Should all nurses be paid the same?

[ControversialSuggestion]

I think a pay rise is needed but in addition it seems obvious that greater powers should be given to employers to adapt pay/ offer incentives to nurses/midwives/AHPs in harder to staff areas - I can only assume that the NHS would be vulnerable to legislation if they did this? Or otherwise why wouldn't they?

For example, I'm a midwife, I work nights in a consultant led unit. We should have the following staff:

(this is long - sorry!)

Delivery Suite:
2 x band 7 - often down to 1
8 x band 5/6, very often down to 5, as low as 3 with even those having being stolen from other areas
2 x band 3 - often 0

Postnatal Ward and Elective C/S bay:
5 x band 5/6 - never 5, mostly 3, frequently 2
3 x band 3 - often 2
1 x band 4 - sometimes 0

Etc, etc.... for all maternity areas - the work is nightmarish due to the low staffing - vicious circle. You quite literally can't pay people to do it.

We work alongside and closely with an emergency theatre team of 5 who are quite literally never short staffed - the contrast couldn't be clearer. They have a specialised role that they do very well that essential for patient safety (we used to do all but one of their jobs ourselves but that wasn't up to standard) but they physically cannot have more than one patient at a time and have very clear, universally respected boundaries for their roles which they stick to with the support of their colleagues and management (and us - it's a newish thing and they're managed completely separately so they very much tell us what they will and won't do). Even a very busy night leaves half their time at work with no patient contact at all. And they're never in a position of responsibility for a patient or feeling they may lose their PIN. So the shifts are filled easily.

Anyway - this is unique to my work place but I bet there are lots of similar examples - I have transferred patients to different wards in the hospital, worked in them when training and encountered much more frazzled nurses in some places than others.

So I propose that pay uplifts/ overtime/ individualized pay would go some way to solving this. It already happens via agency shifts - hard to get to or unpopular unit have higher rates than others. We do have a small NHS bank rate uplift at the moment in an attempt to address the staffing but that will end at some point (keeps being extended). This was initially demanded at the beginning of the pandemic by the band 6s who were being expected to work overtime for less than their standard hourly rate previously. There have also been band uplifts in the past where bank shifts are paid at the band higher and, even rarer, actual overtime rates at 1.3 x normal rates.

So basically I am suggesting that the banding system is not fit for purpose and there could be an algorithm that calculated wages based on difficulty of staffing an area. Is this nonsensical?

And yes, we're likely to be in the bonkers situation where strike staffing is better than normal staffing.

I think those powers are already there. In my Trust there have been enhancements for overtime eg double time rather than time + 50% (I'm shocked that you're only getting x 1.3 because AfC stated 1.5)

But it can also cause problems because you end up pissing off staff who aren't getting it. For eg staff at my trust found out that staff at a nearby unit were getting something like £60 ph for band 5 OT so they demanded that our trust match it. Managenent refused so staff pulled OT and now we're seriously struggling because staffing is even worse.

Logic dictates that normal economic rules should apply, i.e. pay more for less popular roles, either due to nature of work, hours of work, geographical location etc. That's exactly what happens in a "free" market. Unfortunately, unions are all for "equality" and object to pay variations so we're left with unpopular jobs going begging and popular jobs being highly subscribed.

We don't even get 1.3 anymore - that was for about 3 moths about 8 yrs ago!

I think that's what I mean needs to change - people getting pissed off - needs to be more suck it up or sign up for those shifts? All completely transparent.

An economist would have a field day. We have a role for a band 7 24/7 to deal with the fact that there aren't enough 5/6s and when there really aren't enough (true crisis point), up to 2 band 8a/b/c midwives are called in at any hour of day (no idea of the cost). They could all be replaced by maintaining recommended staffing of the lower bands.

I’ve often thought this. Band 5 in outpatients vs band 5 in resus/icu is a very different role/level of skill.
my friend works in a state special needs school and they get an additional allowance to mainstream staff

What a nightmare it would be to manage though. Each and every department thinks their work is the most complex/ worthwhile/ highly skilled. Who would be the decision maker?
Our trust runs a pool for unpopular shifts. They'll pay a bonus if you're willing to turn up and be allocated on the day....we all know where these shifts will be, the very hard and heavy wards that nobody would book in to directly, but for 50% more pay bank will do it. Probably doesn't do much for staff morale on those wards though.

That sounds great - I have often found morale is great on tough wards when they're well staffed - hard work that doesn't feel dangerous or neglectful brings its own rewards.

I was hoping some kind of grand computer programme would work it out - based on vacant shifts - bit like amazon automatic pricing? It would go up and down and up then though!

I've often wondered this - both difficult areas within the hospital and geographically. If you get paid the same for a better work life balance, why not?
I work in a fairly rural trust, and we struggle to recruit as we're not too far from a major city with lots of prestigious hospitals...

No idea how it would work though!

I’m a nurse. I agree every role for the bands in the different specialities should be paid according to the actual job role not just lumping them together. I could never work in some areas of nursing because I haven’t a clue what it would entail however, in my specialist it’s complex and you need a bit of experience to do it which wouldn’t translate from another ward.

also preg at moment a due in a couple of months but my local maternity ward is closed as there is not enough staff to run it or have patients so when I go into labour I will need to drive just over an hour to the nearest hospital … not looking forward to that

It’s a really strange convention/ requirement to stick to the bands regardless.

It brings to mind the dinner lady / bin man wage equity case from years ago…. Seems an exclusively public sector concept. I do appreciate the accusations of sexism there.

Some areas don't stick to bands though. My role would be a band higher in some trusts and a band lower in others.

I think in reality upbanding eg. Postnatal ward midwives to ‘sell’ the shifts would just mean they were treated even worse than they are now.

@Reallybadidea band 2s in our trust recently got back pay for years in some cases after demonstrating they’d been working as band 3s.

That's great - I think band 2 pay is appalling for the job they do. Not that band 3 pay is much better

10 years on the pool at my hospital. This is so hard to define. Everywhere is so short staffed. It's so unsafe for staff and patients. However, in my experience, every ward thinks they work harder than others.