Sep 10, 2026
Nursing students in Canada and the U.S. can rack up 800–1,400+
mandatory clinical hours before they graduate — and not one of them
is paid.
In this episode, The Gritty Nurse Amie Archibald-Varley, traces
that unpaid-labour model back to its actual origin: Florence
Nightingale's 1860s training school and the 2,000+ hospital
"training schools" that turned her vision into free ward staff
within a generation. From there, Amie tracks how nursing education
got professionalized, expensive, and gendered — comparing it to
paid co-ops in engineering and the trades, unpacking why nursing
training stayed unpaid while other fields didn't, and revisiting a
piece of history most nurses have never heard of: a U.S. federal
program that paid 85% of the country's nursing students to go to
school, eighty years ago.
If you've ever wondered why nursing students foot the
bill and do the labour, this is the episode that
connects all of it — with the receipts.
Free Labour: The Real Cost of Becoming a
Nurse
Why do nursing students do the labour of employees and
pay like tourists — in both Canada and the United States? In this
episode, we go back over 150 years to trace exactly how we got
here.
In this episode:
- The NCLEX fee increase hitting Canada and the U.S. on the same
day in 2027 — the first change to either fee since 2000
- Florence Nightingale's 1860 training school at St Thomas'
Hospital, the two-tier "probationer" system, and how fast her model
turned into free hospital labour once it crossed the Atlantic to
Bellevue, New Haven, and Massachusetts General
- How nursing education moved from hospital basements into
universities — and how the cost moved onto students while
the unpaid-labour model stayed exactly the same
- Real tuition and clinical-hour numbers from both countries, and
testimonials from nursing students describing placements as "free
labour"
- How nursing's unpaid clinical model compares to paid co-ops in
engineering and the trades — including real wage data
- The gender question underneath all of this: who gets the paid
seat, and what that means for lifetime earnings
- The U.S. Cadet Nurse Corps — a WWII-era federal program that
paid full tuition, stipends, and housing for nursing students,
reaching 85% of all nursing students in the country by 1945 — and
what today's hospital-run "earn while you learn" programs (Duke,
HCA, SSM Health, and others) prove is still possible
- What actually needs to change, and where the pressure is
already building
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* Listen on Apple Podcasts – : The Gritty Nurse Podcast on Apple
Apple Podcasts
https://podcasts.apple.com/ca/podcast/the-gritty-nurse/id1493290782
* Watch on YouTube – https://www.youtube.com/@thegrittynursepodcast
Stay Connected:
Collaborations & Inquiries: For sponsorship opportunities or to
book Amie for speaking engagements, visit: grittynurse.com/contact
REFERENCES
- National Council of State Boards of Nursing (NCSBN) — NCLEX
registration fee increase announcement, effective February 1,
2027
- British Journal of Nursing — "The legacy of Florence
Nightingale's educational reforms for nursing"
- Wikipedia — Florence Nightingale Faculty of Nursing and
Midwifery
- The Hospital (1917), "The Nightingale School and St.
Thomas's Hospital," via PMC
- Old Operating Theatre Museum — "Why did nursing need to be
reformed in the 19th century?"
- Springer Publishing Company — "History of Nursing
Education"
- Mapping Care Project, University of Illinois Chicago
- Penn Nursing Historical Archive, University of
Pennsylvania
- BC College of Nurses and Midwives (BCCNM) — Centennial
report
- Health Human Resources (HHR-RHS) — "Introduction to the Health
Workforce in Canada"
- Canadian Centre for Policy Alternatives, via CBC News
- AECC Global — Canadian nursing tuition data
- Amber Student — international nursing tuition comparisons
- University Magazine (2023) — Canadian nursing student
testimonials
- CBC News, First Person — Eyasu Yakob, nursing student
account
- Western Governors University (WGU) — clinical hour requirements
by program type
- ScienceDirect — "Variability of clinical hours in prelicensure
nursing programs" (2020)
- BMC Health Services Research (2024), Beks et al. — scoping
review on unpaid clinical placements
- National Association of Colleges and Employers (NACE) — 2025
Guide to Compensation for Interns & Co-ops
- Statistics Canada — "Insights on Canadian Society," co-op
participation by field and gender
- International Council of Nurses, citing WHO–ILO joint analysis
(2022)
- Engineers Canada — gender composition data, via University
Affairs
- U.S. National Science Foundation — engineering enrollment by
gender
- Statistics Canada 2016 Census data, via Global News — median
salary comparison, engineers vs. nurses aged 25–34
- NurseJournal.org — gender pay gap in nursing
- ScienceDirect — integrative review of gender discrimination in
nursing (2021)
- Journal of the Royal Society of New Zealand (2025), Watson et
al. — earnings catch-up modelling, nurses vs. police officers
- National Women's History Museum — "Making a Difference: The
U.S. Cadet Nurse Corps"
- U.S. National Park Service — Cadet Nurse Corps history
- Smithsonian National Museum of American History — "Creating the
Cadet Nurse Corps for World War II"
- Washington State Nurses Association (WSNA) — "The push to
recognize the U.S. Cadet Nurse Corps as veterans"
- Duke University Health System — Duke Nurse Extern (DNE) careers
page
- SSM Health — Student Nurse Externship / Earn While You Learn
program page
- HCA Healthcare — Student Nurse Externship job listings
- University of Washington School of Nursing — LTC Externship
program page
- U.S. Public Health Service — SRCOSTEP program information
- Ontario Health — Enhanced Extern Program
- Government of Ontario — Learn and Stay Grant