This December, nurses will be striking nationwide for the very first time in UK history. The official campaign is calling for a pay rise of 5% above inflation to ensure nurses no longer have to rely on foodbanks, or make the decision to leave the profession. But nurses should be asking to be paid the same as doctors, and even neurosurgeons. Nurses have long been unjustly placed at the bottom of a damaging medical hierarchy in the NHS, and some nurses are starting to call for a more drastic change.
Ministers inadvertently hit the nail on the head when they rejected nurses’ call for a pay rise with the insistence that nursing is “a vocation”. They went further still by insinuating that it is impossible to put a price on care. “Who can put a value on care like that?” one minister asked.
The problem with the idea of a vocation is that it suggests people are willing to work, or work extra long and hard, for free. For nurses, the insistence on their work being a vocation lingers from the days when nursing care was carried out by nuns, or other religiously inclined women affiliated to the church. Care was delivered out of a sense of duty, a drive to replicate the work of Mary, mother of Jesus, in selflessly devoting their lives to others.
This vision of nursing work as something innately feminine, coming purely from the heart and a motherly sense of devotion, continues to be played out in the NHS today.
For example, Health Education England currently promote ‘values based recruitment’, which is used to determine whether students have the correct values of care and compassion before they are recruited onto courses. Care and compassion are therefore seen as values, something innate that people should have before they can commence on a career in the NHS, rather than a skill that can be taught and developed as part of the training.
But as so many medical sociologists and nurses have pointed out, care and compassion are not values, but skills that need to be learnt. Catherine Theodosius, for example explains the complex work nurses have to learn to manage their own and their patients’ emotions. Annelieke Driessen looks at how nurses in care homes have to carefully navigate the wants and needs of people living with dementia. And in my own work I see how nurses’ careful curiosity into the private lives of patients – what support they have at home and what the layout of their house look like – enables them to help with their medical care.
What patients experience as care and compassion, is actually a dialogue and practice which is carefully crafted by nurses. The training for this craft hasn’t always been visible because, as feminist scholars such as Shulamith Firestone have illustrated, much of this education has historically happened in the home, at an early age, and primarily for women. This is perhaps why, along with the idea that care is sacred in some way, some ministers think it strange to put a value on care – because they are so used to receiving it from women at home for free.
If care and compassion are skills, then like every profession in a capitalist society, it is imperative that we address and answer questions of value (a question that UK politicians find it so absurd to ask). In order to do that, we must first confront how the value we currently, implicitly, put on these skills is distorted by a gendered hierarchy in the NHS. Whilst working on a research project observing surgery, I saw how nurses and feminised work get kept in place The surgeon was teasing a nurse about the inevitable win of his football team against hers at the weekend, and then asked if her husband was coming with her to the game. On hearing that her husband doesn’t like football, the surgeon firstly asked if he was gay, and then joked that he was at home ‘doing the knitting’ whilst she was off at the football. At the same time, the surgeon was suturing – or sewing up – a patient. Looping materials together with needle and thread.
Here, it becomes clear how the medical hierarchy is not necessarily based on skill or expertise. The hierarchy is based more on which skills align with more masculine traits, and which skills align with more feminine ones. The feminised skill of knitting is ridiculed and seen as pathetic, whilst the masculinised skill of suturing is unquestionably allied with authority. The historical and practical similarities between knitting and suturing are entirely missed.
So my point is that we need to re-evaluate what value we place on skills, not based on hierarchies of gender, but on what these skills add to others’ experiences. Depending on what a patient needs in that very moment, nursing care can be just as valuable as the work of surgeons. And one of the things that makes it particularly impressive is the way nursing work combines medical knowledge with emotional intellect and curiosity. On this basis alone, nurses should be paid the same as neurosurgeons.
As nurses head to the picket lines, we must pay attention to the ways in which commentators attempt to limit the value placed on feminised work. One nurse recently suggested:
“We aren’t heroes, or brave. We are educated professionals with careers in nursing.”
Nurses are also fighting back against this angels narrative. Nurses United have critiqued the governments’ call for nurses to remember their vocation as a “Dickensian fantasy”, and in the pandemic many nurses asked people to stop clapping and cheering as a show of support. If we want to express our thanks for everything that the nursing profession has done then the best way to do that is to stand in solidarity with them when they take their unprecedented strike action, and call not just for a pay rise to compensate a real-term cut in pay, but for a complete overhaul of staffing hierarchies in the NHS.
More information on the RCN action is here.
About the author: Hannah Cowan (@HannahCowan91) is a medical anthropologist interested in activism, social inequalities, and health and is passionate about bringing non-academic communities and researchers together to help shape research agendas and find everyday ways of resisting the reproduction of inequalities.