Maria’s story

Maria’s story highlights how incredible health challenges can be overcome and have not stopped her achieving her ambition to become an adult nurse.

“It’s taken an awful lot for me to come back and finish my degree which I really, really, wanted to do.”

Maria had her diagnosis confirmed in the second year of the course, this is often a challenging time for students in any undergraduate programme, even those without specific health challenges. Maria reconnected with her ‘why’ to remember her motivations for starting the course to help inspire her to continue. This can be a useful exercise for any student; simply writing a short summary explaining ‘why’, considering motivations for joining the profession, the value this will bring and crucially, what change they are trying to make in the world.

“When you are going through something like that you cannot cope with it on your own…you need your support network, you need your family and your friends… you need your lecturers to support you… Even if it’s just chats about how you are getting on day to day with normal basic things rather than academic things… that is what really helped me…”

Maria’s story highlights the importance of a support network when experiencing health challenges. For Maria the effectiveness of this was related to the diversity of that network (both closer family and friends and university lecturers) but also the nature of the support. Maria notes that the small ‘normal’ chats really helped and sometimes these can be missing for healthcare students. When in employment, there would ordinarily be more communication, perhaps a ‘collection pot’ and a supportive gift sent and regular check-ins from colleagues. Students in a similar position, however, may not be acknowledged in this way by peers or placement staff and this can be isolating.

“I asked to go back in July and do a placement to build my strength… the fatigue was enormous … so I went back and gradually built my hours up. I went to occupational health, and they advised what I needed to do.”

Maria benefited from a break in her learning, often referred to as ‘intercalation’ and when planning her return with occupational health services, negotiated increasing placement hours over time as she regained her health. Students may not be aware of adjustments such as these that can be made to support them and might assume that if they cannot continue with the course their only option is to withdraw, or instead perceive placement as set rigidly into 12.5 hour long shifts when there is usually a great deal of flexibility in this to support students back into placement.

Resources for course teams

Considerations for academic teams

• how do you support students specifically in the 2nd or ‘middle years’ of programmes as they lose some of the novelty and enthusiasm from the first year but still feel far from the finish line?
• how can you timetable or otherwise routinely schedule opportunities for 2nd year students to be reinvigorated by remembering their ‘why’? This could be performed routinely as part of work to re-inspire and re-invigorate mid-programme cohorts as well as an activity to turn to at crucial junctures when challenges occur
• how are you facilitating students to create informal support networks within your course or module?
• how can we facilitate peer and tutor support to students who are unwell or intercalating when they are not on campus or in placement?
• how do course teams acknowledge, support and check-in with students who have a break in learning or those on longer-term periods of leave to ensure students still feel like they belong? What would you do for a colleague in a similar position? How is this different?
• are there opportunities for students to be part of practice-based networks? What might these be in the trusts where students are placed and how are these communicated to students?
• are students made aware of processes for agreeing reasonable adjustments and extenuating circumstances for both theory and placement? Are all staff aware of these processes?
• how do you agree with students how reasonable adjustments made because of health needs are shared with practice?
• how can informal networks and technology help cohorts to remain cohesive in your institution?
• publicising to students from the outset the mechanisms in place within the university for agreeing reasonable adjustments (for both theory and placement) are critical. Course team staff equally need to be familiar with internal processes for these

Tools for academic teams

• finding your ‘why’; publicised by Simon Sinek, an overview of his useful technique can be found on YouTube
• taking a form of self-assessment can also be a useful way to gather values and interests to focus on motivations, resources such as the NHS careers values assessment can help and be used with students
• using a strengths and challenges approach can help you establish students’ needs when discussing reasonable adjustments; national institue for health and care excellence (NICE) have guidance from within social care – search for ‘strengths and asset based outcomes’
• some further suggestions for facilitating peer-to-peer support networks are given at times higher education

(N.B. Links provided are accessible and correct at time of publication, August 2024, but are not endorsed by NHS England unless directing to an NHS England website or resource).

Resources for students

Considerations for students

• how can you prepare for the “2nd year blues” when you might have lost some of your early enthusiasm but still feel far from the end of your course? Rather than plan a holiday or treat at the end of your degree, consider moving this to the middle when we know things can get difficult for students
• reconnecting with your motivations for study can be a really effective way to remember your 'why' and keep you on track; re-read your the universities and colleges admissions service (UCAS) statement or application to university, remember how it felt when you received your offer for university, your first day on campus and your first day on placement. What made you pick this as a career?
• remember that information you disclose to the university about your health or circumstances will not automatically be shared with placement providers so you might need to start this conversation yourself. Try talking to your practice supervisor or practice education team initially
• if you have completed a form or agreement about reasonable adjustments with the university, consider using this as a basis for discussion with practice, otherwise practice staff may not be aware of any difficulties you are experiencing and therefore will not be able to support you
• think about how can you keep in touch with your peers (and with practice) while you are away? There may be schemes available at the university you are unaware of such as peer mentoring or buddy schemes for students in similar positions
• check-in with your personal tutor at regular intervals, they should also check-in with you but it is a two way street, they may not want to bother you with university info if you are unwell or undergoing treatment. A quick email can re-establish communication and reconnect you with what is going on in your course
• occupational health are not just there to test your blood before placement. Contact them with any physical or mental health concerns and they can work with you to ensure you are safe, supported and well throughout your practice placements
• health courses are never ‘all or nothing’ and many students will ‘step-off’ or ‘intercalate’ for a period of ill health or difficulty. Talk to your university, you may be surprised how many others are in similar situations or how common this is. You can return to the course at a later date when you are better or when life is easier
• if you have had a break in your studies, returning to practice may be a cause for anxiety. Remember that there is always flexibility with this and in conjunction with your course team you can agree a period of gradually increasing hours and responsibility, or hours that meet your health needs

Tools for students

• offers tips and resources to help students maintain motivation and manage the challenges of the second year. Visit the student minds website
• finding your ‘why’; publicised by Simon Sinek, view the overview by searching on YouTube
• taking a form of self-assessment can also be a useful way to gather values and interests to focus on your motivations, resources such as the NHS health careers values assessment

Resources for practice staff

Considerations for practice staff

• how can you support students who have health issues and are planning a break in their course? What would you do for a colleague in a similar situation? Students are part of the community too
• are there opportunities for students to be part of practice-based networks that already exist? What might these be where students are placed and how are these communicated to students?
• how are you aware of those students in second year who might be experiencing the 'second year slump'? How can they be re-invigorated or re-energised? How can you begin to give appropriate increases in responsibility to those students approaching their final year?
• remember students who have disclosed difficulties with the university may not have disclosed these to practice educators, supervisors, or assessors (and the university is usually unable to share details directly). How can you create safe spaces for students to speak to practice staff and disclose these if they wish?

Tools for practice staff

• findings from the capital nurse programme provide some insight into supporting second year student nurses but many of the concepts could be used in different healthcare settings
• lead by example: demonstrate openness by sharing your own experiences and challenges when appropriate. This sets a tone of vulnerability and trust
• access, read and consider how you can implement the ‘safe learning environment charter’ for students in your practice area, available at NHS England
• promote Psychological safety: Make it clear that all concerns and disclosures will be met with understanding and not judgment. NHS Employers have a guide on supporting psychological safety

(N.B. The links and tools provided are a selection of those available and should not be considered a conclusive list or endorsement by NHS England. Links are up to date at time of publication).