As the BBC reports, in 2017, more than 33,000 nurses left Britain’s National Health Service.
For an NHS already under immense pressure due to aging patients and overwhelmed hospital wards, this shortage of frontline clinicians is a crisis. But what’s behind the shortage?
I think three issues stand out.
First off, salaries. In England, the 2017-2018 starting annual pay for nurses is between $21,456 and $21,828 (in U.S. dollars). In contrast, according to Drexel University, the average starting salary for an American nurse was more than $66,000 in 2016-2017. Those differences don’t simply speak to the beginning of a career, but the longer-term reward prospects for what is a stressful job. While this has been a longtime challenge – my mother transitioned from the NHS to private nursing in the 1980s in order to earn more – in 2018, the salary-opportunity mismatch is truly ridiculous.
And in effect, it means that where American nurses can have confidence in a good, sustainable income that allows them to pursue their lifelong passions, British nurses are often left struggling just to get by. Indeed, the U.K. press has recently featured a number of stories concerning nurses who have come to rely on food banks.
Ultimately, many British nurses today are only doing their jobs because they truly care about helping their fellow citizens.
The second problem is working conditions.
Where, mostly for reasons of legal liability, American nurses are often not empowered to the degree that they should be, British nurses are empowered but also overwhelmed. In Britain’s socialized medical system, demands on doctor time and access to care are extremely high. This requires nurses to lead the provision of care for many patients as doctors triage their time to the most ill.
The problem, of course, is that when a nurse is managing multiple ill patients on a 12-hour shift without sufficient support, he or she will be overwhelmed and will sometimes make mistakes. And as the pressures keep growing alongside Britain’s aging population, more and more nurses are deciding that enough is enough.
The final concern, I think, is one of respect.
While nurses and the NHS in general are revered by much of the British public (remember the Olympics opening ceremony?), at the point of interaction, nurses don’t get the respect they deserve. As I noted recently, this is best evidenced on Friday and Saturday nights when young Britons partake in their favorite national pastime: excessive alcohol consumption. Ask anyone who has attended an emergency room on one of these nights, and you’ll find a story of morons being aggressive and staff struggling to cope. Who wants to deal with that kind of situation week in and week out?
Only the most selfless.
The British government is going to have to address these issues one way or another.
At the most basic level, they’ll have to increase nursing pay, improve conditions, and impose costs on Britons who decide that they can waste medical resources and time because they don’t feel the costs of that choice in their own pockets. But over time, they’ll have to reconsider the whole manner by which healthcare in the U.K. is organized and allocated.
