Nurse practicum payment: A long overdue promise of equity

The budget promise of financial support for the nursing practicum (the ‘Prac Payment’) by the Australian government is welcome, but long overdue.

The government’s delayed response to ongoing calls from peak nursing and higher education bodies to redress the situation of the unpaid practicum has contributed to an inequitable situation in higher education and the nursing workforce, as well as the suffering of individual nurse students and their families.

A key aim of the Australian government’s Higher Education Participation and Partnerships Programme is to promote equality of opportunity in higher education, including access, participation and degree completion for students from a low socio-economic status (LSES) background, as well as other socially disadvantaged groups, including Aboriginal and Torres Strait Islander students and students from rural and isolated areas.

Nursing attracts a comparatively high proportion of students classified as LSES, as well as students from the other equity groups listed above – who often also fit within the LSES category. Students from LSES backgrounds are, however, less likely to finish their undergraduate degree compared to their middle and high socio-economic status peers. For LSES students, financial issues impact significantly on this outcome.

Financial obligations

Although university students from all social backgrounds are increasingly reliant on income from paid work (86% in 2023), LSES students undertake proportionally more hours to meet the financial demands on them.

As more and more mature-age women enter nursing degrees, these financial obligations increasingly include unavoidable caring and household expenses.

The nursing practicum represents periods during the degree when the student cannot engage in this essential paid work. Unlike many other university degrees, nursing includes several mandatory and assessed full-time practicum placements. These are unpaid and run for a minimum of 800 hours across the degree.

As well as loss of weekly wages, students with dependants must contend with childcare costs and fund transport and parking to and from placement.

The lack of practicum placement availability means some students must travel long distances to access a placement, adding to travel costs, while some face accommodation expenses during this period. This situation can be untenable for those on a lower income.

A range of harms

Research undertaken at a Western Australian university just before the COVID-19 pandemic explored the nursing degree experiences of undergraduate students. This study found a situation of “practicum poverty” where the financial demands of this part of the degree were associated with a range of mental, physical, social and financial harms to the student and their dependants.

Participants described the practicum as an acutely stressful period resulting in interrupted degree progression, lower grades and dropout among dedicated individuals. Participants also reported relationship difficulties with their partners, which for some led to irrevocable breakdown of the family unit. Students with dependent children and families employed in low-paid occupations were especially affected.

In Australia, the current average full-time weekly income is AU$1,888.80 (US$1,260). Given that university students work an average of 12 hours (full-time students) and 30 hours (part-time students) per week, it is uncertain if the proposed means-tested Prac Payment will be sufficient to cover lost income as well as childcare and transport costs associated with the practicum placement.

The impact of the Prac Payment for LSES nurse students must also be considered against wider study-related costs, including annual university fees of approximately AU$4,445 (US$3,000), with additional outlays for compulsory vaccinations, medical tests, police checks, etc pushing the figure up further.

International nursing shortages

A comparison of the response in the United Kingdom to practicum financial stress is interesting. Here, prompted by ongoing nursing workforce shortages, the UK government has removed university fees from the undergraduate nursing degree for domestic students, and now provides a £5,000 (approximately AU$9,500 and US$6,350) annual living cost bursary (non-repayable) per year of study (full time).

Also available is a means-tested parental support payment of £2,000 (approximately AU$3,800) per student per year to help with childcare costs and a potential £1,000 (approximately AU$1,900) available to help towards additional travel and accommodation costs to clinical placements over normal daily travel costs.

Like the UK, Australia is also experiencing a nursing shortage, with the Universities Accord recently announcing that an additional 533,400 healthcare professionals will be needed by 2030 to meet the needs of Australia’s growing and ageing population.

Whether the Prac Payment will help to achieve this goal is debatable, with other issues, such as the lack of sufficient quality placements and accommodation for students on rural placement, being important limiting factors.

What is certain is that without meaningful redress, the unpaid practicum will continue to pose inequitable challenges for less privileged students that will threaten their degree success and well-being. This ultimately contributes to an unrepresentative nursing workforce with an insufficient breadth of skills and life experiences to meet the needs of an increasingly diverse Australian population.

Dr Lesley Andrew is a senior lecturer and AdvanceHE fellow at Edith Cowan University, Australia.