‘If we do nothing, medical care threatens to come to a standstill,’ reports the Hanze University of Applied Sciences. Then the school takes responsibility and from 2024 the selection procedure for the higher vocational education program in nursing will start. Will this eventually lead to more healthcare workers?

Junior Dara Aal (19) and senior Kimber Huitema (23) have known all their lives that they want to work in healthcare. Despite the high pressure on care, they are not discouraged. They notice the effects. Kimber: “During my third internship in home care, I immediately realized that I could and had to do things on my own very quickly. People regularly asked, ‘We’re short of people, do you want to walk a route?’ But we also get whistled down quickly. We’re still students, it’s still not our job to try to close all the leaks.”

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There is a huge difference in the responsibility given to interns, depending on the year of study and the location of the internship. Dara: In my second year of study, I was placed in a COVID ward in Germany and it was very difficult there. So I didn’t feel like an intern. In my second week they allowed me to do everything, which was sometimes too fast for me. Whereas my fellow students were sometimes not even allowed to perform the simplest procedures during their internships in the Netherlands.”

Since 2012, the nursing program at the Hanze University of Applied Sciences is the only one in the Netherlands to have a numerus fixus. It created an additional threshold, but it was also an advantage, says Jacqueline Beverwijk, dean of the Academy of Nursing: “We got a selection of extremely motivated students to whom we could offer enough internships. When we still did not have a numerus fixus, the profitability was much lower. About 80% of our nursing students now graduate within four years. The entry is important, but ultimately it is about the exit of nurses with a diploma”.

Decreases inflow

The admission of nursing students has decreased dramatically in recent years. In 2020, another 450 students entered the program. In 2022, there were 386 students. By abolishing the numerus fixus, Beverwijk expects the influx to remain stable in 2024. Or perhaps even a small increase. “We cannot estimate it. This year we are deliberately keeping a little bit of space, so we can handle additional students next year.”

But the problems are not only at school. The trainee hands-on supervisors are also extremely busy, as Dara and Kimber note. Dara: “Often I had no idea who could guide me and who I could approach. That was an added concern.” Kimber: My internship supervisors couldn’t find a solution with their services and didn’t know where to find the time to help me. They wanted to, but couldn’t. So you end up in some kind of limbo, who can continue to guide me?

Will we soon lose intimate education?

And that creates uncertainty now that the numerus fixus is being abolished, both students agree. ,,We were told that by using numerus fixus, all students should have the opportunity to do an internship.” If caregivers already have difficulties with supervision, how will that be possible in the future with more students? And there are more insecurities among students. “Now we have smaller classes, which is great for us,” says Dara. “Maybe soon we will lose that intimate education.”

“Student well-being and a courteous approach on a small scale are extremely important to us,” says Beverwijk. “That’s why we are also starting to pay more attention to student guidance, for example, with the use of a ‘buddy system’ in the new school year.”

In the meantime, other solutions for “learning by doing” are being studied together with the professional field. Are long-term internships feasible? Beverwijk: “Or we should look for other ways of learning by doing.” More projects, for example, or combine an internship with research. Also, prospective students want more control over their own education. That is why the program is working on a new curriculum, in which students have more freedom of choice.

‘Inmate Abuse Warnings’

The high pressure in health care does not despair Dara and Kimber and the school helps too, students say. Kimber: ,,Teachers indicate that there are workplaces that use or even abuse interns. They warn us to pay attention to this, to indicate what we do and what we don’t want to do and what we want to learn”. Dara ,,The days we return we can put on the table everything we find during an internship. That also gives me a bit of peace, knowing that I’m not the only one who sometimes has a hard time. You can ask anything, you can make mistakes, they are all there for you. And in the end, it’s all for a good cause.”