What goes around...

What goes around comes around. Never is this saying more true than when it comes to nurse training. When I trained  in the New Wave era of the 1980s, it was basically an apprenticeship as it had been for generations before me. Our training was fully funded. We worked on the wards and were paid a pittance because we knew nothing but we were a pair of hands - an increasingly useful pair as we progressed. We learned in modules in the classroom in between each placement. Alongside us on the wards were enrolled nurses - doing two years to our three for a 'lesser' qualification. And there were degree course students - doing four years - who spent more time studying and less time in the sluice but came out as registered nurses like us. I had friends in all nursing streams and while I was envious of the degree course nurses - with proper recognition for their academic work - I understood the intent of the enrolled nurses, many of whom just wanted to qualify as quickly as possible and hadn't understood when they applied that they would get a 'lesser' qualification.

Gradually the profession learnt the folly of having two tiers of qualification - some of the best nurses had an enrolled qualification but their careers were stymied - they couldn't progress. Many 'converted' via extra training to become registered nurses. From the turn of the century diploma and degree courses ran side by side with many people opting for a diploma course because they couldn't afford to do a degree. By 2013, nursing was a degree only profession. The move was of course accompanied by the usual moans about nurses not needing to be educated and educated nurses meant compassionless care. Education doesn't make someone a bad nurse, although overwork, poor pay and lack of managerial support can make compassion hard to find.

Nurses, together with some other professions allied to nursing - physiotherapists for instance but not paramedics - currently still have their training paid for via an NHS bursary but they are no longer paid to work. They are supernumerary to the numbers on the ward. Again this can be a blurred line - the more skilled they become the more appropriate it is to leave them to get on without hovering over them - but is that exploiting them?

And now, just two short years later in a move Chancellor George Osborne describes as 'modernising' the profession, the government has announced that nurses will pay £9,000 a year for the privilege of training. All for a job with a starting salary at band 5 (staff nurse) of £21,000, rising to the dizzy heights of around £28,000 some eight years later (If increments are still permitted). And the majority of nurses will stay at band 5.

Not everyone can progress to higher levels - much as the police force needs its constables, the NHS needs its staff nurses.  Added to which  there are  few jobs around at band 6 - many of these are ward manager posts, downgraded from band 7. The latter (with a starting salary of £31,000) is now vanishingly rare amongst the nursing profession.  For more on nursing pay rates visit the RCN site here.

So there is every chance a newly qualified nurse will earn just enough to have to start paying back her student loan and, with the threat that hangs over incremental pay (on the junior doctors' list of grievances) they may never earn even a modest pay rise. MPs got their 10% rise on the back of their independent pay review body but the equivalent pay review body for nurses recommending a 1% pay rise was turned down in 2014 by the health secretary as too expensive. A 1% rise was granted in 2015 but was hedged with freezes to incremental pay.

A nurse may never move beyond staff nurse  - in 40 years of nursing her (and it is 90% likely to be a 'her') pay will hardly rise. This will do nothing to close the gender pay gap already present between male and female graduates - with 20% of male graduates earning £30,000 or more compared to just 8% of women.

Throw in that most of the nursing workforce are women (did I mention that?) and that women are still the only ones biologically able to give birth so their chances of career progression and better pay will be curtailed or at best postponed for several years by childcare. And all the time they must make sure they remain up to date, complete sufficient clinical hours and pay an annual subscription of £120 to the Nursing and Midwifery Council (NMC).

One of the arguments for student loans was that graduates would earn more than those who didn't go to university. That argument is now redundant. True if degrees are in civil engineering or mathematics as this article in The Telegraph shows but nursing doesn't feature here. Graduates will earn on average £12,000 a year more than non-graduates entering the job market who can expect to earn around £22,000. Nursing graduates are below this on £21,000. And yet they will be paying the same level of tuition fees for their training as someone starting on £30,000.

Not like other students
The reason why there is a shortage of nurses is because NHS Trusts, scrapping to get their books in order so they could apply for Foundation status 'miscalculated' the number of nurses they would need. this translated into fewer training places and now future nurses will be paying a very heavy price for this mistake.

At the time of Osborne's announcement, chief executive of the RCN, Janet Davies said: “Student nurses shouldn’t be the ones having to pay for it. Student nurses aren’t like other students. Half of their time is spent in clinical practice working directly with patients and their families and they have a longer academic year.

Davies also said "The proposal could deter the sizeable number of student nurses already owing significant amounts from a previous degree, Davies warned. “The average age of students on nursing degree courses is 29. They’re not all 18-year-olds.”


But now the idea of 'nursing associates' is being sold as the answer to those who can't afford to pay for a degree. Back to two tiers of nursing. Badged as nursing apprenticeships and hedged with sentimental quotes about nurses being the 'lifeblood' of the NHS (despite being so badly paid) this is a sell out by the nursing hierarchy who have argued for so long for an all degree profession.

Find out how to respond to government plans to scrap the NHS bursary here and use the RCN's online calculator to work out just how far nursing salaries are lagging behind