Wage slaves: ITU nurses

Working in an intensive therapy unit is one of the toughest jobs in nursing. Patient death rates of 20-30 per cent put considerable pressure on nurses in the 235 ITUs in England and Wales. Recruitment shortfalls have added to the stress.

Pay


Most ITU nurses earn £16,510 -£19,935 - due to go up by 3.6 per cent in April. Many nurses get stuck on the grade E banding, and find it difficult to get vacancies at higher levels. At the very top of the profession, a few consultant nurses can earn up to £45,000, but this is rare. The pay system is due to be overhauled - the changes are expected to be announced this spring - and should introduce greater comparability between different health professionals and pay tied to job evaluations.

Pension


NHS nurses (including ITU nurses) are automatically signed up to the index-linked NHS final salary scheme when they start work. The scheme is a one-eightieth scheme - providing a pension equal to one-eightieth of salary at retirement (usually at age 60) for each year of service. There is also a lump sum payment equal to three times the amount of the yearly pension.

Perks


Holidays are usually 25 working days a year plus public holidays. Membership of the pension scheme includes life cover with a death in service benefit lump sum payment to dependents of twice the annual salary. Nurses made redundant can draw an early pension from age 50.

Advantages


The very strong team spirit keeps many ITU nurses going, and they get to know each other better than nurses in other departments. Because of their unusual shift patterns, they enjoy long periods of time off. In future, this mostly female profession will become more flexible for working mothers and those with other care commitments.

Disadvantages


ITU specialists dislike night shifts, not just for the anti-social hours but for the way it messes up the body clock and the high stress levels. Nurses, rather than doctors, often end up explaining the medical situation to relatives. The recruitment of agency nurses can also be demoralising for staff nurses. The agency recruits are much higher paid, but may know little about ITU.

The future


When the recruitment problems are solved (as they have to be), there is likely to be an increase in the number of ITU beds - currently estimated at fewer than 1,500 in England and Wales.

Like the Americans, we will put more hospital resources into the high-tech, specialist ITU departments where the nurse-patient ratio is usually 1-1 or 1-2. ITUs are already starting to spread their wings to prevention - trawling other hospital wards to see who is likely to fall seriously ill - and into follow-up.

Developments in drugs and technology will continue to transform the care of the very sick, although costs - estimated at £1,500 a day for an ITU patient - are unlikely to fall.

My view: Derek Ramsay

'It's not a depressing place to work,' says Derek Ramsay, an ITU nurse for the last six years. Like other nurses on these wards, he is in the unusual position of rarely getting to know the patient, who is usually unconscious, but he does talk a lot to relatives.

He often encourages relatives not to sit at the bedside too long. 'We try to lighten it up. If we walked around with long faces all the time, people would not be able to cope with it. But you can find yourself getting hardened.

'At first you find it sad, then it doesn't affect you so much. Then all of a sudden something happens and it really gets to you - like, for me, seeing a young man come in who has a wife and child. You can see yourself there.'