'There will be fewer trained nurses and their role will be largely supervisory'

Readers' comments (19)

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  Adrian Bolt | 15-Apr-2011 6:14 pm

  What keeps you awake?
  Nothing.
  
  I had the same trouble when I was doing my nurse training.
  
  
  
  'There will be fewer trained nurses and their role will be largely supervisory'
  
  And there you have the nub of the problem, who is going to do the "nursing" when all the nurses are doing "supervisory" roles.
  
  The recent move to place nurse training in Universities, making nursing an "academic" profession risks pricing nurses out of the jobs market ltogether as unqualified care assistants and support workers do all the jobs that Nurses used to do.
  

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• mike | 15-Apr-2011 9:11 pm

  Or on the other hand Edwin, it will make a stronger case for us to get the pay we deserve instead of the derisory salary we get now!

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  Adrian Bolt | 16-Apr-2011 2:35 pm

  The pay we "deserve" will soon be determined by the market and if you think what you are getting now is derisory now take a look at what the voluntary/ private sector is paying people to do a broadly similar job. And that is without the final salary pension and other in-service benefits you are getting working for the NHS for which you could probably add another £10 - £15k to your current salary if you were working outside the NHS.
  
  I have said this before and I will say it again. I don’t think I am badly paid for what I do and the hours I work. Friends of mine who work in private industry are paid more but they work an awful lot harder and are subject to an awful lot more stress than I am. Not a popular thing to say I know but public service workers have been shielded from the harsh economic realities of the modern world for a long time and it shows.
  

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• mike | 16-Apr-2011 3:19 pm

  Edwin, you're having a laugh, right?
  
  Bearing in mind our profession is highly educated, highly skilled, highly regulated, with a large amount of responsibility and accountability, and the fact that health care is a singularly necessary societal profession, let us compare our pay with that of a Bankers, for example. You think a city banker performs a more important role in society than we do? No? Yet they get far more pay plus millions in bonuses. Let us compare our pay to a binman, it actually isn't that much different, yet I would argue our role is FAR more essential, and those able to do the role are far harder to come by; you don't need a degree to empty a bin, for example, so why should they earn almost as much as we do?
  
  And you think those in industry are far more stressed and work harder? Now I know you're taking the proverbial.

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  Adrian Bolt | 16-Apr-2011 6:25 pm

  Bearing in mind our profession is highly educated, highly skilled (&) highly regulated.
  
  And soon to be out of work if our lives become anymore “regulated” by which I think you mean protected.
  
  
  "You think a city banker performs a more important role in society than we do?"
  
  Not more important, not less, just different.
  
  
  "Yet they get far more pay plus millions in bonuses."
  
  Some bankers get millions in bonuses, the number of bankers in the wage bracket you allude to can probably be counted on the fingers of both our hands. The rest of this much maligned group of workers, like us, could probably be described as middle income earners. The average salary of a branch manager in the SE is about £32k which is what I am on and the manager of a bank is not going to get six months off sick on full pay followed by a further six months on half pay when he needs it or a final salary pension when he retires either.
  
  The basic salary for a bin-man on the other hand is about £17.5k or £21K if you are the driver (for which you need an HGV license). Without bin men society would probably grind to a very smelly halt in less time than if all the nurses went on strike. Remember the refuse strikes of the 1970’s? Bin men earn their money believe me, it is hard smelly and unpleasant work for which they are paid considerably less than we are and they have to work outside in all weather as well so I don’t know where you are getting your figures from (the Daily Mail I suspect).
  
  
  “And you think those in industry are far more stressed and work harder? Now I know you're taking the proverbial.”
  
  And you clearly don’t know anyone who lives outside the rarefied and protected environment of public service. It will come as quite a shock when you end up working for Virgin Healthcare or BUPA and find out what your services are really worth on the open market.
  

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• mike | 17-Apr-2011 5:55 pm

  There are a number of issues here edwin.
  
  'Not more important, not less, just different'.
  
  That is where we differ, you see, as I hold the public services, health, teaching, military, policing, firefighting etc etc in far more regard than I do jobs such as banking, business, retail, manufacturing, etc. Whilst those jobs are important too, and provide people with a living (which I will always respect), quite simply the public services are more fundamentally important. The most basic society wouldn't exist at all without healthcare, protection, etc.
  
  'the basic salary for a bin-man on the other hand is about £17.5k or £21K' (you didn't include overtime or holiday pay in that, as I know binmen who earn considerably more on that basis). You just made my point for me there, why should a job requiring no quals get almost as much as one requiring a degree? It is a dirty horrible job yes, and they work hard, yes, on that we are in complete agreement, but why should those jobs automatically command a high wage? NURSING can be a dirty, horrible job sometimes, and WE work bloody hard too! Isn't the whole point of getting degrees, getting a profession, to better yourself and not HAVE to do the low skilled jobs? There is a low skilled social status for a reason, and there will always be people who cannot or do not want to gain professional quals there to do them So I ask again, why should they be paid an equivalent wage? If I choose to better myself, struggle to get a degree and beyond, gain a profession, then I should be on considerably more than someone who can walk straight into a job with no quals, otherwise what is the point?
  
  'And you clearly don’t know anyone who lives outside the rarefied and protected environment of public service'
  
  I know a great many people, and was not always in the public service field myself, thank you. Put simply, working in an office, or a bank, or a shop, or industry, or whatever other career you can think of, whilst having stresses of their own, quite simply cannot compare to the unique stresses of our profession. An open market, where skill in playing with numbers on a computer in an office is worth more than life saving skills, just shows how backward this country is.
  
  Oh, nice to hear you are on 32k by the way, I'm not - yet.

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  Adrian Bolt | 18-Apr-2011 2:00 pm

  Mike you raise some interesting points.
  
  You hold public service in higher regard that private industry because without public service (health, education, law and order etc) there would be no private industry. Ok that is your subjective opinion and you are right to a point. In a state of nature the life of man would indeed be nasty brutish and short. But the converse also holds true without private industry to pay for it there would be no public service in the first place. If you have any doubts on that point ask yourself how many developing economies can afford a fully developed and publicly funded health service?
  
  You talk about what nurses”deserve” to be paid. I asked that question of a friend of mine, (he is a contracts manager in a waste recycling company); he looked genuinely bemused by the question. “What do I deserve?” he asked “whatever the company is prepared to pay me”. In private industry people have a completely different mind set to those of us in the public sector. No one asks in private industry what do I “deserve” they ask what am I worth and then they go and find an employer that is prepared to pay them that amount. I think you are confusing “Worth” with “Value” the value of a nurse to society is beyond measure and no doubt we will get our reward in heaven because we sure as hell will not get it down here on earth. But a nurses “worth” is what ever the market is prepared to pay or what ever the government can spare.
  
  As for your salary don’t worry keep plugging away at what you do and in time with incremental pay rises earned regardless of skill or ability you will get there eventually.
  

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• mike | 18-Apr-2011 4:40 pm

  That's if we can manage to keep our increments the way things are going Edwin.
  
  I see your point, although I do disagree with it, I see what you are trying to say. The difference is, whereas you see 'worth' and 'value' as two separate things, I believe that worth should be linked to the inherent value to society.
  
  If you'll forgive the extreme example, is the inherent value of a footballer on thousands a week equal to his worth? I think not. On the other side of the coin, is the inherent value of a Staff Nurse equal to their worth of 21,000 a year starting out? Again, no. You are right in that this is what market forces are willing to pay, but it should not be like that. The worth of public service personell should much more closely relate to their value to society.
  
  There is also another point to consider, take our marketable skills as a Staff Nurse. Many of us hold Degrees and beyond, we hold highly educated clinical skills, we act as managers with the inherent admin skills, we act as teachers and educators, etc etc. Are all of these marketable skills not enough to demand a higher worth?
  
  At the end of the day, I do not believe in a reward in Heaven or the next life, so I think we should get our rewards right now, in this life.

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• mike | 18-Apr-2011 4:47 pm

  And one more point, taking your 'worth' in the public sector mindset argument, imagine if we were totally within the private industry sector for a moment, how much worth do you think people would put on their lives and their health then? Would that equate to our worth now or would it be a lot higher do you think?

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  Adrian Bolt | 18-Apr-2011 6:02 pm

  "The worth of public service personell should much more closely relate to their value to society."
  
  And in a perfect world it would, but this world is far from perfect and to argue that because Nurses "care" for people and are therefore of greater value to society sounds like special pleading to me of the most egregious sort. Who decides what is of greater value, a nurse or a business man? How do you measure the "value" of either. Is a Nurse of greater value than a social worker, fireman or teacher who all "care" for people but in very different ways?
  
  
  "Are all of these marketable skills not enough to demand a higher worth?"
  
  You are always at liberty to take your marketable skills into the market place and sell them to the highest bidder.
  
  Sainsbury's and M&S are always looking for graduate trainees for their management program if you think these employers would value your worth at a higher figure take them there and find out.

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• dino-nurse | 18-Apr-2011 7:07 pm

  We seem to have strayed from the most important point here boys. That nurse educators believe that in the future there will be fewer RNs than at present. So despite all the reseach that proves that reducing RN numbers costs lives, those who are training the nurses of the future in the UK are already hanging up their boots. The rationale behind moving nursing into the community is because government misguidedly believes that this will be cheaper. This will certainly be the case for those of us who cannot afford a live-in RN as we will get an HCA a few times a day (just as community nursing seems to do today). How many will be able to afford home physio or other rehab that will no longer be provided by the NHS? Not to mention other measures that are currently possible at home ( ventilation, dialysis, NIV therapy...need I go on?) The rest of the world will continue to realise that the best way to keep people safe and healthy is to increase the number of RNs but not the UK. Oh no. Once university fees kick in then the numbers applying for nursing courses will drop and solve the problem for us. I dread to think what the NHS will be like in 5 years and god only knows what it will be like when I need it in my old age.

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  Adrian Bolt | 19-Apr-2011 8:44 am

  @ dino-nurse
  
  "nurse educators believe that in the future there will be fewer RNs than at present."
  
  and those that are left will be doing "supervisory jobs". As I said at the top of this thread that is the nub of the matter. Nurses are in danger of pricing themselves out of the job market altogether and the trend to continually hype up the academic content of nurse training with all nurses being educated to degree level and above will only accelerate this trend.
  
  The team I work for has three community support workers who already do most of the “nursing” and probably do more in a day than the rest of us do all week and at a fraction of the cost. It does not take the brains of an Archbishop to work where that trend will take us eventually. My trust sent an e mail out to the entire workforce stating that it needs to make £24m in savings this year and is offering a severance package in return for voluntary redundancies so that it can avoid making them compulsory.
  
  In five years time the NHS will have out-sourced the recruitment of newly trained staff nurses to the Philippines where they are cheaper to train, will work for less and are prepared to get their hands dirty nursing rather than filling “supervisory” roles, unlike the dwindling number of their Uk contemporaries.

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• dino-nurse | 21-Apr-2011 4:01 pm

  Cheaper doesn't always produce the best quality Edwin. I'm sure the support workers do a very good job but why are they the ones doing the "nursing" as you put it? By this I assume you mean attending to personal care...I am an ICU sister and spend most days attending to personal care for my patients and I am certainly not afraid to get my hands dirty. I also have a degree. The vast majority of the RNs in the UK are on a Band 5 salary so thats a maximum of £28K...most are actually stuck behind one of the gateways so are on alot less. Hardly a kings ransom. You can get 2 HCAs for the cost of an RN and this is why we have support workers. Previous points about other jobs that pay higher just go to show that carers are not valued in the UK at all. If qualified nurses had also gone on strike when the binmen did, I'm pretty sure the UK would have noticed...no ED for starters, no outpatients clinics...no care in hospitals or care homes, no health visitors, no midwifes.... When I worked in the US I was on 3 times my UK salary...in France and Germany I was on more as well. Most other countries do not have HCAs as they realise that nursing needs to be done by nurses. Just like teaching needs to do done by teachers...oh, no wait...in the UK we think that support workers can do this to, as well as policing. Lets face it, the mindset in the UK is that all public sector jobs could be done by a monkey. We are not pricing ourselves out of the market as other countries are prepared to pay more. If I do an extra shift in the ICU of a private hospital (or a UK one that takes agency) I get around £45 a hour...someone thinks that we are worth it. As for nurses from the philippines...most have degrees and want to work in the US and they are certainly not cheaper to train and as most have massive student loans to pay off they will not work for less...many of my colleagues are from there and are quite open about why they came to the UK- to improve thier English so that they can also go to the USA. I am a little sick of pointing out that degree nurses are not too psh to wash and are not all after Band 8 jobs. I qualified before P2K came in and completed a degree in my own time and paid for it myself as part of my professional development. One final point. ICU admissions over the last decade from medical wards have skyrocketed...I believe this is linked to lack of RNs on the wards and deliberate understaffing at that...most weeks we get poor old souls that are admitted with renal failure because no one has kept track of their fluid balances. Every patient that ends up on the ICU on renal replacement therapy stays for around 10 days...at a cost of between £5K and £7K a day depending on treatment. How many RNs would this pay for? Not to mention the elective surgical patients who end up with chest infections due to inadequte pain control and not mobilising enough-and also come to us for NIV or ventilation and all those who become septic. This is waht happens when you replace qualified nurses with HCAs and APs, I'm afraid.

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• Andrew Fishburn | 23-Apr-2011 7:49 am

  I think you guys are missing the elephant in the room. This is nothing to do with our 'worth' and 'value', or private verses public sector, but more to do with the numbers of individuals who are RNs: I'm sure we therefore have the biggest wage bill in the public sector. And there's the nub - under the mantra of 'reduce the deficit', we are the obvious target for the unelected dictatorship that is the current govt. And as Mike has pointed out many times, we are a female dominated sheep-like profession with spineless unions. We are the easy and obvious target to start reducing the healthcare wage bill.
  
  Edwin, it's pointless making scary noises about what our salary will be like in the private sector - for this argument to stand you need to look at other health economies in societies like our our own - Australia and USA come to mind and their RNs do better, so it doesn't automatically follow that we would do worse in a similar environment.
  
  But the real worry about this thread, as dino-nurse points out, is that the education establishment are towing the gov't line. I would have hoped that anyone in education may have read the evidence about the higher RN to patient ratios = better health outcomes (and often cheaper), and that evidence comes from those nasty private systems in Oz and USA where ratios are embedded in the legislation and RNs are paid more.
  
  I'm sure the next argument we will be having is when the unelected dictatorship applies the rules we have in the community to hospitals. And this is kinda mixed in the argument of fewer RNs being needed to 'supervise'. In the community, individuals pay for social and personal care, and nursing care is free. Won't be long before we see this being 'debated' by the gov't for hospital care. If we need fewer nurses to do the nursing, then this is really social and personal care, and the individual is charged for this when in the hospital environment. Great! More of that wonderful private healthcare thinking coming your way.
  
  We have a responsibility, enshrined in our code, to protrect the public in our care, and to do this we need unions that will fight our corner, ensuring we are paid well to attract the calibre of individual to do the job well (that old free market thing again), and we also need leaders in education articulating how this equals better, safer, and therefore ultimately cheaper, care than trying to dream up degree courses in supervision that will tow the gov't line. Sitting quietly on the sidelines whilst the gov't tinker with the profession to pander to their political wills (oh, and check their salary if you want a debate about value and worth) will not achieve this. We need our voice heard, we need a debate about these issues in public - if our union leadership cannot achieve this then it's time for them to make way for someone who can. Look at what those RNs achieved in Oz with a bit of strike action. This is a pivotal moment for our profession - it's no use whinging about the lost opportunity in 2 or 3 years time when we are all busy 'supervising' and not nursing.
  

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  Adrian Bolt | 23-Apr-2011 6:01 pm

  @ Dino nurse
  
  You raise some interesting points but you are arguing against yourself. The current trend in nurse education (as opposed to training) is to produce fewer nurses and have them doing supervisory roles. You pointed out yourself that the reason ICU admissions have skyrocketed is because patients on medical wards are now being looked after by HCA’s and not nurses.
  
  You appear to decry the use of HCA’s to nurse patients but then go onto support the move to a degree only profession and the move away from doing the job of nursing this seems to imply. Well you can’t have it both ways, do we want a small number degree educated super-nurses sitting in an office polishing care plans or a larger number of ordinary nurses “trained” rather than educated to do the job of nursing patients?
  
  
  The question of what we call the qualification nurses gain is irrelevant. Nurses need to be educated or trained to a sufficient level of competency to do the job at hand. Whether you call this a certificate, diploma or degree matters not one whit, as I said before a rose would smell as sweet by any other name, but what job do we want nurses to do, nurse or supervise others who then do the nursing?
  

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  Adrian Bolt | 29-Apr-2011 9:53 am

  @ Andrew
  
  "Edwin, it's pointless making scary noises about what our salary will be like in the private sector - for this argument to stand you need to look at other health economies in societies like our own - Australia and USA come to mind and their RNs do better, so it doesn't automatically follow that we would do worse in a similar environment."
  
  True enough although Australia does have a healthcare system broadly similar to our own but I was looking to the sort of wages being paid in the voluntary and charitable sectors in the UK for a comparison.
  
  

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• Anonymous | 9-Mar-2012 0:30 am

  Binmen work in a dirty smelly Job? I can't think of a job any dirtier than nursing, working with infected bodily fluids every day!

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  Dr Why ? | 9-Mar-2012 3:06 pm

  'There will be fewer trained nurses and their role will include a large supervisory element.'
  
  I don't like the idea of trained nurses, supervising inadequately-trained staff who are performing duties which should properly be performed by trained nurses. Don't like it at all !
  
  And welcome back, mike. We thought your 'nurses and doctors are equal' campaign, had led to the GMC abducting you and locking you in its dungeon cells !
  
  

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  Dr Why ? | 9-Mar-2012 3:09 pm

  Adrian Bolt | 23-Apr-2011 6:01 pm
  
  If HCAs are nursing patients, then HCAs should logically be nurses. Moving nurse training into more 'academic and elevated' levels, and exapanding the roles of nurses, does not alter the issue that anybody providing what was once described as 'basic nursing tasks' needs to be capable of properly performing them - if HCAs are to be up-skilled, then they should be described as nurses ! If they are not to be adequately up-skilled, the yshould not be doing nursing tasks above pretty basic levels.

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