It took Francesca Elner 20 years from when she first started studying nursing to the moment she finally qualified last year. She set out on her chosen career aged 18, but was halfway through a course when life intervened and she left to have a family. Over the next two decades, she tried various other jobs, but nothing stuck. “I realised all I ever really wanted to do was be a nurse,” she says. So, in her mid-thirties, Elner started a nursing degree, graduated last year and has been working in the emergency department of a hospital in Wrexham, north Wales, for nine months. “I’m loving it,” she says. “Genuinely.”
If she feels she has to convince me, it’s hardly surprising. Because while Elner’s passion for nursing hasn’t changed in those 20 years, the response to her job choice has.
“When I first started studying nursing, all those years ago, nine times out of 10 the reaction was, ‘Oh, that’s wonderful – good for you,’” she says. “Now, when I tell people, the majority ask why on earth I’d want to be a nurse in this day in age. They tell me it’s an awful choice of job. And it's even worse from other nurses."
Traditionally, nursing has always been a career held in esteem, with great respect and warm feeling awarded to those within it. TV shows like Call The Midwife trade on the public's sentimentality towards the profession. Yet, looking at the differing reactions – 20 years apart – to Elner's choice of career, does that still stand in 2017?
Nurses are still the lifeblood of our healthcare system. They deliver our babies, look after us and our loved ones when we’re sick, care for our elderly relatives. This year, more than ever, we’ve been reminded of the compassion and courage they bring to their jobs. Whether it's those who rushed into work in the middle of the night to treat victims of the Manchester bombing, or the off-duty nurse who ran towards the fire at Grenfell Tower while everyone else was running away, their heroism — along with that of other emergency services — has been hailed.
At the moment, it’s all hanging together on goodwill. But there will come a time, and I think it’s coming quite quickly, when that goodwill will evaporate
But nurses have become headline news for other reasons, too. From Yorkshire nurse Victoria Davey confronting Theresa May about her pay on a Question Time election special (and receiving the infamous “There’s no magic money tree” response), to the failed Labour motion to the get the public-sector pay cap scrapped from the Queen's Speech, and then news this month that, for the first time on record, there are 20 per cent more nurses now leaving the profession than joining it. Especially in light of the fact that – for those quitting before retirement age – the biggest reason given is working conditions, it’s hard to escape the fact that nursing is itself in a critical condition.
The uncertainty of Brexit is also having a huge impact. The NHS currently relies heavily on EU nurses to plug the gaps, but since the referendum result there has been a staggering 96 per cent drop in EU nurses registering to work in Britain — just 46 came to work in the UK in April, down from 1,304 last July. With 40,000 vacant nursing positions already in England alone, it's a loss the NHS can't afford.
“There aren’t enough nurses on the wards or out in the community,” says Josie Irwin, head of employment relations at the Royal College of Nursing. “That puts more pressures on the ones that are there, and because they’re working flat out they become ill and stressed. It just feels like a treadmill – a vicious circle.
“At the moment, it’s all hanging together on goodwill. But there will come a time, and I think it’s coming quite quickly, when that goodwill will evaporate. Because there’s only so much a person can take.”
Last month, the RCN launched a “Summer of Protest”, a series of countrywide demonstrations calling on the government to scrap the public-sector pay cap that limits annual rises to one per cent. “This is about nurses being really fed up with the cap that has been in place since 2010,” says Irwin. “On average, nurses have lost out on about £3,000 in real terms because pay has not kept up with inflation.”
A survey of RCN members published last year found that 30 per cent are struggling to pay gas and electricity bills, 53 per cent were working extra hours to meet their cost of living, and 14 per cent had missed a meal because of financial difficulties. Less than half would recommend their career to someone else. The Cavell Nurses Trust, which supports nurses facing personal or financial difficulties, saw a 36 per cent increase in demand for their services last year.
“I really do feel for nurses starting out now,” says Irwin. “It’s actually awesome that they keep coming into nursing and wanting to deliver quality service, but they are coming in against a background of huge challenge.”
There are very basic things you can do as a nurse – get someone a cup of tea, make sure they’re comfortable in bed, make their hair look smart if they’ve got visitors. Things where you can see the difference in somebody immediately
So what still draws people like Francesca Elner into the profession, despite all this?
“For me, it’s the combination of the medical side with the caring,” she says. “I remember doing CPR on someone for the first time and them surviving, and that’s an incredible moment. But it’s the more human moments that are so satisfying. There are very basic things you can do as a nurse – get someone a cup of tea, make sure they’re comfortable in bed, make their hair look smart if they’ve got visitors. Things where you can see the difference in somebody immediately. It’s a holistic job — you see every side of a human in a way no other job lets you.”
She often meets people at their lowest ebb. “They’re feeling really unhappy, usually in pain. To be able to make that person feel like somebody cares is just the most amazing privilege.”
It’s this goodwill that Jeremy Corbyn last week accused the government of “recklessly exploiting”, by keeping the pay cap in place. And Elner agrees that the general good nature of nurses are being taken advantage of. “I think the government knows we do it for love. They know we have that deep connection to our patients and they’ve played on that for too long. Yes, I will keep on doing this job if you pay me pants money – but it’s not fair.”
Although the pay cap affects workers of all genders, Irwin does think there’s an implicit gender bias at play, which has contributed to the current crisis in nursing – just earlier this year, new statistics revealed that nursing is still an overwhelmingly female profession, with just 11.4 per cent of UK nurses being male. “Nursing is still a female-dominated profession; 90 per cent of nursing staff are female,” she explains. “There is the sense that if it were blokes that shouted a lot more, the government wouldn’t treat them like this. I think there’s still this idea that it’s a profession for girlies who can do it for a while and then get married, and their own income isn’t really of importance to them, which of course is completely untrue. It’s a graduate profession; it’s highly skilled. And in many areas, like intensive and emergency care, it’s highly technical.”
Since 2013, nurses now need a degree to enter the profession — but last year Jeremy Hunt announced plans for an “earn as you learn” apprenticeship scheme to encourage more people to train. Following the government’s decision to replace bursaries with loans for nursing students — a move then-chancellor George Osborne said would help lift a cap on student numbers and create 10,000 extra training places — applications to nursing and midwifery course have fallen by 23 per cent.
Money isn’t the prime motivator for people who go into nursing. As Irwin explains, it attracts “individuals who have a value system around providing public service and giving something to others".
But with stagnant pay that lags way behind inflation, and nurses struggling to meet the cost of living, that feeling of being undervalued can’t fail to have an impact.
“When you know you’ll have a huge student loan to pay off and nursing salaries are £22K, then you see that the supermarket Aldi is offering £42K for new graduates to come in and manage, then that starts to look quite attractive,” says Irwin.
The average age of a new starter is currently 29, with many choosing nursing as a second career, but the RCN says the decision to scrap bursaries is deterring mature students, as those with families and mortgages can't afford the financial hit. Six thousand fewer mature students applied by the end of March 2017 deadline compared with 2016 – a fall of 28 per cent from 21,060 to 15,160.
Ffion-Medi Ryan, a 28-year-old student nurse who left teaching to retrain, admits she worries about the future. “I love the decision I have made to enter nursing, but it would be good to be able to practise without worrying that the NHS will crumble,” she says.
“People often ask me if I’m mad, and tell me I picked the worst two careers to go into. But as soon as I start talking about my days on placement, the people I've encountered and how just a two-minute conversation can change a patient's day for the better, they understand.”
For those who have been in the profession a long time, staying positive is harder. One health visitor I spoke to who has been in nursing for 29 years — and who wanted to remain anonymous — broke down in tears telling me about the pressure of the job now.
I think there’s much more of an awareness of what nurses do in reality now. It’s not pitying or patronising. It's admiring
“I am now working in intolerable conditions where my services are being cut, clinics closed, my role has been devalued and my families get less support from me. I live in fear of 'missing something’. The pressure is horrendous and I don’t sleep well any more.”
Why does she stay? “Because no one will do the job if we don't. It's so hard to walk away from these families. I recently sat with a mum whose child was diagnosed with a terminal condition and helped another mother who is homeless. The relationships you build in nursing are a privilege.”
Even so, she doesn’t know how long she can last. “I have to consider my own mental health and my own family who hardly see me.”
Like many nurses, she’s become politically active — recently joining protests to scrap the pay cap. “Fighting mode keeps me sane,” she says.
Nursing is no longer just a profession, it’s become a battleground, and those entering it today are braced for a fight. “My involvement in the political side, that’s what keeps my head afloat,” agrees Elner. “Meeting people who still believe in it as a profession and are willing to do things about it — those people pick me back up when I’m down. I know that nursing is a great profession. I’m proud to be in it. I want other people to be proud of it.”
If, come the chancellor’s autumn statement in November, the pay cap is still in place, the RCN will consider industrial action (members have already voted 91 per cent in favour of striking).
Irwin says recent developments like the failed vote on abolishing the pay cap have built a sense of momentum and won the public’s support. “I think there’s much more of an awareness of what nurses do in reality now. It’s not pitying or patronising. It's admiring. It’s ‘How do you manage to keep on going in the face of all that crap?’”
She’s hesitant when I suggest nurses need an extra level of resilience these days. “I’m wary of that word – it puts the onus on them. It’s the government’s responsibility to provide a working environment that’s safe for nurses and their patients, where there can be a decent work/life balance. It’s not up to them to put on a brave face and nice smile and battle on through it.
If not then resilient, perhaps nurses are braver than ever? “Yes. Brave and courageous. I think those are very good words.”