The Royal College of Nursing has announced nurses across the UK strike for the first time in its 106-year history in December.

This comes after the union balloted 300,000 of its members – two-thirds of the nursing workforce. No details about how long the strike will last for have been released, but it is set to start before Christmas.

But what will the mass walkout mean for the safety of patients?

The industrial action is a result of a years-long dispute over nurses’ pay. But RCN claims the strike is also about protecting the safety of patients. RCN’s general secretary, Pat Cullen, described the nurses strike as a ‘once in a generation chance to improve pay and combat staff shortages’ that puts patients at risk.

“This action will be as much for patients as it is for nurses. Standards are falling too low and we have strong public backing for our campaign to raise them. This winter, we are asking the public to show nursing staff you are with us.”
RCN General Secretary, Pat Cullen

The strike is a last resort, with the RCN having exhausted every option to have their voices heard. They argue that if they don’t take a stand now, the nursing crisis will only continue to worsen, thus having an even greater impact on patients in the future.

But there is a fine line between causing disruption and protecting patient safety.

How will the Nurses Strike affect patients?

The strike has to follow the life-preserving care model. This means some aspects of nursing care will be exempt under what is called derogation. Members whose roles are safety critical will agree to keep those services running.

Exemptions will include:

  • Emergency intervention for the preservation of life or the prevention of permanent disability
  • Care required for therapeutic services without which life would be jeopardised or permanent disability would occur
  • Urgent diagnostic procedures and assessment required to obtain information on potentially life-threatening conditions or conditions that could potentially lead to permanent disability.  

Intensive care units, as well as cancer pathways, should be staffed to the same extent as usual.

Worst hit areas are expected to be routine or elective operations, community nursing, health visiting, chemotherapy, and dialysis. It is also set to affect patients being discharged or transferred from hospital.

The withdrawal of non-emergency admissions will only add to the ever-increasing seven million backlog of cases. There will be many disappointed – and most likely furious – people who already have waited months or years for surgery only to be told it has been cancelled. They will have to endure yet more pain and discomfort while they wait for treatment to be rescheduled.

One of the major concerns is that strike action is being taken during the winter months, possibly in the weeks leading up to Christmas. This is always a period where the NHS is in greater demand, particularly amongst the most vulnerable patients.

Nurses feel underpaid, undervalued and under-appreciated. Most of the public support and recognise the dedication of our NHS nurses. But will this walkout impact the respect from the public if too much disruption to care is made?

Will all hospitals be affected by the Nurses Strike?

By law, the ballot was held at hospital level. This means each NHS Trust has had to meet the 50 percent threshold, and reach a majority vote, for it to be legal.

Not all Trusts have voted for the strike, meaning not all hospitals will take action. Staff in 131 NHS organisations across England, 12 in Wales, 23 in Scotland and 11 in Northern Ireland have voted for strike action. It may be the case that you have two neighbouring hospitals, one of which will strike and the other which will not.

However, it is likely that the majority of patients will face disruption with their care. 

A vote in favour of strike action does not mean every nurse has to strike, although they will have the choice to do so.

Throughout any industrial action, the code of practice remains in place. This means registrants who take part in the strike will still have a duty to uphold professional standards.

Minimum staffing levels will have to be adhered to. This could see hospitals working to a bank holiday service with a reduced rota. If there are any concerns about safety levels within a Trust, then staff may be pulled off the picket line.

Unison general secretary, Christina McAnea appeared on BBC Newsnight before the results were announced to say that we could see higher staffing levels in the NHS because of agreed minimum staffing levels.

Why are nurses striking?

The RCN says the strike is an urgent measure to address the unsafe staffing levels and deliver pay parity.

Nurses face constant moral injury: they cannot provide the care they are trained to give due to acute and chronic understaffing. They are haemorrhaging nurses at an alarming rate. This is said to be as a direct result of pay and working conditions.

After years of squeezes on nurses’ salaries, the RCN called for a pay rise of 5% above the rate of inflation. However, the government has offered a pay award of 4.75% for nurses in England and Wales. This will mean an annual increase of around £1,400 for the lowest paid nurses. In Scotland, the pay award is 8%.

Once inflation has been taken into account, nurses’ average take-home pay has fallen by 6% since 2011, compared to 4.6% for the overall UK workforce. Research as also found that real-term salaries of experienced nurses have fallen by 20% since 2010, meaning they work the equivalent of one day unpaid each week.

Cabinet Office Minister, Oliver Dowden said the Department of Health has ‘well-oiled contingencies in place’ for scenarios like this. But we are seeing record number of nursing vacancies, about 47,000. This is on top of around 25,000 nurses who have left the register in the last year, plus an 8% fall in new entrants.

The state of NHS services has been thrown into the spotlight in recent years. Wards are terribly understaffed, nurses work gruelling 12-hour shifts without a break, unpaid students are drafted in to fill the void, and burnout rate is at an all-time high.

The Nurses Strike is not the only industrial action planned. Unison and GMB are also holding ballots for paramedics and non-medical staff such as porters and cleaners.

Funding cuts are clearly hurting the NHS. The RCN and government need to negotiate quickly to protect against the collapse of the NHS before it is too late.

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