Nurses have never gone on strike before – something the Royal College of Nurses (RCN) says describes the seriousness of 100,000-strong protests.
RCN general secretary and chief executive Pat Cullen said: “Every nurse feels a heavy weight of responsibility to make this strike safe. Patients are already at great risk, and we will not add to it.”
Like many working people in the UK, nurses struggle to cope with the cost of living crisis. A recent survey found 14% now survive on food banks, with 74% working overtime or agency shifts to pay this winter's energy bills.
At the same time, NHS nursing is experiencing an unprecedented workforce crisis. There are a record 47,000 nurse vacancies in England alone – something the RCN says is keeping over 13,000 patients stuck in hospitals because they can’t be safely discharged. Many nurses feel they are working without safe support, and the strikes are designed to demonstrate their strength of feeling about the risk facing patients.
"I miss doing the job I trained to do, the job I’m good at. I miss being a nurse. I just wish there was a safe way back.”
Natalie Brooks, 40, is an experienced emergency care nurse in the east of England. She’s been a nurse since 2018 and was previously a healthcare assistant.
She works between two trusts, one of which is striking. Natalie is also a regional chair at the RCN, so she’ll be working on the strike committee on both 15 and 20 December to put staff back into work to support patient care and keep the strikes safe. The committees have the power to call nurses back for emergencies.
Not every nurse or nursing student is taking part – for example, nurses at some local hospital trusts have voted not to.
Whole departments have been exempted where nurses felt the risks were too great. On 2 December, the College exempted chemotherapy, dialysis, critical care units and neonatal and paediatric intensive care from the strike action.
“The biggest misconception is that we’re going to walk out and leave our patients,” she says. “That’s not going to happen. When we strike, it will be done in the safest way possible.”
But, Natalie says, a long-term shortage of nurses is one of the main reasons for the strike.
“It's not something nurses want, or that I want to do, but I've been left with no choice,” she says. “My patients aren't safe. I went into nursing, to care and to be patient-centred, and that's not possible at the moment. The strike is scary, but we need to do this.”
At the moment she says every shift is down two or three nurses and one healthcare assistant. She and her colleagues regularly go home or start a shift in tears because of fears of what might go wrong. From a team of 45, nine nurses have left recently, she reports.
When she started nursing in 2018, she usually managed about six patients at once – now it’s 10. The latest Ucas figures show a 10% fall in the number of students accepted onto UK nursing courses, suggesting that many potential applicants are put off by the lack of investment in the profession.
Natalie worked through Covid and says amongst nurses who’ve stayed on, much of the trauma of the pandemic is resurfacing.
“I kind of put it in a box at that time. But I’m dealing with it now.”
Patient safety is at risk because of the workforce crisis, and poor pay exacerbates the situation as the cost of living crisis continues. Several trusts in Natalie’s areas now run food banks for nurses – at Natalie’s hospital, they have an anonymous, help-yourself one to prevent people from going without because of the stigma.
Natalie doesn’t use her food bank, but when I spoke to her on 8 December, she still hadn’t turned on her heating, despite the first frost appearing the night before we spoke. In the evenings, she and her partner go to bed early to avoid using more energy. She’s also given up her car and walks to and from work to save petrol money. She says she wonders how others cope when NHS staff have to turn to these measures.
Maxine Wade, 31, is a nurse associate in Yorkshire. She joined the NHS as a healthcare assistant in 2013 and qualified as a nurse associate in June. She’s striking one of the days, then working as a picket line supervisor on her day off.
Maxine says her role is now increasingly similar to a nurse’s. The nursing associate role was introduced after the Mid Staffs scandal and the Francis Report. They don’t have the same responsibility as nurses (for example, taking charge of a shift), nor are they paid as much. When the role was launched in 2018, experts warned that people in the role could be exploited as a cheap substitute for nurses.
“You feel like you have to come back before you're ready because in this line of work, if you don't turn up, that makes it unsafe.”
Nurse associates are also strongly encouraged to train as nurses. Still, many report a lack of opportunities to do so: in 2019, Health Education England’s chief nurse admitted that of the 80% who’d like to upskill, only 40-50% would go on to qualify.
There are staffing shortages everywhere, Maxine says, and despite qualifying six months ago, she’s already been signed off with stress. But like many nurses, she says it’s hard to take leave when you know it leaves colleagues in the lurch.
“You feel like you have to come back before you're ready because in this line of work, if you don't turn up, that makes it unsafe,” she says. “It means potentially leaving your colleagues in it – and you've worked those kinds of shifts, and you know what it's like. There's very little support because everyone's in the same boat. It feels like it's never-ending.” Although pay is not her main reason for striking, Maxine is a mother of one and says they don’t put the heating on much this year.
My body is so hairy right now I basically don’t need to turn the heating on.
Morale is rock-bottom, she says: “There aren't any positives of the job anymore. It's long hours, it's antisocial, it’s badly paid, it's emotionally and physically taxing, and if you get it really wrong, not only can you end up injuring or killing someone, you can end up in prison.
“Nurses don’t leave because they don't care. It's because they actually decide to value themselves. I don't begrudge them at all. But if I was to leave I don't want it to be because I feel like I just can't manage – I'm not done with nursing yet.”
Maxine’s anxious about the strike but ultimately feels proud of her profession.
"It's only if we stand up and say, enough is enough, that will collectively change.”
“We've collectively decided to make this decision after essentially being walked over for years,” she says. “I'm excited to finally have our viewpoints made mainstream. It's only if we stand up and say, enough is enough, that will collectively change.”
Nurses are campaigning for a pay rise of 5% above RPI inflation: the RCN says that real-terms pay cuts have left experienced nurses 20% worse off since 2010. But the government’s offer to all health service workers is capped at 3%.
The profession also has extended solidarity to NHS colleagues: paramedics, striking on 21 December, and junior doctors, who will vote on whether to take industrial action on 9 January 2023.
Outside the NHS, postal workers and train staff are also taking action. Both professions cite the cost of living pressures, with train staff also concerned for passenger safety.
On Monday, 5 December, the OECD published evidence that UK nurses fare worse than most European countries, not only in comparison to national average earnings but also with the day-to-day cost of living.
Pat Cullen wrote to health secretary Steve Barclay MP, saying: “I must ask you how you will respond to the categorical evidence that the United Kingdom values nurses less than others. With the facts laid out bare by the OECD, you may now feel clearer on why my members across the four countries have voted so decisively for strike and why the remedial action on the part of governments must be as significant as it is urgent.
“As I have made clear on multiple occasions, you have the option to avert strike action by opening formal negotiations about the current pay award.”
Following a meeting with Steve Barclay MP, on Tuesday RCN's Pat Cullen, said: “The government was true to its word – they would not talk to me about pay. I needed to come out of this meeting with something serious to show nurses why they should not strike this week. Regrettably, they are not getting an extra penny.
"Ministers had too little to say and I had to speak at length about the unprecedented strength of feeling in the profession. I expressed my deep disappointment at the belligerence – they have closed their books and walked away.”
Normality has almost returned. So why don't I feel happy?
