‘We pay to do free labour.’ How unpaid placements affect New Zealand’s healthcare students: a proposal for sustainable workforce development.

Aotearoa New Zealand is experiencing significant workforce shortages in healthcare. However, to qualify in these professions students must complete hundreds, if not thousands, of hours of compulsory unpaid clinical placements. This thesis focuses on the experiences of nursing, midwifery, and mental healthcare students. It seeks to understand how the challenges of unpaid placements affect the recruitment and retention of students and new graduates, and whether there are more sustainable pathways to completion of training.

Qualitative research methods were utilised to gain an in-depth understanding of student experiences. Eighteen semi-structured interviews were conducted with nursing, midwifery, and mental health students, as well as a supervisor from each of the three disciplines to capture a range of perspectives. The research paradigm is one of critical realism as student experiences are subjective and sit within broader, influential social structures. Reflexive thematic analysis is used to identify themes. The analysis is grounded in intersectional feminism in recognition of the historical, social, and cultural barriers that compound inequities between people. The findings confirm that placements are an essential part of training. However, students report challenges of heavy workloads, power dynamics, bullying, and exposure to trauma. They also note a lack of transparency about the clinical hours and hidden costs associated with training. Placements restrict students’ capacity to undertake paid work which pushes many into financial hardship. Burnout is common and attrition rates are high. The financial costs mean these programs continue to create barriers to diversifying the workforce, especially for Māori, Pasifika, and mature students. Avenues for remuneration are considered, including whether students could or should attain employment status. The thesis concludes that the law is uncertain on the status of students but a stipend is a suitable solution for remuneration, as per the United Nations’ recommendation. A Code of Practice should be introduced under the Education and Training Act 2000 which includes entitlement to remuneration, tripartite agreements, restriction of hours on placement, rest between shifts, pastoral care, supervision, and access to grievance processes. Retention of new graduates may be achieved through quality training experiences, voluntary bonding, and greater emphasis on workforce wellbeing.