the pandemic era. I don’t remember it.’”

No support, no relief

Several students who spoke with the Daily say that their experiences in the program led them to seek support which they ultimately did not receive.

Speaking to the Daily just before her final block, which happened to be her clinical placement, Laura expressed a great deal of anxiety about her exams. They had been pushed back only a few weeks to compensate for classes she missed due to medical leave taken when she contracted COVID-19. Her exams were rescheduled during the first week of her clinical rotation, with no options for further extensions. Other students echoed this struggle with inflexibility and an overall lack of understanding of their needs for accommodation.

“The consensus, I agree, has been like ‘this is a hard year and we’re here for you.’ But aside from, solving the pandemic, I don’t really know how much can be done.”Talia, U2

Around halfway through Fall semester, Laura contracted COVID-19 while she was doing online courses from her apartment. Both of her roommates, also Nursing students, were in different blocks, meaning that one was attending clinical rotations while Laura studied at home. When her roommate contracted the virus from her time in the hospital, Laura got sick as well. Getting COVID in a small student apartment, Laura explains, was a “whole lot of trouble.” Only one of the three roommates tested negative, which meant that Laura and her roommate had to try to isolate themselves from common spaces.

On top of the complications that come with contracting COVID, Laura says McGill’s lack of support made her recovery much more difficult. According to Laura, she was instructed by her lab coordinator to check McGill’s administrative website to see what she should do or where she could access help, but it “didn’t specifically tell [her] anything.” Though she looked for COVID-specific support or relief for students, Laura says McGill offered none – leaving her to figure out food, medical care, mental health support and her academics on her own. “I couldn’t go get groceries for myself […] I was just so overwhelmed,” she told the Daily. “I didn’t know what to do until my friend who also got [COVID-19] told me to report [my positive COVID result] on Minerva.”

Though Laura has recovered and is feeling better, she says she wishes McGill offered more specific support for students who contract the virus – she described the designated university website as unhelpful and difficult to navigate. Throughout her illness, Laura says the University reached out only once – not to offer accommodations or support, but to get statistical information for contact tracing.

For Laura, contracting COVID-19 during her semester was an overwhelming experience that she says still stays with her. With her own clinical rotation coming up, Laura is worried about her condition. “I’m more sensitive to my symptoms now. When I get stressed my heart rate goes back up and I have difficulty breathing, and I’m like oh my gosh is it coming back again. Once you experience it, it’s really hard to get it out of your head.”

Burnout beyond the classroom

For Maya, concerns lay not with her safety from COVID-19, but with her stress levels during her clinical placement. “I found the [hospital] floor here was pretty calm, pretty safe, they have enough PPE for us and everything – [safety] wasn’t really an issue,” she explains. But she found that her anxiety during her clinical block was “ten times higher than it had been in the past” and became a significant barrier to her learning experience.

As U2 students adjusted to an accelerated clinical schedule, Maya’s experiences were not uncommon. Before the pandemic, the Daily’s sources report, clinicals would occur once a week alongside students’ other classes. Now, Maya and her peers are at the hospital 5 days a week – thrown into busy and hands-on shifts where they must “show what they know” for several weeks straight. “Going from [once a week] to five days a week for four weeks straight, especially after eight, nine months [of] not being in the hospital was kind of insane,” Maya says. “I felt very ill-prepared and I felt like I basically forgot everything from before, like I was kind of going in blind and basically with no knowledge.”

However, Maya’s anxiety and difficulties on shift were not met with support. Instead, she faced even more pressure from her supervisors. This came as a surprise to Maya, as she says the School seemed to be supportive at first. “They told us, ‘You guys can take a day off any day you want because we know this is going to be difficult.’” Midway through her rotation, as evaluations began, Maya’s concerns and her struggle to work through her anxiety were brushed off, and she was told it may jeopardize her progress in the program. “I got this sense in my evaluation that was like, ‘You should work on your mental health. Your knowledge is good when you have good days but when you have bad days, it’s awful.’ It felt like a completely different side of what they were saying before. They start out with, ‘We understand it’s going to be so hard,’ but then at the end they’re like, ‘Oh, it was hard for you. That sucks.’”

“I have never felt, especially this year, that the administration has actually truly considered the implications for mental health, for isolation”Laura, U2

Talia echoed this sentiment, emphasizing the overwhelming stress that many Nursing students have been feeling. “I did notice there was a lot of burnout and I felt that I was plateauing in what I was able to learn.” As the semester went on, Talia says she was “just trying to get through each day and passively trying to get through the shifts.” “I think I would describe it as information overload.”

Both Maya and Talia agreed that the first two weeks of clinicals seemed to go well, but by the third week, Maya could “feel [herself] starting to shut down.” Allowed a few days off, Maya took a mental health break to cope. As her fourth week loomed closer, Maya says she realized that she couldn’t take another day off, and that there was “nothing [she] could do.” “My mental health was so bad by the end [of clinicals], that I was just completely burnt out.”

The need for flexible accommodation

In such a complicated semester, the Daily’s sources say that instead of offering support specific to their needs, the University encouraged a mentality of “just pushing through.” Laura, who did manage to speak to some administrators about her experience, expressed frustration with how difficult student advocacy is in the Nursing program. “It’s hard to continue [the advocacy] process when you’re going through stuff so quickly and you don’t have the time or the energy to stay back and advocate. There’s just no time.”

“I have never felt, especially this year, that the administration has actually truly considered the implications for mental health, for isolation,” Jamie agrees. “And I still think they’re asking students to do too much.”

“Since we’re the ones going into hospitals, working with these patients, […] there should be a lot more support,” Laura tells the Daily. A major part of this support, Nursing students say, includes being given more time off – the same amount of time given to other faculties, at the very least. In December, when the winter break was extended for most other faculties, McGill singled out Nursing students and other life science programs as exempt. “I feel like they say a lot about how they want to be there for their students,” Talia explains. “I’m not saying it’s empty words, but it’s been an exceptionally hard semester for everybody, and it’s a marathon, not a sprint. So I think people need to have the opportunity to take a break.

This was especially important for Jamie, a student in U3. Due to family illness, Jamie wanted to go home not just to have a break from the hectic semester, but also to spend crucial time with her loved ones. Jamie spoke to the administration, explaining her situation asking for extra time off – just enough to return home and self-isolate once back in Montreal. But the administration suggested that she get a medical professional to excuse her based on her mental health, which Jamie “repeatedly said is not [the issue].” “I shouldn’t have to prove that it’s beneficial for me or any student to go home over winter break. I shouldn’t have to prove that it’s detrimental for any student to be trapped in a city alone because of restrictions. I shouldn’t have to have a note to prove that.”

Jamie was not the only Nursing student with this issue: an email sent out to the ISN program on October 20, 2020, asked students to “seriously weigh the possible risks that may be involved in traveling,” implying that they were encouraged not to leave the city. The email also stated that “the [ISN] will not be able to accommodate students who were unable to meet the self-isolation requirements before the start of their Winter lab and/or clinical courses and this can result in significant delays in your course of study,” meaning that if students were to travel over the break (which did not include sufficient time for self-isolation), no accommodations would be made. Though the email cites red zone traveling guidelines as the reason for this restriction, there seems to be a tacit understanding that the health of Nursing students’ potential patients is more important than the students themselves.

Mounting expectations

Although they are not yet professional nurses, Jamie feels that students in the ISN program are being treated as such. “[Just because] students signed up for a professional degree does not mean that they should be treated like professional working adults. We’re still students; we’re adults, but we’re undergraduate students.”

Jamie, like other U3 Nursing students currently in externships were not afforded time off for the holidays at all. Jamie explains that many externships are placements in hospitals to supplement nursing staff, which is especially needed during the pandemic. “The only reason that [the externships] are happening is that it’s much cheaper to get the labor of a student than actually hiring nurses because you can basically have them do almost the same duties as a nurse, except for a lot cheaper.”

Over the holidays – a time when positive cases and hospitalizations skyrocketed in Quebec – McGill’s nursing externs have had their placements extended in order to allow Registered Nurses (RNs) in Montreal hospitals to take time off. Nursing students have been swept up in the wave of urgency to suppress the virus, leaving students like Jamie “very, very stressed out.” “They’re hiring students instead of RNs to work,” she tells the Daily, That’s a huge responsibility that I’m feeling now.”

I have never once received a thank you or a spotlight from McGill nursing programs or the Faculty of Medicine saying thank you for doing this.”Jamie, U3

Jamie says that she hasn’t really had a chance to catch her breath since before the pandemic. “It’s been challenging because I think most nursing students, at least in U3, did work in the hospitals over the summer. So it was isolation from your family, your friends, I didn’t have any contact with barely anyone for months.”

Going into the Winter semester, Talia adds, this mounting pressure will continue. “After winter break, we’re going to be in school straight until the end of June, because we have a double summer clinical. So we go straight from the Winter semester right into that.”

A dangerous lack of transparency

McGill’s lack of transparency and communication with Nursing students and the broader McGill community is concerning. Despite anecdotal evidence of at least two separate outbreaks amongst ISN students as a result of clinicals, McGill has maintained in several mass emails to the student body that the only cases of COVID-19 contracted “on campus” have been in residences. Though hospitals are not technically “on campus,” clinicals are mandatory components of Nursing students’ degrees that put them directly in harm’s way. 

In an email to the Daily, Dr. Anita Gagnon, Associate Dean and Director of the Ingram School of Nursing, stated that “no student testing positive for COVID-19 has ever, under any circumstances, been forced to attend their clinical internships or lab courses, nor have they been forced to attend their clinical internships in clinical settings with reported outbreaks of COVID-19, nor will they be.” Though students did not report being explicitly forced to attend clinicals, it is clear that mandatory completion of these assignments has directly resulted in several students contracting COVID-19. When asked why contact tracing data from the ISN is not being made public, Dr. Gagnon replied that “divulging students’ COVID-19 statuses would be a breach of confidentiality, and contact tracing is not in the purview of ISoN – it is managed by the University centrally and provincial bodies, on whose behalf we are not in a position to comment.”

Jamie adds that “There haven’t been any sort of emails, or any resources sent out for students that have had to pause [their classes] because [they got] COVID or don’t know the process [for self reporting]; not even a list of testing centers or anything like that,” a claim which lines up with Laura’s experiences. Town halls – a resource touted by McGill as an outlet for complaints – have been a dead end, despite student grievances. “At the last town hall, we asked for [biweekly communication] in September,” Jamie says. “Since then we have never, ever gotten any biweekly communication.”

In light of this exhausting semester, Nursing students say that, above all, McGill’s expectations are too high and students’ responsibilities are too great – especially when set against the lack of support and understanding from the University. “A lot of our professors have been saying, ‘Well, you know, you’re a Nursing student. You’ve signed up to be a nurse who is called to act in times of public health crises,’” Jamie says. “I think it’s very important for the administration to acknowledge that we are still students and we should not be left without support or resources like this.”