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Is it worth working nights?

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As unions and trusts propose new unsocial hours payments, Richard Staines finds out how nurses feel about these shifts

As every nurse will know, working nights can be lonely, physically draining and difficult to reconcile with family commitments. Along with that, it seems that age can often bring an added intolerance to unsocial hours working.

Janice Bailey, a nursing sister at University Hospitals of North Staffordshire NHS Trust, says that she now finds night shifts especially difficult to cope with. ‘The older I get, the harder I find it. I just feel very, very tired, especially if I do a night and then have to do a day shift. You don’t get enough time to recuperate.’

Rachel Binks, nurse consultant in critical care at Airedale NHS Trust, often works nights and agrees. She believes that night shifts may suit younger nurses who are new to the profession.

‘Sometimes as staff get older, into their 40s and 50s, they find working late shifts more difficult,’ she says.

But not everyone is averse to night working. Some are glad to have the extra pay, while others enjoy going against the normal working grain – taking advantage, for example, of less traffic on the roads and a quieter work environment.

Ms Binks says that critical care settings in particular are more placid at night. ‘Morale is good,’ she says. ‘People may not like being at work at night but the atmosphere can be much more relaxed.’
However, in some settings, the workload can be as heavy – if not heavier – at night.

Ms Bailey says the A&E unit where she works is often busier and therefore more demanding at nights. What’s more, she says that night shifts do not offer the same opportunities for learning and continuing professional development and that working a lot of such shifts in succession is not good for skills or career progression.

In the community sector working unsocial hours presents a range of problems of a different nature.
Sue Koenig is a sister at Shropshire County PCT. She runs a minor injuries unit at Ludlow Hospital, which is open until 10pm. The only medical support available is from the county’s on-call doctor service and the nurses are responsible for closing the community hospital.

Ms Koenig believes that current unsocial hours arrangements are not sufficient to compensate for the extra responsibilities the nurses are taking on while working such shifts. ‘We are taking on a big responsibility and should really be paid double time for doing it. As it is, we only get paid 30% more,’ she says.

A rural setting can often compound the difficulties of working unsocial hours. Many nurses have to travel long distances to work and because there is a more limited pool of staff to draw on, they
can sometimes find themselves working back-to-back evening and morning shifts.

‘Most people have to travel at least half an hour,’ says Ms Koenig. ‘We don’t always close at 10pm because [we haven’t finished with our] patients and that means we don’t get home until 11.15pm. Nurses are then still expected to get in at 8 o’clock the next morning.’

In acute settings night shifts may not only pose problems for staff but can also have implications for continuity of care.

‘People are more likely to call in sick. You have got a lot more bank and agency staff as a result,’ says Ms Bailey.

For many nurses, working nights is a juggling act and many report that they find it difficult to balance night shifts with family commitments – especially if their partners also work unusual patterns.

But regardless of whether nurses find the idea less attractive of spending time on nights while other people are with their families, for many working in acute settings, unsocial hours are just part and parcel of the job.

Nurses on acute wards know they have to work such hours and they will often have worked late shifts during their training. The message from senior acute nurses is quite clearly not to join the profession if you are not prepared to work late.

Amanda Webb, senior nurse at University College London Hospital NHS Foundation Trust, says: ‘We are all used to doing it – we’ve never done anything different. You certainly don’t come to A&E not expecting to do unsocial hours.’

Ms Binks agrees. ‘I get frustrated when people moan they have to work nights when it is part of their normal workload,’ she says.

Fairness has always been central to the debate around the issues of night working, both in terms of workload and pay. Most hospitals now operate a shift rotation system so that everyone has to do their
fair share of night shift duty. Ms Bailey says nurses who now work only nights are few and far between because ‘hospitals don’t give out those kind of contracts any more’.

And it looks likely that, for nurses above Agenda for Change band 6 at least, there will soon be more equity of pay too.

After more than three years of wrangling, unions and NHS trusts have finally been able to agree on unsocial hours proposals that would mean senior nurses will have their unsocial hours payments calculated according to their basic wage as opposed to a rate at the top of band 6, as was previously the case.

So would the extra money for nurses in higher pay bands be sufficient to compensate for the inconvenience of working nights?

For those nurses in question the proposals are undoubtedly good news. But the problem that remains is that most of the nurses who work nights are not on the higher bands.

‘There are very few nurses in band 7 and above who work nights – mainly in ICU and A&E – so it won’t make a massive difference,’ Ms Webb explains.

That said, she believes that the existing unsocial hours payments for nurses are about right. ‘It works out at up to an extra £300 a month for a band 7 or 8 nurse, which I think is about fair,’ she says.
Ms Bailey, a band 7 nurse in ICU A&E, says that the extra money under the new arrangements would be welcome but that, given a choice, she’d ‘still prefer not to do nights’.

One reservation that nurses have about the new proposals, it seems, is that hospitals may attempt to reduce the number of experienced nurses on duty out-of-hours in order to avoid having to pay the extra cost.

Ms Binks warns: ‘Trusts are likely to put more junior staff on duty when they start realising they will have to pay more. After all, we are not going to get any more money to pay for all this.’

For those who would like to contribute to the new proposals, Unison is currently balloting its members with papers due to be returned by 15 February. The RCN and Unite are also running ballots, which close on 18 February.

The pros and cons of working unsocial hours

Advantages

  • All nurses earn extra money for working unsocial hours

  • Under new proposals by unions and employers, the cap on unsocial hours payments above band 6 would be removed, meaning senior nurses would receive more money

  • Staff can avoid rush-hour traffic and in some specialties, such as critical care, night shifts are likely to offer a calmer working environment

  • Working under the Hospital at Night initiative or within critical care outreach teams, nurses can gain valuable experience by assuming more responsibility

  • Many hospitals now operate a shift rotation system so that night working is distributed more fairly

Disadvantages

  • The work can be just as hectic. Many A&E units are just as busy – if not busier – at night than they are during the day

  • Night shifts can be physically demanding and very tiring and their effects seem to be exacerbated by age

  • It can be a juggling act and nurses may find it difficult to balance the work with family commitments

  • The shifts may pose problems for continuity of care with more reliance on bank and agency staff

  • Under new proposals to pay senior nursing staff higher wages at night, there is a concern that trusts would employ fewer of them at night, with more responsibility falling on the shoulders of less experienced staff.

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