C/O Jessica Yang
How nursing fails to accept and equip a diverse range of students
In Canada, healthcare is a highly selective field to pursue. Unfortunately, within such a selective process of selecting students, the student body is not fully representative of the population it’s supposed to help.
Tsinat Semagn, the president of the Canadian Black Nurses Alliance McMaster, shared how the small number of Black students present within her nursing cohort at McMaster leads her and her Black friends to become hyper-aware that they are among the only Black students in the program.
Nursing students participate in care scenarios three to five times per semester depending on their classes. Yet, within her three years as a nursing student, Semagn said that only once was a Black person used for these kinds of case studies.
“A lot of these scenarios are white people. There are a few Indigenous people but you rarely see diversity. There are very, very few Black patients represented in these care scenarios. I think I can only remember one time where we actually had a scenario, in my entire three years and we do three to five per semester, every semester . . . A week ago I did my first Black patient,” said Semagn.
Over a long span of time, these disparities in learning can lead to disparities in the healthcare provided to Black patients.
“In healthcare, there are studies that show that white physicians and healthcare professionals have this perception of Black patients, that Black people are stronger [and] don’t experience pain the way that other races do. So that of course affects their care,” said Semagn.
Within the health sciences program, to encourage equitable admissions, McMaster created the Equitable Admissions for Black Applicants process. It allows for self-identifying Black students to have their applications processed by a panel of Black faculty members, alumni and students. This came to be implemented because the faculty of health sciences noticed that black students were underrepresented in the program.
However, an admissions process like the EABA is not offered to nursing students. Moreover, nursing is one of the only faculty of health science programs that do not have a supplemental application.
“On top of [grades and the CASPR test], having a supplementary application where we are talking about life experience and bringing more of us and what we have to offer . . . being able to articulate that as a written [component] would be beneficial. They can see that this person has a lot to offer,” said Semagn.
Semagn noted that McMaster doesn’t promote a lack of diversity on campus. Instead, the university only mentions there are ways in which they can improve and allow for a more diverse atmosphere.
“I don’t know if I could say that I feel like McMaster as a whole is adding to [racial biases in the education system]. But I do know that there are some things that they are not doing — that they should be doing — to promote diversity,” said Semagn.
Programs like nursing at McMaster serve as an example where Black students are disproportionately underrepresented. In a field where lived experience affects patient care, lack of diversity fails to prepare them for the populations that they will meet in the future. It is up to universities, to decide to listen to the students and patients around them to better the systems they have created.
C/O Rosie Merante
The Silhouette: Please introduce yourself.
Rosie Merante: I'm Rosie Merante. I'm doing nursing at McMaster [University] and it's just the basic Bachelor of Science for your RN [Registered Nurse certificate]. I've had placement every semester, except for one that got pushed to the summer because of [the COVID-19 pandemic]. But I've been in placement for the full three years. . . First year I was in long-term care, second year I was at Joseph Brant [Hospital] in Burlington and I was in the orthopedic surgical unit. Then I had Idlewyld Manor for long-term care. I was in the secure unit there, so it was kind of the [more agitated patients] with dementia or Alzheimer's. Now I'm [in] mental health and forensics.
What do you do [in that placement]?
I just started last week . . .but I got a really good grasp because I was there for 14 hours. Those are the shifts once a week. It's not as much physical head to toe assessment that I would have [done] last year because it's more focused on mental health and these patients have been there for a long time, years even. . .But the majority of it is vitals, doing rounds. It's high security. We have to watch them since they're all coming right from the court system and they weren't deemed fit to stand trial due to their mental illness. It's mostly just that and then most of the assessments we do are mental status examinations and things along [those lines]. We're making sure that they're not going to be a danger to themselves or others and that they're taking their meds and everything's okay.
Do you know how it would have been different if it weren't for COVID-19?
I think now that the regulations are lifting, I'm already noticing some differences from my past placements. We no longer have to wear face shields or get tested every other shift. One thing that I noticed is relationships with people. Obviously, with the pandemic, people are still always going to be paranoid about getting close together and having visitors. So the visiting policy is way restricted right now. They allow one visitor per day for each patient but it's still a big difference from what it was before. I think that's such an issue, especially for mental health. I feel they should lessen the restrictions or increase the amount of visitors allowed because these people are already going through so much, and even if a lot of them don't have family or friends, the ones that do and can receive that support. I feel it would be as beneficial as medical treatment if they could actually see people they love and care about. A lot of them are depressed too because they can't really go out as much and do things that they used to. And they're confined [and] they get privileges to go out, to go around the hospital, to go outside to do things if they're on good behaviour. There's obviously a lot of precautions we have to take but they're allowed to leave. And now, with [COVID-19], that's reduced a lot. A lot of them just end up at the front desk and they're like "Do I have my privileges? Yeah? Look, I want to leave. I'm so bored." That's also kind of what I noticed. At least in the mental health aspect, I think the biggest impact is on the visitor policy . . .At the long-term care homes, I was at three of them, I noticed a big shift with [COVID-19] because of the visitors, privileges to go outside, and for even people from outside to come in and do activities with them, as well as just the residents being close around each other, it's not as good as it used to be. There's a lot less socializing and togetherness, there's a lot more confusion because they don't necessarily understand what's going on and that actually increases some of their behavioural symptoms. They can be very agitated because they don't fully understand why they need to wear a mask, why they need to stay inside, why certain people can't come in [or] why their family stopped visiting. It's hard for them to grasp these concepts on top of the memory loss. That's also what I noticed at some long-term care placements. I'm seeing, just observationally, what seems to be a higher incidence of depression in the elderly.
Is there anything that you're really looking forward to in your current placement?
I'm really looking forward to getting to know [the patients]. The patients aren't in and out, they've been there, so knowing their stories, knowing them more personally, so I can help care for them better.
Do you have any big takeaways from your experiences in your program or your placements?
I don't know, there's so many of them. One of them is to treat the patient or think of them, not in an unprofessional way, as someone from your family or as a friend. Be empathetic. Remember that they're not just a patient. They're a person with dignity and they're your client. It could be your mother, your grandmother. You need to treat them with respect and dignity. I know that the culture of long-term care homes, at least, is very poor quality care. They [the patients] need so many more RNs and [personal support workers] so that they can be more valued and treated with more dignity and respect.
Nursing students are struggling to meet the challenges of COVID-19 and aren’t receiving much support
By: Maxine Juneau, Contributor
There is no question that the shift to online classes and the COVID-19 pandemic have hit students hard this semester. Many are struggling to adjust to the new format and keep up with the course expectations despite the inability to access in-person student support and resources. Nursing and midwifery students are in an especially unique position this year as many continue to have in-person clinical placements.
At the start of the pandemic, there were questions on whether or not nursing students would proceed with in-person placements. With practical skills and patient interaction being such a vital part of the program, many students questioned if we would even be able to meet program requirements without clinical experience. More questions arose as other nursing schools across the province announced that they would be transitioning to virtual placements.
However, the Faculty of Nursing at McMaster University moved forward with level three and four placements starting on schedule in the fall term and level two placements starting in the winter term. While many students are grateful to have the opportunity to work on the frontlines, others are struggling to meet the challenges and stresses that COVID-19 presents.
In a recent Spotted at Mac post, an anonymous nursing student asked if anyone else was feeling uncomfortable about in-person clinical placements with COVID-19 cases spiking. They expressed how they were worried because a classmate had recently caught COVID at their placement.
While these fears are perfectly valid, fellow nursing students and recent graduates were quick to remind them that they had “signed up for it.” Many replied with comments such as, “well, as long as you wear your personal protective equipment, you will be okay.”
These kinds of comments that say this is “part of the job” are dismissive of the ways that COVID has negatively impacted nursing students. They don’t even begin to recognize that some students may not have a choice in whether or not they can take a semester off. While as students we decided to go into the semester knowing that COVID would be a factor, nobody could have predicted the different ways that it has impacted us.
This pandemic has affected the mental health of many students, including nursing students. Students are worried about catching COVID at clinical and passing it along to their family and friends. They are also worried about accidentally bringing it into the clinical setting or passing it between patients and why shouldn’t they be? They are seeing friends and family catch it, they are seeing patients suffer from it and they are seeing outbreaks on their own units.
Students are worried about catching COVID at clinical and passing it along to their family and friends. They are also worried about accidentally bringing it into the clinical setting or passing it between patients and why shouldn’t they be? They are seeing friends and family catch it, they are seeing patients suffer from it and they are seeing outbreaks on their own units.
Clinical anxiety is something that many students experience even during a normal year. Lying awake in bed the night before not being able to get a wink of sleep, feeling like you’re going to throw up from nerves when you step on the floor. Even having to take a deep breath to slow your heart before going into a patient’s room are all normal parts of being a nursing student. Now, the fears and anxieties of COVID have been added on top and students are struggling to cope.
Even many registered nurses these days are struggling to cope with the stresses of COVID-19. The International Council of Nurses recently reported that nurses with COVID patients suffer from burnout and psychological distress. Many health care workers, including health science students, have had to face the pandemic while also self-isolating from friends and families. Even with all the public support for health care workers, there is no denying the mental health pressures this pandemic has brought.
Yes, masks help. Yes, we made the decision to go into this semester. Yes, it is part of the nurse’s role. Still, we are nursing students first and foremost. Many of us are still learning to cope with the pressures of the clinical setting. Many of us are still just trying to keep up with classes. Now, we are being asked to put on a brave front and face the pandemic head-on? Nursing students are struggling to meet the challenges of COVID-19 and more needs to be done to support them.
To any nursing students that are reading this, I want to let you know that you are not alone. Any fears and anxieties you may be having are completely valid and there are many of us who stand beside you. If you ever need someone to talk to there are resources out there for you. We are all in this together and never feel afraid to reach out!
Mental health resources:
→ Good2Talk — https://good2talk.ca/
→ McMaster University Student Wellness Centre — https://wellness.mcmaster.ca/
→ Wellness Together Canada — https://ca.portal.gs/
→ Barrett Centre for Crisis Support — https://www.goodshepherdcentres.ca/services/barrett-centre-for-crisis-support/
The Canadian Council of Registered Nurse Regulators is facing backlash after moving to an American practicing nurse licensing exam called the National Council Licensure Examination last January. All nurses are required to pass the licensing exam in order to begin practicing. These changes were brought forward because the CCRNR wanted to move to an online system with the NCLEX. However, this marked the end of the Canadian test, the College of Nurses of Ontario Registration Exam.
Carolyn Byrne, the Associate Dean and Director of the School of Nursing, is among those pushing for reassessment.
“We are the only country in the world, excluding the United States, that uses an American exam. [There was] no discussion about this, it was just announced that it was going to happen.”
Those who wrote the exam for the first time struggled with the American adjustments to the test, including the use of the generic names of drugs dominant in the U.S. and the use of the U.S. imperial system instead of the Canadian metric system.
Due to this gap between U.S. and Canadian convention, there was a drop from an average pass rate of 90 percent to 72 percent across Canada. This fall is indicative of a similar decline in the number of people who achieved a passing grade, with a drop from 94 percent to 85 percent for McMaster students.
“It’s very upsetting, you know? These are bright students,” said Byrne.
When asked about if there is a capacity for change with the CCRNR, Byrne said she does not know.
“But we are certainly fighting back. We did have a conversation with [the CCRNR] but to me at this point they’re not prepared to change anything.”
The Bachelor of Science in Nursing degree will not change their curriculum to suit the exam, but there has been an overwhelming response to support the students.
“In [Ontario] students only have three chances to write an exam. In the States sometimes they can write forever. We are trying to make changes. We would like a Canadian exam [but] I don’t know if we will get that. If we use NCLEX for the rest of this year, we would like to give students four chances to write rather than the three, with the fourth one being free. Say none of this changes, we are putting in special workshops to help the students learn how to write that exam,” said Byrne.
Photo Credit: School of Nursing
McMaster’s School of Nursing has helped to set the path towards significant developmental aid for Hamilton youth, but this initiative is at risk of losing funding by the New Year.
The program, called Primary Care for At-Risk Youth, has been providing nursing services in the local high schools of Hamilton. Once a week, a nurse practitioner along with several third-year Nursing students, offer their services for half a day at Sir John A. MacDonald and Cathedral Secondary School.
The results of such a program have been clear, with as many as 15 students seeking attention every hour. Larissa Glover, a third-year McMaster Nursing student involved with this initiative, has noted that the numbers are set to increase, “with more and more students learning about the centre.”
At Sir John A. MacDonald, one third of the student population is without family doctors, and 50 per cent of the students do not speak English as their first language.
Dyanne Semogas, an Assistant Professor in the School of Nursing and a project leader, stated, “ESL significantly influences access to healthcare, and the Hamilton Center for Newcomer Health, [a joint initiator of the program], is one of those places that sprung up with a grass roots approach to addressing gaps to health services for newcomers.”
The Primary Care for At-Risk Youth initiative attempts to forge bridges between immigrant students and healthcare resources within their own community. Semogas explained that in many families stricken by poverty, some students are still unable to fully benefit from their services if the link between their help and overall community resources remains vulnerable.
Because nutritious food is often unavailable in low-income communities, if students are prescribed antibiotics that need to be taken with food, they may take it with unhealthy food. As a result, the program can also provide supplementary nutritional resources that will benefit the students beyond their immediate concern.
The need for readily available access to healthcare within inner-city high schools is pressing, and this is precisely what drove McMaster’s School of Nursing and local Hamilton school boards to begin the talking about how to build a program that addresses youth health.
Semogas previously stated that, “Studies have shown that youth having access to health care in schools are more likely to stay in school.”
The benefits of the initiative extend beyond the scope of the high school students to the very students behind the desk – McMaster nursing students are able to gain valuable experience towards their future practice. “Any place where you can interact with the population is really beneficial,” says Glover.
First-year Nursing student Emma Carscadden re-iterated the program’s importance.
“In the past there were nurses in most schools, and it’s a shame that nurses have been taken out of these important roles. I hope that this initiative will be successful, as nurses have a vital role in promoting healthy lifestyles and choices to children who need it.”
Despite the program’s progress and its considerable role in providing youth health services, funding is set to end in December. Semogas and Glover remained hopeful about the potential fundraising opportunity offered through the Aviva Community Fund, which contributes $1 million to Canadian projects that enable positive change.
With several qualifying rounds, the Primary Care for At-Risk Youth initiative has made it to the semi-finals. However, the future still remains tentative. “Some programs have crazy numbers of votes, up in the thousands, and they may outbid us,” said Glover, “but I am really, really hopeful for it.”
Assistant News Editor
What’s hotter than a nurse? A male nurse. What’s hotter than a male nurse? McMaster’s Nursing Health Services Research Unit (NHSRU).
On Nov. 3, the provincial government’s new Chief Nursing Officer, Debra Bournes, extolled the NHSRU for their efforts in pioneering undergraduate research with the Undergraduate Student Research Internship Program (USRIP) at an educational showcase event hosted by the Faculty of Health Sciences.
For twenty years, the NHSRU has held the USRIP as an opportunity for undergraduate students to delve into healthcare-related research.
Each year, under the funding of various bodies such as the Canadian Health Services Research Foundation and the Ontario Critical Care Secretariat, two or three students from a variety of undergraduate levels are involved in research that centers around both patient care and public health policy.
It was only in early November of this year, however, that the program was analyzed and subsequently deemed a success.
To come to this conclusion, the initiatives of the program, from how to best build and sustain the nursing efforts to how to enhance a student’s research skills through education, were assessed in an evaluation entitled, “Preparing Tomorrow’s Leaders Today: Investing in Capacity Building for Nursing Health Services Research”.
After applying the document’s framework, which is an assessment strategy to foster capacity building, it was determined that the USRIP is both a valuable and a cost-effective approach to building research capacity.
In addition to this, the variety of funds granted continual insurance and enhanced the ability to invest in future healthcare leaders through the program itself.
“The program exposes students to what they would not get exposed to during their academic experience,” said Andrea Baumann, scientific Director of the nursing research unit.
“Students get the opportunity to meet those in high-level civil services in health and education. They get exposure to bureaucracy and clinical management, which they wouldn’t get in school per se. We thought it would be good if they received those types of exposures during their university experience so they get certain generic skill sets such a writing, ability to do research, ability to critically analyze material.”
She continued, “I only wish that undergraduate research was very common. So far, it isn’t.”
Perhaps, though, the success of the program, where both the researchers and leaders of tomorrow are being built, may serve as a stepping stone for such innovative opportunities for undergraduate research.