Budget cuts leading to more U of S nursing students making mistakes in clinical classes, co-ordinator says

More nursing students at the University of Saskatchewan are being put on "performance contracts" for making errors in their medical surgical clinical classes, according to a course co-ordinator. 

Co-ordinator says bigger class sizes, deficit of faculty are to blame

The percentage of nursing students at the University of Saskatchewan being put on “performance contracts” due to making errors in their medical surgical clinical classes has more than doubled. (Cory Herperger/Radio-Canada)

More nursing students at the University of Saskatchewan are being put on "performance contracts" for making errors in their medical surgical clinical classes, according to a course co-ordinator.

These contracts are often the result of an instructor noticing a pattern of safety errors and practice concerns in a student, says Kathy Rodger, who has been an associate professor and medical surgical clinical course co-ordinator for more than 20 years.

Rodger and other faculty members say bigger class sizes, less supervision, budget cuts and a deficit of faculty are to blame for the jump in mistakes and contracts.

Starting in second year, nursing students take clinical courses where they care for patients, administer medications and oxygen therapy, and do intravenous monitoring and dressing changes.

"What becomes at stake then is any aspect of that care can be compromised if the student just is perhaps not doing well or isn't well enough prepared," Rodger said in an interview with CBC News on Monday.

"Then things can go poorly and patients can suffer."

The contracts outline specific benchmarks or requirements that need to be met in order for a student to pass the course. If a student can't meet the requirements, they may fail the class. The College of Nursing only allows two attempts at a clinical course.

Percentage of students on performance contracts more than doubled

Rodger said she has seen a steady increase in students being put on performance contracts in medical surgical clinical courses over the last six years in particular.

More than 20 per cent of students per term are on contracts, whereas in 2016 and before that, five to 10 per cent of students were on contracts, she said.

Rodger said common mistakes that students make include medication errors, not being adequately prepared to look after patients and a lack of knowledge of safety protocols.

Kathy Rodger has been an associate professor and medical surgical clinical course co-ordinator at the University of Saskatchewan for over 20 years. (Submitted by Kathy Rodger)

Rodger said she believes there's been an increase in contracts in other clinical courses as well, but she doesn't have access to that data.

Dr. Solina Richter, the dean of the College of Nursing, was not available for an interview and did not provide this information. 

In a prepared statement, Richter wrote, "The College of Nursing has considerably fewer students on contract by the time they reach fourth year compared to in the past, which means they are addressing their areas of improvement earlier in the program."

Having a student on contract "is about success and not a negative thing," she added.

Bigger classes, less 1-on-1 time

More students are on contracts because clinical group sizes have increased while instructors are overworked, according to Rodger.

"We're often requested to have upwards of seven or eight students in a group," she said, adding that ideally, medical surgical clinical groups should have five students.

"Having seven or eight students in a group with one instructor on a very busy demanding medical surgical unit can be overwhelming, and not just for the teacher, but also for students," Rodger said.

Nursing faculty passed a motion of no-confidence last week against the college's leadership team, citing frustrations with decisions including a deficit of faculty.

The college is short 31 full-time faculty, according to a meeting agenda obtained by Radio-Canada.

Rodger said that, as a result, professors are supervising more students and soon-to-be nurses are getting less critical one-on-one time.

"It's very, very tenuous at times and overwhelming. And I can safely say that clinical instructors become very closely drained … physically and emotionally and mentally," Rodger said.

Nursing regulatory body asked to investigate

On March 1, nursing faculty members submitted a formal complaint to the College of Registered Nurses of Saskatchewan (CRNS) — the regulatory body for registered nurses, which awards the college its undergraduate program approval.

They are asking CRNS to investigate the quality of nursing education, safety concerns and whether accreditation needs to be revoked.

"There have been a number of recent changes to the undergraduate program which we believe have significant implications for the safety of the public, educators, and students," faculty wrote in the complaint submission.

They noted that between 2017 and 2021, the U of S decreased the college's operating envelope by about $4 million. Teaching loads increased by 25 per cent, there was a reduction in staff, clinical hours were reduced and class sizes ballooned.

"There is an increasing reliance on inexperienced casual staff, despite arguments for years for stability among faculty to enhance the quality of education," the complaint submission said.

Students concerned

Sarah Nickel, a third-year nursing student and president of the Saskatchewan Nursing Student Association's Saskatoon chapter, said she regularly hears from students who want more clinical training opportunities than they are given.

"But they're denied access to practise with equipment outside of our scheduled lab time, which has been cut recently," Nickel said in an interview with CBC News on Monday.

Sarah Nickel is a third-year nursing student at the University of Saskatchewan. (Submitted by Sarah Nickel )

For example, Nickel said she couldn't access an infusion pump because of a shortage of supplies.

"I'm paying all this tuition too, so it's pretty sad," Nickel said.

Nickel shared a document with CBC News in which six nursing students shared their concerns about the program and the college's leadership.

"The bottom line is that improperly trained graduate nurses affect patient safety," wrote one fourth-year student.

A third-year student wrote, "the crisis of insufficient critical resources is palpable."

"I fear that I will lack the education and skills that are supposed to be provided to me so that I can become a nurse," wrote another.


Yasmine Ghania is a reporter for CBC Saskatchewan, currently based in Saskatoon.


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