Since 2010, nurses have been engaged in a dispute with the Department of Health and the Health Service Executive (HSE) over pay. This dispute is now entering a new phase, with the Union of Students in Ireland (USI) now vocally supporting the campaign of nurses.
Five years have passed since the Christmas-time declaration in 2010, when plans were outlined to drastically reduce the salaries of fourth-year student nurses and midwives with the initial intention of abolishing pay entirely by 2015.
Despite anticipation that recent efforts would change the situation for those beginning their internships in the next year, these hopes have now proven to be unrealistic. Speaking to The University Times, Aoife-Martha Kiernan, a current nursing student in the National University of Ireland Galway (NUIG) who began the popular campaign “Equality for Student Nursing and Midwifery Interns” in October, said: “This should be a time of excitement and joy as we commence our nursing professions. Instead… we will walk onto the wards in January commencing our nursing careers receiving below minimum wage and this disappoints me greatly.”
Since 2010, various agreements, protests and alterations have taken place. Yet, so far, the situation for student nurses has not significantly improved. In response to the increase in the minimum wage in the government budget for 2016, Dylan McGowan, President of Letterkenny Institute of Technology Students’ Union (LYIT SU), has attempted to raise again the issue of internship pay of nurses with politicians. Speaking to The University Times, McGowan said that in response to a parliamentary question, Leo Varadkar, the Minister for Health, confirmed that the percentage rise in the national minimum wage would be reflected in nurses’ internship payments next year. Varadkar also confirmed that the Department of Health and the HSE are to consider the issues of pay for student nurses during the fourth-year 36-week placement with the nursing unions. However, McGowan described this increase in pay as “insignificant”, given that the wage per hour would still stand below €7.
On December 10th, following two weeks of negotiations between the Irish Nurses and Midwives Organisation (INMO) and the HSE regarding the overall issue of overcrowding and staffing in Accident and Emergency Departments, it was confirmed that the Department of Health and the HSE will at last consider the issues confronting fourth-year interns. The two main issues to be resolved are pay and incremental credit.
However in a letter seen by The University Times from the Workplace Relations Commission, which regulates the treatment of staff and monitors employer and employee relations, it is stated that such considerations between the Department of Health and the HSE may take up to three months to be finalised. This means that decisions may not be reached before this year’s cohort of nurses begin their internships after Christmas. Dean Flanagan, Student and New Graduate Officer at the IMNO, told students via email that if the outcome is “unsuccessful, we will be looking to begin a National Campaign”.
The current employment conditions faced by nurses could not be more different from the years prior to 2010. Before then, student nurses were paid 80 per cent of the lowest staff nurse salary for 36 weeks, and were entitled to receive premium pay for working weekends and nights. Additionally, the 36-week placement stood to students after completion as they were then entitled to be paid at the next highest level of a nurse’s salary. In other words, students received incremental credit for the period of the internship.
However this all changed in December 2010, when the government decided it would radically overhaul this system in favour of a hugely scaled-down model of pay. This suddenly reduced the status of a fourth-year students from a nearly qualified nurse earning a salary of €18,000 over a nine-month period to an unpaid intern.
The response from students and unions, inevitably, was anger, with many questioning how the work student nurses and midwives were doing could be so undervalued as to even be considered unworthy of earning them a single cent.
Protests organised by the INMO took place in early 2011 with around 3,500 people marching on February 9th, with another 3,000 students at a march the following week. Fourth year students also balloted for industrial action. The protests successfully pressured the then Minister for Health, Mary Coughlan, to request a review of the decision to end the payment of salaries to student nurses by 2015. Yet in June 2011, in response to negotiations with nursing representatives, James Reilly, the then Minister for Health, claimed in the Irish Times “that if the undergraduate pay cut was reversed then the money would have to be found elsewhere within the nursing/midwifery arena”.
By October, however, Reilly had backtracked on the plans which would have eradicated pay by 2015. Instead, the pay rate would drop to 76 per cent of the staff nurse salary in 2011, and by 2013, it would be reduced to only half. Despite continuing discontent, this meant student nurses working between 2012 and 2013 earned a salary of €9,387 for a 36-week placement.
The situation changed again in May 2013, however, following the Haddington Road Agreement, which came out of negotiations between public service management and some of the various unions. By increasing hours in a working week from 37.5 hours to 39 hours, the agreement meant students’ hourly rates of pay was forced below both the general legal minimum wage of €8.56 an hour, but also below the prescribed wage for those undergoing a course of structured training or directed study.
This change led to the implementation of the current rates of pay for nurses, which increases as their training progresses. The first third of training is set at €6.49 an hour, the second third at €6.92 an hour and the final third at €7.79 hourly, a rate which is still significantly below the legal minimum wage.
It was in early 2014 that a fresh wave of protests re-emerged. On March 6th, over 700 student nurses and midwives gathered outside Dr Steeven’s Hospital in Dublin for a march organised by USI, calling on James Reilly to increase the wage. They argued that all three rates of pay fell below the national minimum wage, meaning that a fourth-year student, carrying out all the same duties as a fully qualified nurses, except in the administration of medication, would earn considerably more working as a waiter than as a nurse, despite having finished their four-year degree course.
The other key issue raised by the INMO is that of incremental credit. The changes five years ago mean that the nine-month internship no longer allows Irish nurses to enter the pay scale at a higher level than nurses trained in other countries, who have not previously had any equivalent working experience.
Paradoxically, the Irish internship is recognised in the UK and if Irish nurses work there and later return home, suddenly their nine-month internship is recognised by the Irish system, allowing them a higher rate of pay than if they had never left the Irish health system.
Yet, almost two years later, the situation has not yet changed for student nurses and midwives. Despite an upturn in the economy and an election-friendly budget, the facts remain the same. Interns work 39 hours a week, doing shifts of up to 13 hours and in return are receiving €6.49 an hour.
What has changed, however, is the demand for nurses. According to Flanagan, since the Haddington Road Agreement, the INMO are inhibited from campaigning for an increase in pay. Instead according to Flanagan, the INMO must lobby the government to retain nurses because by “showing the nurses that they are valued and appreciated”, more will stay in Ireland.
This is a significant problem, argues Flanagan, who emphasised that “we’ve lost 5,000 nurses just from the front-line” in the past five years. For the INMO, there is a real danger that more and more nurses will be attracted to the United Kingdom’s National Health Service (NHS), which is currently facing a shortage of nurses, and is increasingly offering more bursaries and post-graduate opportunities. In comparison, with an Irish system that only trains 1,500 nurses a year, the INMO hopes that the government has no choice but to improve the lot of nurses currently still in the Irish system if they are to avoid a health system crisis.
Indeed, a USI survey recently revealed that 93 per cent of students wanted to emigrate after graduation. Speaking to The University Times, Kevin Donoghue, President of USI, expressed concern with the conditions faced by student nurses and that if the issue cannot be reduced to one of pay. He described their conditions as “jaw-dropping stuff … when they have to carry out work that even fully qualified nurses shouldn’t have to carry out”.
Daniel Waugh, Vice President for Campaigns of USI, and Donoghue, met with the INMO for the first time this year on Monday. Donoghue emphasised that “it would make sense to work with the INMO … we have the same goal”. He added that it has been students who have been “completely disregarded” by the under-funding of the sector.
However, some student nurses have expressed frustration at the three-month delay. Kiernan told The University Times that “the fact that this issue continues to be dragged out is a further reflection of the lack of respect and consideration our government has for nurses”. She stated that “many of us are making plans for this time next year in a bid of achieving the treatment and respect we deserve elsewhere”.
After five years of strife, it seems that the issues surrounding the pay and conditions of nursing and midwifery interns are not nearer to a resolution. While the campaigns will attempt to resolve this, for now it seems that nurses will still continue to emigrate to the UK. For this year’s cohort, they again face beginning their nine-month internship being paid below the national minimum wage.