Stop saying ‘the band 5’: why referring to colleagues by their pay band has had its day

Hierarchical blindness undervalues staff and has no place in a post-pandemic workplace

A Twitter discussion instigated recently by @DrHayeLo got me thinking. 

She posed this question: ‘Does anyone else who works in the NHS hate it when people refer to others by banding – “This is Lorraine, she's the band X”?’

Agenda for Change banding is often used to identify staff members

In the ‘new normal’ of post-pandemic healthcare, we should be thinking about those we have worked side by side with and ask ourselves whether their banding defined their contribution.

Did you call for ‘a band 6’ or ‘a band 7’ regardless of strengths or weaknesses, or did you seek someone you knew by name who had the experience and knowledge that was needed?

• RELATED: Please don’t call me ‘the student’

Hierarchy and the use of the Agenda for Change (AfC) banding system as a shorthand for identifying people affects how we see each other at work.

In the Twitter thread, I said that I think hierarchy can be a killer – and here’s why.

Labelling by pay band undervalues many staff members

On one level, the AfC banding is a necessary signifier of professional accountability. But when used as a bald definition, it sends messages about your value – or perceived lack of it – your level of experience and your usefulness in a team.

Being called ‘the band 5’ can hold nurses back by undervaluing what many of them do. Using a number to label someone is a nonsense.

‘My job was banded as a 6 but I didn’t disclose this to senior colleagues for fear of not being taken seriously. The job required a certain amount of leverage and I needed them to see me as more of a band 8’ 

I know a couple of healthcare assistants (HCAs) who are on band 4 but whose knowledge, skills and experience in a specialist area far outweigh those of a newly qualified band 5 nurse.

But if a doctor were to call the unit and the HCA answered, it’s highly likely they’d be asked to get a 'qualified' person to give information on a patient, even if that HCA had the information the doctor required.

This is professional snobbery and nurses can be guilty of it too.

In a past NHS role, my job was banded as a 6 but I didn’t disclose this to senior colleagues for fear of not being taken seriously. The job required a certain amount of leverage. I had to challenge decisions of those at a higher level than me and achieve changes in policies and procedures – I needed them to see me more as a band 8.  

So, I never disclosed my AfC status. I don’t think I’d have been given the time of day if I had.

COVID-19 has changed the way we are all perceived

Preconceptions of who can and cannot do what have gone out of the window recently, haven't they? When the COVID-19 pandemic began, many senior nurses came out of retirement or back from non-clinical or managerial roles, going from being on band 8 to being ‘the band 5’.

Their banding didn’t matter. They brought lots of experience, but they also had a lot to learn, and quickly. While their banding was helpful in setting boundaries of accountability, it certainly didn’t define them.

• RELATED: Back to the bedside: our reflections on returning to clinical practice in the pandemic

Systems of hierarchy have always been with us. As with most jobs, you need leadership and those who carry out instructions, but thankfully nursing has evolved and we now have autonomous practice. We’re no longer handmaidens for doctors. We practise as a profession in our own right and along with this comes responsibility.

Seeing nursing colleagues as a name not a number

When I started my training to be a state enrolled nurse (SEN) in the early 1980s, there were clear roles that were designated by your educational level. You entered either as an SEN or a state registered nurse (SRN) to become a staff nurse.

You worked on wards, having undertaken modules in school, and were known as either ‘pupil nurse’ or ‘student nurse’ followed by your family name. Qualified nurses were called either ‘nurse’ or ‘staff’, ‘sister’ or ‘charge nurse’, or ‘matron’, and their family name.

This was less dehumanising. We were seen as people with designated roles, levels of education and training and, crucially, with names of our own. Patients were referred to by their full names and not bed number or diagnosis. There was a sense of dignity and good manners – and no one was a number.

What can we learn from the unparalleled events we have been living through? We can learn that some attitudes that come out of working in a hierarchy are outdated. We can learn that calling each other ‘the band 5’ or ‘the band 7’ does not reflect who colleagues really are and what they can do. It can denigrate the experience and skills a person has and it could ultimately make them feel less valued.

Labels matter. By identifying people based on who they are and what they do, we are less likely to undervalue them.

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Jane Coomber is a former nurse adviser for a London NHS trust