Nursing staff working over their contracted hours isn’t anything new. However, if they work for the NHS, they should be paid for this time as stated in Agenda for Change (AfC) terms and conditions says Will Malcher, RCN steward and learning rep.
Will, a senior nurse at St Thomas' Hospital, worked with fellow RCN member and A&E Nurse Mark Boothroyd and trade union colleagues, to secure the implementation of a standard operating overtime procedure for all nursing and midwifery staff at Guy’s and St Thomas’ NHS Foundation Trust (GSTT) in London.
The domino effect
During the Omicron wave of the COVID-19 pandemic in England (roughly December 2021 to February 2022), there was a huge amount of pressure on the wards at GSTT.
“That’s where most of the COVID admissions were ending up,” Mark explains. “There was a lot of staff sickness and that was causing bigger workloads for those who were able to work. Nursing staff were having to stay really late.
"At one point there was a nurse-to-patient ratio of two to 28, and this became frequent. We even had one shift where no nursing staff turned up as they were all off sick. It was the stuff of nightmares,” he says.
There was a lot of staff sickness and that was causing bigger workloads
At this time Mark discovered that staff in the trust’s intensive care unit were given a one-off overtime payment during the first wave of the pandemic. He decided to ask ward staff to begin filling in overtime sheets, so they could ask for the same payment.
Upon doing this, he came across some ward managers who had already started to do this – filling in sheets on overtime, giving the reasons for staff staying late, changing it on the roster and allowing staff to take time off in lieu.
“So, there was a system in place for recording overtime on some wards, but it was inconsistent across the trust and there was no policy to pay staff for it,” says Mark.
Will investigated and learned that the AfC terms and conditions state all staff on pay bands 2 to 7 are eligible for overtime payments.
There is a single harmonised rate of time-and-a-half for all overtime, with the exception of work on general public holidays, which is paid at double time. Overtime payments apply when an employee's hours exceed the standard hours of 37.5 hours a week.
Cross-union effort
“We set up a weekly meeting to come up with a strategy, and we gathered all the nursing reps at the trust together, so it was a real cross-union effort,” says Mark.
It proved a good way to share information. “We learned that members of estates staff and radiographers are given overtime," he adds. "You can’t treat staff within the same trust differently."
Mark wrote a position paper for the trust’s pay and policy forum, signposting to the AfC terms and conditions and suggesting a procedure to be implemented. The forum signed this off, and then it went to the managers of the trust. It was finally approved in June 2022.
Going forward, RCN London officers will support members denied overtime payments and help challenge this through grievance. To do this, members should come forwards via the RCN Advice team or their local rep.
“Nursing and midwifery staff at GSTT can now claim overtime in 15-minute blocks, paid time-and-a-half. Every time I say that out loud, I get a big smile on my face,” says Will.
Why is being paid overtime important?
The overtime sheets Will and Mark were collecting stated the reasons why the member of staff stayed late.
“Almost every time, it came back down to patient care and chronic understaffing,” Will says. “In the nursing profession, you can’t just push your tasks into the next day without this having an impact that could lead to patient harm.”
Working overtime and patient safety are interlinked. “If staff are working extra hours and not being rewarded for this, they'll be not only tired, but demoralised too,” says Mark. "An overtime policy won’t necessarily stop overworking or understaffing, but it will make sure that the trust has to record where nursing staff are doing extra hours, and this should then show where staffing problems are sooner.
"It’s essentially a safety mechanism to signal when there’s an issue.”
Will highlights that working overtime can be part of the job. “If you have a patient that’s in cardiac arrest, you’re not going to say, ‘I’m stopping compressions now as my shift finished five minutes ago’. Sometimes it’s a case of working overtime for professional duty,” he says. “But what isn’t professional duty is unpaid overtime.”
Rep power: how you can affect change
The success at GSTT shows the power of nursing staff working together, getting organised and scoring wins for the masses.
“My advice to any rep wanting to take action is to identify the people within your organisation who want to action change, gather your local reps and find out details of your staff side committee. A joint approach works much better,” says Mark.
Representing members can empower and motivate you, Will says. “When you’re sat there listening to how a member can’t afford to eat or live, and then you hear about the hours and dedication they’re giving to the NHS, that’s what keeps you going,” he explains.
“It gives you the courage to stand up in front of executive boards and chief nurses, which is nerve-wracking, but you’re doing it for your members.”
