The Nursing and Midwifery Council's (NMC) (2018)Code makes clear that nurses can use it to promote safe and effective practice in their place of work. Prioritising people is a central tenet of The Code and the nurse has to put the interests of people using or needing nursing services first. Nurses must also take account of their own personal safety. The Code also requires them to act without delay if they believe that there is a risk to patient safety or public protection, raising and, if necessary, escalating any concerns.
Nurses, like many professions, have the right to take part in lawful industrial action, including strike action. Any nurse taking lawful action will not be in breach of The Code. The NMC notes that during action employers of health and care services play an important part in planning and preparing how the individual needs of people can be met (NMC, 2019). But is our Code incompatible with industrial action? Its tenets continue to apply during any action and the NMC reminds all nurses that they have a duty to uphold professional standards and behaviours.
For the first time in the over 100-year history of the Royal College of Nursing (RCN), members in Northern Ireland took strike action for better pay and increased staffing in a service that is in crisis. Their walkout was a serious escalation after weeks of industrial action by other healthcare workers.
Compared with the rest of the UK, Northern Ireland has the worst hospital waiting lists for a range of services (Department of Health, 2019). Most nurses did not want to take industrial action, but many felt it was the only option left to make employers, politicians and the Government sit up and take notice. It could be suggested that what nurses did is fully aligned with the tenets of The Code—acting in the best interest of patients is clearly at the heart of their action.
Many factors have driven nurses to take this unprecedented industrial action short of a strike, as well as strike action; they were demanding measures are taken to promote safe nurse staffing and pay equality. There are currently around 2800 unfilled nursing posts (RCN, 2019) across the system, with a similar level of vacancies likely in nursing homes, along with record levels of expenditure on agency staff brought in to try to fill the gaps. Nurses' pay in Northern Ireland has continued to fall behind the rest of the UK and, despite the staff side raising these issues for a number of years, no action was taken by employers.
In Northern Ireland the real value of nurses' pay over the past 8 years has fallen by 15%. The costs associated with securing nurses via agencies are at an all-time high, amounting to £52 million in 2018-2019 (RCN, 2019). NHS nurses in Northern Ireland receive less pay than those in Scotland, England and Wales. This unacceptable inconsistency is the antithesis to one of the founding principles of the NHS. Pay rates should be the same throughout the UK, yet salaries of our colleagues in Northern Ireland have fallen far behind.
Safe staffing levels are about having enough nurses with the right skills and knowledge, in the right place, at the right time. Without this, nurses will and are often, through no fault of their own, unable to provide patients with the safe and effective care that our Code dictates we provide and that the people we offer care and support deserve.
In the UK, in Wales safe staffing legislation covering NHS hospitals has already been introduced and in Scotland the Health and Care (Staffing) (Scotland) Act became law in May 2019; however, in England there is no such legislation. It is imperative that safe and effective staffing are protected in law in each of the four countries of the UK.