Pay Rise Cancelled for NHS staff

lana22

davilown wrote: »

Originally Posted by donaldtramp

One last note - doctors are overpaid. There are very few who are good at their jobs. More importantly there are too many who are appalling, incompetent and even negligent. Junior doctors need more training. Why do you think August and February are know as the start of the killing season in hospitals -something due to the intake of newly 'qualified' doctors?

Firstly, yes, junior doctors need more training. But not at medical school level. For one thing, no one could afford to go to medical school for longer than they do already, it would be impossible. Secondly we need to conversly be given more responsibilty as final year medical students. At present we have literally no responsibilty to do anything, then all of a sudden come August, we can prescribe the whole of the formulary. It's the leap from being hand held to being entirely on your own that's the problem, in my eyes.

Secondly, you might want to get your facts straight before you make overblown statements about junior doctors effectively killing people. THERE IS NO NEW INTAKE OF NEWLY QUALIFIED DOCTORS IN FEB. So if your "research" has shown increased death rates in feb you need to find another cause. I suspect it isn't entirely unrelated to the february weather.

Junior doctors do need more training and that can only be acheived by us working longer hours, and more out of hours like we used to. But that (obviously) requires us to be paid for that service, something which people like you and the "system" feels is undeserved. You can't have it both ways.

donaldtramp

http://www.timesonline.co.uk/tol/news/politics/article5989766.ece

From Times Online
March 29, 2009
NHS managers get large payrise despite downturn

David Rose

Top managers in the health service have seen their pay rise by more than three times the average for the rest of the public sector, figures reveal today.
Directors of NHS trusts England received average pay increases of 6.4 per cent last year, far exceeding the Government’s 2.2 per cent pay rise for nurses and midwives, and its 2 per cent target for other public servants.
Since 1997 the average earnings of NHS chief executives have increased by 98 per cent compared to 50 per cent across the public sector as a whole.
But the rapid growth of health bosses’ earnings will embarrass ministers determined to rein in the public sector wage bill as Britain prepares for its first period of deflation for 50 years.
The number of people in management roles in the health service — 39,900 — now exceeds the number of senior doctors, the NHS census revealed this week.
The figures for top managers’ pay reveal a widening gap between the salaries for directors of flagship foundation hospitals and other executives......

lunar

lana22 wrote: »

I'm not sure that's entirely correct. The sisters on my ward earn (deservedly) more than I do.
I agree wholeheartedly that junior doctors do get taught and helped a lot by nursing staff, particularly senior ones, during our working life. However there are 2 sides to it. You call on us to make the ultimate decisions, and it is our name down in the notes when we decide to give that IV frusemide or whatever.
We can't all be experts when we first start out, and many more junior nurses require hand holding by both senior nursing staff and medical staff. The amount of times I get entirely innapropriate bleeps is unreal, asking stuff like "can you review this patient please, they are tachycardic at 92 bpm". Answer. No, I can't, and my pulse is probably a hell of a lot higher than that now!

The other thing is the student debt. Nurses get their fees paid and a bursary, on a 3-4 year degree. We get neither on a 5-7 year degree. So we start out in a much worse position financially than newly qualified nurses.

I have also noticed, yes, that sisters and ward managers do tend to stay longer hours on the ward than they are contracted for. Our ward manager went home at 11am from a night shift the other day. It's not fair and it the level of staffing should allow her to go home on time. It's a problem for us too, out of hours cover is terribly low and so if we want something doing we have to stay behind, especially if we have a sick patient.

I should have added more detail, i work in an area that is very specialsed. no matter what a new doctor perscribed to one of my patients, if i gave it and it was wrong the coroner has happily told us its the nurse he would crucify as we should know better with this patient group. I agree with this in my area too.

the funniest bleep my OH got from a new nurse in his SHO days was, the prescription said 1 gram but we only have 500mg tablets, can you change the prescription!

I was stupid enough to do the nursing degree, with no bursary and fees to pay. Im not really sure what i was thinking.

lana22

lunar wrote: »

I should have added more detail, i work in an area that is very specialsed. no matter what a new doctor perscribed to one of my patients, if i gave it and it was wrong the coroner has happily told us its the nurse he would crucify as we should know better with this patient group. I agree with this in my area too.

the funniest bleep my OH got from a new nurse in his SHO days was, the prescription said 1 gram but we only have 500mg tablets, can you change the prescription!

I once got asked why I had prescribed 1000mg of paracetamol as the dose is normally 1g! Must be commoner than I thought!

If it's very specialised (oncology?) senior nurses with more experience are bound to know more, especially as our training as juniors is very broad based.

I have lots of funny bleep stories, I also once got bleeped by a CCU nurse (who usually know better!), asking if I could come and see a patient because he felt cold. His temp was normal and he wasn't spetic or anything. I reluctantly went because it was on my way to the next cannula, and found the patient sitting in the chair with a short sleeved shirt on beneath an open window! I wrote in the notes

"ATSP as felt cold.

O/E Patient is shivering, wearing a tee-shirt, sitting under open window.

Obs stable, temp 37.2.

Impression : Cold due to lack of clothing and open window.

Plan: close window and put a jumper on patient."

lana22

lunar wrote: »

I should have added more detail, i work in an area that is very specialsed. no matter what a new doctor perscribed to one of my patients, if i gave it and it was wrong the coroner has happily told us its the nurse he would crucify as we should know better with this patient group. I agree with this in my area too.

the funniest bleep my OH got from a new nurse in his SHO days was, the prescription said 1 gram but we only have 500mg tablets, can you change the prescription!

I was stupid enough to do the nursing degree, with no bursary and fees to pay. Im not really sure what i was thinking.

Now days the degree courses have their fees met by the NHS.

donaldtramp

http://www.telegraph.co.uk/comment/personal-view/5066806/Six-simple-steps-to-a-healthier-health-service.html

beccam

lunar wrote: »

I should have added more detail, i work in an area that is very specialsed. no matter what a new doctor perscribed to one of my patients, if i gave it and it was wrong the coroner has happily told us its the nurse he would crucify as we should know better with this patient group. I agree with this in my area too.

the funniest bleep my OH got from a new nurse in his SHO days was, the prescription said 1 gram but we only have 500mg tablets, can you change the prescription!

I was stupid enough to do the nursing degree, with no bursary and fees to pay. Im not really sure what i was thinking.

I'm in a similar position to yourself though not a ward sister just an old E grade now lumped into a band 5 with all the other plebs!
Its a specialised area so we don't have JHO's come to us but most of our SHO's will have no previous experience in the area.
I have often had to tell them word for word what to prescribe and how to prescribe it or spend hours trying to explain the basics in order for them to understand what the problem actually is.
Don't get me wrong I have great respect for (most of) the doctors I work with but it does annoy me at times when I think of the salary they are getting.
As for the silly bleeps.......I work a twilight shift 3pm-1am, docs go home at 5.30pm and work on call from home, we have now been told we are not allowed to contact the SHO on call unless it is a 'life threatening' matter since they get paid for every phone call they take.
My issue is that now as a band 5 nurse who is normally nurse in charge on the shift..I am expected to decide if it is worth calling a doctor when a patient is ill, not in a normal way of knowing there is nothing wrong or when someone is really ill but having to really make tough decisions........like is this person clammy and pale because his BP is low or is this person clammy an pale because they are having an MI.....if its his BP I can deal with it but what if its not?
Also we have had our abilities to give paracetamol etc taken away....it requires a doctors prescription so I have now had to tell our patients (who attend from home 3xper week) to bring their own painkillers, antacids etc as I can't call a doc to prescribe them and can't give without prescription.

It all makes me cross really, I feel that nurses are taking on more and more responsibility but getting less and less respect for it and not getting the wage to reflect the pressures they are under.

lana22

beccam wrote: »

I'm in a similar position to yourself though not a ward sister just an old E grade now lumped into a band 5 with all the other plebs!
Its a specialised area so we don't have JHO's come to us but most of our SHO's will have no previous experience in the area.
I have often had to tell them word for word what to prescribe and how to prescribe it or spend hours trying to explain the basics in order for them to understand what the problem actually is.
Don't get me wrong I have great respect for (most of) the doctors I work with but it does annoy me at times when I think of the salary they are getting.
As for the silly bleeps.......I work a twilight shift 3pm-1am, docs go home at 5.30pm and work on call from home, we have now been told we are not allowed to contact the SHO on call unless it is a 'life threatening' matter since they get paid for every phone call they take.
My issue is that now as a band 5 nurse who is normally nurse in charge on the shift..I am expected to decide if it is worth calling a doctor when a patient is ill, not in a normal way of knowing there is nothing wrong or when someone is really ill but having to really make tough decisions........like is this person clammy and pale because his BP is low or is this person clammy an pale because they are having an MI.....if its his BP I can deal with it but what if its not?
Also we have had our abilities to give paracetamol etc taken away....it requires a doctors prescription so I have now had to tell our patients (who attend from home 3xper week) to bring their own painkillers, antacids etc as I can't call a doc to prescribe them and can't give without prescription.

It all makes me cross really, I feel that nurses are taking on more and more responsibility but getting less and less respect for it and not getting the wage to reflect the pressures they are under.

That's really unusual, I have never heard of an SHO salary where they get paid for taking calls. Our new salary deal did away with all that. They are lucky to have non resident on-calls at SHO level too, that's exceedingly rare.
Also, I do think nurses often overestimate what their doctor colleagues are earning.

With your sweaty/clammy scenario, that's the exact thing that we have to deal with all the time. It is stressful and difficult. However it is a doctor's job to decide that sort of thing, so you shouldn't be told not to call the SHO.

With regards to not being able to give paracetamol, that is ridiculous, nurses should have a limited formulary. It is just as annoying for us having to walk 15 mins to the other side of the hospital to prescribe paracetamol as it is for you having to call us.

Ultimately, in a specialist area, a nurse who has been doing the job for years in that area is going to know more about that specific area than the junior doctor who is yet to specialise, and changes jobs every 4 months. That's always going to be the case. But in then end, if the patient is clammy and sweaty because of an MI then it's us you call on to sort the patient out.
I don't think that the roles of doctor and nurse can really be directly compared because they are so different with such different responsibilities.

beccam

lana22 wrote: »

That's really unusual, I have never heard of an SHO salary where they get paid for taking calls. Our new salary deal did away with all that. They are lucky to have non resident on-calls at SHO level too, that's exceedingly rare.
Also, I do think nurses often overestimate what their doctor colleagues are earning.

With your sweaty/clammy scenario, that's the exact thing that we have to deal with all the time. It is stressful and difficult. However it is a doctor's job to decide that sort of thing, so you shouldn't be told not to call the SHO.

With regards to not being able to give paracetamol, that is ridiculous, nurses should have a limited formulary. It is just as annoying for us having to walk 15 mins to the other side of the hospital to prescribe paracetamol as it is for you having to call us.

Ultimately, in a specialist area, a nurse who has been doing the job for years in that area is going to know more about that specific area than the junior doctor who is yet to specialise, and changes jobs every 4 months. That's always going to be the case. But in then end, if the patient is clammy and sweaty because of an MI then it's us you call on to sort the patient out.
I don't think that the roles of doctor and nurse can really be directly compared because they are so different with such different responsibilities.

Well I have been off work for 5mths but as far as I'm aware the same rules still apply!
The on call doc can be an SHO or Reg as they take it in turns to cover and may also be one of the reg's from another hospital who will cover if needed. Apparently it all came about because the SHO's used to be around the hospital until a lot later but were told they had to leave (as best as possible) by 5.30 to avoid working too many hours and also avoid overtime payments. This in turn led to them being (naturally) a bit keener to document the calls they took during the evening and if it involved them having to come to see a patient.
I totally agree that, like in the example I've given, it is not my call to make, the doc should see and assess the patient. Sadly I have been told on more than one occasion that I should not call the doctor and was also pulled up by the consultant (head of dept) for doing so!
We have now had to start filling out IR1 forms (incident forms) for when doctors have refused to come to see a patient, this was after one evening when a man with known cardiac history displayed some early symptoms, the doc refused to come in, said if he still felt unwell at end of treatment he could go to A&E, now this man had been out of the house from 5pm, and was not finished with us until after midnight, he felt rough and just wanted to go home which he did against our advice but understandably did not want to wait in A&E for hours to be seen. He later had a massive MI and died in the early hours of the morning.

Many of our docs who have worked in the dept for a long time know me well enough to know that if I call them I need them. When a patient is ill I will assess them, take routine bloods and cultures, wait for these to come back, ask for history etc etc and then decide if I need the doc, the problem comes when it is new docs who don't know me (or the other nurses) and don't realise that when we call we really need them!! Nothing bugs me more than having to ask a doc to write up paracetamol, gaviscon or for us saline (its dialysis we use alot of saline!!! )

I also have issues with them not being on site, I called a doc one night soon after the new rules came in as a patient went into (what we suspected was) anaphylactic shock......he told me he'd be there in about half an hour depending on traffic!! :eek: Since the patient was struggling to breathe at this stage I decided to call the crash team (at my wits end) by the time the doc arrived the patient had been intubated and taken to ICU!

I know docs work long hard hours, especially junior doctors who take the brunt of it and I don't envy you at all!! I also know consultants who will regularly be in at 11pm, midnight and later, they do work hard but at the same time I have no doubt that the SHO's (often 2nd yr) are earning a lot more than I am on band 5.......rightly so for the work and responsibility they have but if I am expected to make the decisions I do and teach new docs who come to my area then should I not be entitled to more?


(sorry very long winded post and quite off topic!!! )

lana22

I guessed it might be dialysis.
I think you have got it slightly confused when you talk about doctors being paid for taking calls.
The way our pay works is that we get a basic salary (in my case £21k), then either 0%, 20%, 40%, or 50% "banding" pay on top of that which is different for each 4 month rotation. We cannot get any pay other than that - ie no overtime, no bank holiday pay, no extra pay for getting called out.

If we work out of hours (ie outside 7am-7pm or at weekends), or longer than 48 hrs per week then we have to get banded pay. What happened is that management decided we should work fewer hours etc and get less pay. What actually happened was that we still worked the same number of hours as before, but got less pay. So they brought in "monitoring". They tell us we have to fill in a form to say what hours we work. When we tell the truth (ie say we work more hours than we are contracted for), then they send us on time management classes and tell us we are working too slow. They also give an earful to our consultants and tell them it's there responsibilty to make sure we leave on time.

So that's why the doctors write down the number of times they are called, I suspect they are trying to convince the management that they deserve a higher banding (which they likely do).

In the case of the anaphylaxis, calling the crash team would have been my plan of action too (whilst instigating treatment). My rule of thumb is any "A" problem (ie airway) needs an anaesthetist, and the only way to do that is to get the crash team.

As I said, luckily non-resident on calls are very rare at SHO level and there aren't many departments who don't have resident cover of some form, even if it's house officers.

Also there is no doubt in my mind that nurses are very deserving of their pay, but I can also see the logic behind doctors having a different pay scale.