It’s seven in the morning and Helen has just started her shift as a cardiology nurse in Buckingham. First there’s a handover with her colleagues working nights. Then she assists with breakfast and helps patients to wash and dress before carrying out clinical observations like blood pressure and temperature checks. ‘I do wound swabs and transfusions, prep patients for procedure, and take bloods,’ she explains.
Alongside that, she carries out a significant chunk of paperwork, updating care plans and reviewing documentation following doctor reviews. That’s on top of making sure discharges are sent home and new admissions are taken in. ‘I’m constantly updating family members and relatives, over the phone or in person, and liaising with other healthcare workers like physiotherapists, dieticians, doctors, and social workers.’
The afternoon consists of more documentation, medication administration, receiving post-procedure patients, more observations, and then assisting with dinner and more medication. At 7.30 in the evening, she hands back over.
At 24, Helen has worked in the NHS for six years, qualifying as a nurse three years ago. In that time alone, she says, the profession has changed considerably. For one thing, an ageing population means more patients with complex care needs, who need more time and more care—but it’s impossible to meet those needs when staffing and morale are at an all-time low. ‘I find I’m doing the work of 1.5 or two nurses per shift because of how short-staffed we are,’ she says. ‘That’s simply not safe for patients.’
34-year-old Sharon works in intensive care, after qualifying as a nurse in September 2019. She tends to work nights. Following a handover, she carries out safety checks, assesses patients and determines whether scans are required. ‘Things don’t always go to plan—I can spend half my day just trying to fix someone’s blood pressure to keep them alive, and then there might be an arrest in the bed next door where we have to help. This is while admissions and discharges are taking place as well as trying to support junior members of the team, students, and new starters,’ she recounts.
‘Then I get my drugs ready and counter-signed in-between the madness, and give those while updating our patient system on the computer. Things change every five minutes in ICU, and I have to be able to multitask at all times.’ Visiting hours on the ward are from midday until 7PM, and Sharon is also charged with ensuring patients are ready for visitors, and that visitors are updated on their loved ones’ status and the plan for them.
On top of that, patients who come to the ICU are some of sickest in the area, and often don’t make it. Sharon will therefore often spend a lot of her working day caring for an end-of-life patient. ‘We try to make sure they have a dignified death,’ she says. ‘What we would call a “good death”.’
Sharon was only three months into her job when Covid hit, and it hit hard. ‘I was looking after three fully sedated and ventilated patients, and our unit was at triple the capacity, using theatres as an overflow,’ she tells Tribune. But for her, the pandemic proved how valuable ICU nurses are, in times of crisis and outside them. ‘You can have all the ventilators in the world, but you need that bedside nurse to be able to use it and know what she’s doing, when her patient relies on that alone to keep them alive.’
Noting this workload in increasingly difficult conditions, let alone during the pandemic, it’s hard to imagine seeing nurses as anything other than some of the most crucial members of our society. But in reality, nurses’ real pay is down more than £5,000 since 2010, according to the TUC—and this year, as inflation spirals, and after spending Covid clapping on the doorstep, the government is still refusing to give nurses anything other than another real-terms pay cut.
It’s not only the succession of real terms pay cuts that have made life harder for nurses. While the government claims that the NHS has been protected from the sweeping cuts made to public services over the last decade, austerity’s impact on the NHS and the day-to-day work of nursing staff is clear.
The cuts to adult social care alone have been particularly damaging, putting huge pressure on hospitals and the nurses who staff them. For Helen, it means looking after patients who are medically suitable for discharge but waiting for a package of care that’s increasingly hard to come by. In turn, that blocks bed flow from emergency departments to the wards.
Simon, who qualified as a nurse more than ten years ago and now works in Kent, says the beds crisis is causing harm to patients. ‘The focus is on getting patients out of the hospital, and early in the day,’ he explains. ‘Those waiting for social care in my hospital are in the high double-digits, a full two-wards’ worth last I heard.’
This is only one part of a process that’s seen the hospital environment change a lot since Sharon was a clinical support worker and, later, a student on the wards. ‘The wards had more staff, people didn’t seem in such a hurry, and community caseloads were smaller,’ she says. ‘Now I’ve seen standards slip first-hand, and the nursing staff be so stretched that on the ward one nurse will have to look after twelve patients.’
Both a cause and a result of this is large numbers of qualified and experienced nurses leaving the NHS—the equivalent of one in nine in England in the year to June 2022 alone. The figures reflect a long-term trend, but Sharon noticed a drastic change following Covid, watching swathes of her colleagues exit after the virus’s third wave.
‘Some left the profession completely, others retired, and others moved to different areas just to try and escape,’ she says. ‘I now have PTSD and take regular antidepressants due to some of the horrific sights I saw during the pandemic. In all honesty, I don’t think many of us will ever be the same again.’
At the other end, training as a nurse in the UK has become prohibitively expensive for many. ‘The Tories cut the NHS bursary enabling nurses to have their training paid for, which was a massive selling point when I started my studying,’ says Sharon. Secondments like hers, through which companies paid for nurses to do training, were also stopped.
‘Real-terms cuts year after year does not make anyone keen to go into hefty debt,’ says Simon. ‘I got a free diploma, and it was still tough to get through—student hours in the classroom and on the ward make it very difficult to work enough to cover expenses.’ Placing fees on training when we already have a ‘chasm of vacancies’, he adds, ‘seems a deliberate act of sabotage.’
The impact of the recruitment and retention crisis on the day-to-day experience of the nurses who remain can’t be overstated. On Simon’s small coronary unit, he says his team are often told how good their staffing levels are compared to the rest of the hospital. ‘It’s why they move the extra nurse that makes going to the toilet or having breaks away from the ward safe. We are constantly short on staff and unable to take a break during twelve-hour night shifts, and then unable to accurately update our roster programme because it won’t accept a shift without a break—because it’s illegal.’
Saving the NHS
When Simon specialised in cardiology, he says he was quite lucky to get the job with three years of experience. Today, the vast majority of those joining his unit are newly qualified nurses. By the time Helen was just nine months qualified too, she says, she would often find herself in charge of a ward of twenty-eight patients.
‘I work in an area where we have incredibly poorly patients,’ says Helen. ‘I am supposed to have for four patients but nowadays will have anywhere between seven and nine. You can’t give the care you want to, and the care patients deserve.’ It’s due to these worsening circumstances that Helen has now made the difficult decision to hand in her own resignation.
Today marks the second day of the Royal College of Nursing’s first ever national strike, and it’s stories like Helen’s—everything from the hectic, break-free shifts and the burnout to the pressure without experience and the final decision to leave—that show why so many feel action is necessary. ‘Working under these conditions is completely unsustainable,’ says Helen, her tone both sad and angry. The nurses now on the pickets have been keen to hammer home the point that they’re not only striking to demand their worth in the form of a proper pay rise, but in the interests of the patients for whom they care.
‘Something needs to be done so that the next generation of nurses feel valued and appreciated,’ says Sharon. ‘Turn back the clock two years ago—we were deemed heroes and angels, people clapped for us. But we aren’t angels or heroes. We are highly trained, educated and skilled professionals who sometimes end up being all that lies between life and death. It’s time we were treated like that.’
‘If we don’t have nurses, we don’t have “beds”, nor a health service at all,’ points out Simon. ‘I am extremely concerned by the noises coming from both sides of the house. Does anyone actually want to save the NHS?’