5 October 2023

Nurses are highly skilled workers – and should be paid as such

Conversations around salary ignore the fact that nurses today do work that was traditionally the remit of junior doctors.

By Pat Grey

This month nursing students across the country will be starting their three-year university courses – but there will be far fewer of them than in recent years. Figures from the Universities and Colleges Admissions Service (Ucas) show that 12 per cent fewer people are expected to take up nursing courses in England this September. This will have serious consequences for the NHS for years to come.

Nursing staff like myself have been at the heart of the NHS since its inception 75 years ago. We are a highly skilled profession, and our role has evolved and developed over the last three quarters of a century. Yet our pay has not, and the simple fact is that we will never attract enough new nurses – or retain the staff we have – until we are paid fairly for our high skillset.

Since nurses took strike action over the winter and spring, a lot of the discussion around nurses’ pay has focused on the need for a fair pay rise because nurses are struggling with the cost-of-living crisis – especially after 13 years of real-terms pay cuts. This is entirely valid, but the discussion has rarely covered how highly skilled this job has become. We haven’t spoken about how the role has changed and that we now do many of the roles that were once carried out by junior doctors, despite the fact that our pay doesn’t reflect this.

Nurses are university graduates and many have additional qualifications. Yet a lot of people’s impressions of nursing are stuck in the past – from 75 years ago or more – and often they perceive nursing to be solely about working to a doctor’s instructions or giving basic personal care. While kindness and compassion are at the core of nursing, rapid advances in scientific knowledge in healthcare have resulted in a graduate workforce that is almost unrecognisable in its role compared to even just 20 years ago.

Nursing is a highly skilled profession, with nurses working autonomously in their own sphere of expertise, whether that’s clinical care, research, education, or leadership. These roles require a huge amount of continuous training, which often goes unrecognised and unrewarded. It is often said that nursing is both an art and a science – the art of caring backed up with scientific evidence.

In many jobs that require you to study and acquire more qualifications, there’s a high chance you will be remunerated for that. With nursing it doesn’t matter if you have more than one clinical speciality qualification, including multiple master’s degrees; you may stay a “band 5”, the same band that nurses are on when they first qualify. The salary for a band 5 nurse is between £28,500 and £34,500 in England, while the average total student debt for studying nursing in the first place is roughly £48,000, according to research from the Nuffield Trust.

I’ve seen this ever-growing scope of practice – and the lack of recognition for it – throughout my career. I’ve worked in sexual health, HIV and contraception for over 30 years. For a long time now, nursing staff have been carrying out procedures that were traditionally the responsibility of doctors, and they aren’t fully recognised for it.

They probably have prescribing qualifications and carry out many roles, such as fitting contraceptive implants, which require practitioners to sit the relevant doctor’s examinations and hold a diploma that was once held only by doctors. Patients will also find they often access nurse-led clinics and services, which are run, managed and delivered by highly qualified, skilled nursing staff.

Yet we are not always awarded additional pay when we take on more responsibility, and we also often have to pay to maintain our qualifications out of our own pockets and undertake training in our own time. Not all employers are willing to help with these costs, which come on top of the compulsory regulatory fees that nurses pay for, as well as student loan repayments.

Ensuring nursing pay accurately reflects our qualifications, skills and workload would be an extremely effective way to promote nursing to the next generation as a viable career with a long-term future.

For the sake of patients, it’s crucial we attract and retain more nurses to the profession – and we also simply deserve to be respected for the highly skilled work that we do.