As soon as Lee arrived home, he rushed to the bathroom to wash his hands and dispose of the face mask he was wearing. He then scrubbed his hands with soap again, before jumping into a hot shower to clean himself thoroughly.
This has been Lee’s routine in the past three months since Hong Kong was gripped by the coronavirus outbreak in late January. The virus, which has infected more than 1,030 people in Hong Kong and over three million others worldwide, suddenly turned his part-time job in a Hong Kong hospital into a risky line of work.
The 23-year-old, who did not wish to reveal his full name, is a final year nursing student at the University of Hong Kong (HKU). He worked at the Queen Mary Hospital as a Temporary Undergraduate Nursing Student (TUNS).
While going in and out of a hospital seems to be fraught with danger, Lee said he was glad he had a chance to practice his clinical skills before graduation. Many nursing students in his year were not so lucky.
Nursing institutions in Hong Kong have halted the months-long practicum for graduation year students – also known as the “long consolidation” – after the Hospital Authority declared an “Emergency Response Level” in public hospitals on January 25 in light of the threat of the deadly virus.
The prolonged suspension of the final practicum has cast uncertainty over when students can graduate and attain their licences, as would-be nurses are required by the Nursing Council of Hong Kong to complete at least 1,400 hours of clinical practice during their five years of study.
They also have to take on a continuous practicum of no less than three months, before becoming a registered nurse.
Students could still work as a TUNS under the employment of the Hospital Authority, but those who were posted to high-risk wards — such as the isolation and respiratory medical units — were barred from working.
“We would have a lot more exposure during long practicum. Assuming that [a final year student] did not work as a TUNS, [they] would have been sitting at home for months. It is very easy to become rusty,” Lee said.
In late March, legislator Joseph Lee of the Health Services constituency wrote to the Nursing Council urging the organisation to address the issue of clinical placement. He said if the practicum remained at a standstill, it could delay the supply of manpower to both public and private hospitals, which have already come under strain during the outbreak.
In response, the Nursing Council announced in mid-April an exemption of up to 20 per cent of the total required minimum clinical training hours, with the new threshold being 1,120 hours, 280 fewer than before.
The requirement to complete continuous training was also waived. But institutions had to replace the exempted hours with “alternative modes,” such as simulation, to train and assess students’ clinical skills in different specialities.
The decision was met with mixed reactions within the healthcare sector, with some questioning the effectiveness of the alternative training methods and raising concerns over the capability of nursing graduates who would join the workforce in July.
Mr Ng (full name withheld by request) has been a registered nurse for nine years and has doubts: “This one-off arrangement is unprecedented. I think the biggest concern is whether the clinical skills of the students can really meet the standard when their practicum hours are reduced. Or would it lead to letting some graduates with inadequate skills into the workforce?”
The Pamela Youde Nethersole Eastern Hospital nurse said there was a “substantial difference” between using simulation and treating real patients, adding that the reduced number of practicum hours could put patients at risk.
“Just like when you’re learning to drive, learning it online and actually driving a car on the road is very different. If anything happens to the patients, will the Nursing Council be held accountable?” he asked.
In a reply to HKFP’s enquiry, the council said this was a one-off approval, only applicable to students who apply for registration or enrolment before the end of this year. In their application, students would need to state clearly the number of exempted hours and actual hours of clinical training replaced by simulation.
“The Head of School of Nursing should personally certify that the competencies of the graduates concerned have satisfied the Council’s requirements in support of the claim for qualification for registration or enrolment with the Council,” it wrote in an email.
Nursing students like Lee admitted that they would get more hands-on experience in a full practicum, and the replacement of clinical hours with simulation would not be as authentic. But they disagreed with claims that this they would be less competent in taking care of patients.
“Whether you’re a student nurse or a newly licensed nurse, everything that we do is backed by a rationale. We would not mess around and harm the patients,” Lee said.
Another nursing student surnamed Wong – who studies at the Hong Kong Polytechnic University (PolyU) – told HKFP that not all practicum experiences were enriching. Like many student nurses, she was only asked to perform basic tasks like recording body temperature and cleaning wounds, similar to the work of ward assistants.
“The work of student nurses is very different from that of the actual nurses. We will learn things from scratch when we become staff, and we will keep learning on the job,” she said.
Ms Choy – her full name withheld by request – is an Advanced Practice Nurse in the West Kowloon cluster. She agreed with the students that they would gradually pick things up when they join the workforce, adding that with their previous placement experience, the new nurse recruits would not be “complete laymen.”
She said remarks should be made during the recruitment process, to ensure the fresh graduates would not end up in a unit where they had not been posted at before. Nurses in charge should also delegate work carefully based on the recruit’s experience so that the tasks they perform would be well within their capability.
” [The graduates] obviously won’t be equal to nurses with 10 years of experience, but they have to enter the workforce eventually,” said Choy, who has worked in the sector for more than 20 years.
Responding to questions from HKFP, the Hospital Authority said an induction programme would be provided to the new nurse recruits to familiarise them with the hospital’s clinical services. The spokesperson added: “HA would further strengthen preparedness of fresh graduates joining in the current situation… [and] ensure the professional standards of nursing staff are maintained.”
Lawmaker Lee, who is also the chairman of Association of Hong Kong Nursing Staff, said the change in requirement and training format would not affect students’ clinical competency, adding that doubts on the graduates would be put to rest once they become licensed.
“Once the Nursing Council grants the licence, there should not be a question on the competency of the graduates. They are all well-qualified to be a nurse,” he said.