Last week, UNISON health conference passed a significant motion for the nursing workforce, titled ‘valuing nursing fairly’. Introducing the motion, UNISON member and registered nurse Andrea Prince described the impressive skills and advanced clinical expertise of the nursing colleagues she worked with in her hospital. But, she warned, many were not banded correctly and are earning far less than they should.
This problem, which sits at the heart of the nursing workforce crisis, is not new. The Government and NHS have been grappling with it for over a decade.
The demands on nurses have developed substantially in recent years: patients tend to have more complex clinical needs; other public services are dramatically over-stretched and leaning on the NHS, and there are many more students, associate healthcare professionals and overseas recruits in teams where they require supervision and teaching.
All of these issues pre-dated the Covid-19 pandemic, which required nurses to rapidly adapt to the huge challenges they faced. UNISON nurses working in ICU, like Victor Tapah, delivered advanced, life-saving support and managed more critically ill patients than ever before.
Yet pay and recognition have not kept pace with these changes. As NHS jobs evolve, this should be recognised by the system. Roles should be re-banded to reflect their increased responsibility and complexity. This relies on accurate job descriptions.
But job descriptions for many nurses are inaccurate and out of date. In a 2022 UNISON survey, 90% of respondents said that their jobs have grown more complex but most don’t believe their job descriptions capture the full responsibilities of their role.
This is partly because job evaluation in the NHS has not been functioning as it should. UNISON has been demanding significant investment so the system works effectively for all staff. But it’s also because of the size of the nursing workforce. Nurses are the biggest occupational group in the NHS.
This under-valuing has gone unchecked for too long. The pay that nurses receive simply doesn’t reflect the high-pressured, highly-skilled work that they do. Many nurses remain at lower bands, earning less than other healthcare roles, and compared to other non-health graduate professions, nurses earn significantly less. Add in the long hours and huge student debt English nursing students incur and it’s obvious why the numbers of people applying to study nursing have dropped dramatically over the last five years.
The wider costs to the NHS are enormous. Enough is Enough, our safe staffing campaign, shows that on the majority of shifts, nursing staff don’t believe they have enough staff to deliver safe care. This leads to errors, longer stays and adverse safety events for patients. Employers are subsequently forced to spend huge amounts on agency staff or recruiting overseas because we do not attract and retain sufficient UK nurses.
UNISON is working with our members and branches to educate nursing staff on job evaluation and how to get their roles re-evaluated. Following NHS industrial action in 2022/2023, we have been negotiating with the NHS, Government and employer representatives on steps to re-build job evaluation and improve nursing career progression.
A number of positive steps were recently announced by the Secretary of State at UNISON Health conference, including: steps to strengthen job evaluation; the intention to issue national guidance on recognising overseas experience for overseas nurses, and clarifying NHS terms and conditions to help nurses make the case for progression to band 6. Crucially, we have led a thorough review of the national nursing and midwifery job-matching profiles which will be published in June.
Whilst these are all positive developments, it remains to be seen whether they will ensure nurses are fairly valued. UNISON aims to work in partnership with employers but with the current strain on finances, getting our nursing staff fully valued will be hugely challenging. HCAs in UNISON have organised and fought for re-banding and back pay through our hugely successful ‘Pay Fair for Patient Care’ campaign. If the NHS and government don’t play ball in valuing our nurses fairly, we will have to take the same approach.
I’m proud of our leaders in UNISON and what we’ve achieved for nurses. We’ve identified the challenges we face and done the hard graft to outline the constructive solutions we need: supported progression to band 6 for early career nurses, strengthened job evaluation processes, established clearer terms and conditions.
But how can we deliver the necessary change?
We’ll soon be launching our ‘Right Band for the Job’ campaign, which will help nurses get organised to fight for their full value. If the Government and the NHS are not receptive, it will be all of our jobs to make them listen. Whether we succeed in valuing nursing fairly will be in your hands.
The article Opinion: The battle to value nursing first appeared on the UNISON National site.
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