Why are dental nurse salaries so low?

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The letter

In the July issue of BDJ Team we published a letter sent in by dental nurse Claire Stirrup, Dental nurses are paid no more than shop assistants (http://www.nature.com/articles/bdjteam2016115). In it Claire described her dismay at reading that the average salary of a dental nurse in the North West of England is £15,000 a year, according to a salary survey conducted by the Dental Recruit Network.

Claire wrote: ‘Since [GDC] registration began it still seems that the dental nurse has not got the “professional” recognition they deserve [...] With a lot of dental nurses who are low paid it must be a real financial struggle, with the extra bills like CPD, indemnity and registration – it all seems unfair.’

Claire counts herself lucky to have a job that she loves, however: ‘In the role that I am in I now feel very, very lucky that I am paid a decent hourly rate’. But she would like to see a wage pay scale that reflects a dental nurse's skills and knowledge.

A Facebook frenzy

When we posted the letter on BDJ Team's Facebook page (www.facebook.com/bdjteam) it caused a storm of responses from DCPs, with 37 comments and numerous ‘likes’ and shares.

A selection of comments

‘It's absolutely shocking how little we are paid considering our qualifications! Dental nurses should all be banded as they are within the hospitals and community! And now as well as our registration fee we have to stump up for indemnity insurance. No wonder more and more nurses are leaving the profession. Some nurses are still paid minimum wage. I've been in dentistry for 25 years and slowly watched dental nurses' wages go down, but their responsibilities go up’ - Lynsey

‘I work as a locum dental nurse whilst at uni; I charge more than double and then some to what a nurse gets. If everyone did that then every dental practice would have to increase what they paid. It's absolutely disgusting how badly nurses get treated!’ - Rebecca

‘I've just finished training as a dental nurse and it's my biggest regret now realising the shoddy pay scale. It's so insulting to have to put so much hard work into something and get minimum wage while you run around for dentists earning a bomb.’ - Kaye

‘I find it disgusting that nurses don't get the recognition they all deserve. We have to train on a regular basis and continue to do so. We are in a similar position to the dentists, a trustworthy one! I might go and work in Aldi!’ - Helena

‘I was in dentistry for over 30 years. Manager for ten. I didn't even crack £9 an hour. It really isn't enough for the roles and responsibilities. Fantastic profession though!’ - Charlotte

‘The GDC don't care ... as long as they are getting the money they're happy. I've been a qualified dental nurse for ten years; I did my sedation, radiography and oral health certificates. Been working as a maxillofacial dental nurse for ten years and we get treated like ^****. They see us below average because we're not “real nurses” whatever that means. I thought a nurse was a nurse. Now apparently I'm not qualified to assist with oral surgery procedures...’ - Teresa

‘Perhaps don't blame the profession blame the employer. I have been in the dental industry since 1998 and have always been paid well (I've worked for three different people). I have lots of friends who regard themselves as receiving an appropriate wage. My current employer pays our GDC [annual retention fee] as well as our indemnity. We're perhaps luckier in our area with appreciative employers’ - Mel

Table 1 What did the DRN salary survey show?

The BADN salary survey

2011

The British Association of Dental Nurses' (BADN's) salary survey in 2010, with over 2,000 respondents, revealed that the majority of dental nurses earned less than £20,000 a year at the end of 2009.

The survey also found that more than 70% of dental nurses receive no contribution from their employer towards their Annual Retention Fee (ARF: £120 pa); nearly half have to pay all their CPD costs; and 95% receive no additional benefits.

Then-President Sue Bruckel commented: ‘We were shocked, but not particularly surprised, at the results of the survey. What is particularly disturbing is that the majority of the respondents were full-time, fairly senior, dental nurses with more than ten years' experience – and the salaries are still well below the median pay for full-time employees in the UK of around £25,500, according to 2009 Annual Survey of Hours and Earnings (ASHE) and less than half the median pay for full time “health professionals” of around £53,500.’

2013

BADN conducted another salary survey in 2013, with over 2,000 respondents, which again revealed that the majority of respondents earned between £10,000 and £20,000 (£10k-£15k 28%, £15k-£20k 29%).

BADN salary scale

In 2011 BADN put together an advice sheet in response to demand for guidelines on dental nurse salaries. This can be found at http://badn.org.uk/wp-content/uploads/2014/02/BADN-Salary-Scale.pdf.

The advice sheet shows minimum salaries considered acceptable by BADN for a 37-hour week, taking into account other factors such as specific job roles and duties and local conditions:

Registered dental nurse^*  From £20,000

Registered dental nurse - extended duties^**  From £24,000

Senior dental nurse^***  From £28,000

^* Registered with the GDC

^** Registered and holding and using one or more post-registration certificate

^*** Registered, holding post-registration qualifications and with an additional supervisory function.

BADN's appeal to the GDC

In 2012 BADN wrote to the GDC formally requesting that the GDC recognise that dental nurses are paid considerably less than other DCP groups and that they set a separate ARF for dental nurses that realistically reflects dental nurse salary levels (no more than £150); set a lower ARF for part-time workers in all registrant categories; and make provision for quarterly payment of the ARF for those paying by direct debit.

BDA DCP Pay Survey 2013

The British Dental Association's (BDA's) report, Dental care professionals pay - Findings from the Dental Business Trends Survey published in December 2013 explored average pay among DCPs.

The report is designed to be ‘a general guide to help practice owners in their pay determinations’. A survey conducted in summer 2013 elicited 1,342 responses. It found that on average, trainee dental nurses were paid £6.98 per hour and qualified dental nurses £9.98, with some variation according to NHS commitment. Higher rates of pay were found in southeast England and London compared with the rest of the UK.

£9.98 for a 37-hour week would equate to an annual salary of £19,201 – which tallies with BADN's findings.

Almost two thirds of practice owners had increased the rate of pay for their dental nurses over the past 12 months. Nurses who worked in practices with a high NHS commitment were more likely to have received a pay rise.

Why are wages so low?

British Dental Association

Judith Husband, Chair of Education, Ethics and the Dental Team at the BDA, comments:

Dental nurses are vital members of the dental team who should be remunerated appropriately in line with their skills, training and experience. Dental nurses are essential to patient care and carry significant professional responsibilities.

There are recruitment issues in some areas which give us cause for concern. We especially hear of experienced dental nurses leaving the profession when they become aware that their salary begins to stagnate after several years in the role, and further opportunities are scarce.

With the development of GDC-approved ‘enhanced duties’ there are exciting and rewarding opportunities to acquire additional skills. To utilise these skills we require appropriate practice structures, and funding to support individuals to work to their full potential. The BDA is lobbying for a prevention-based NHS contract; within this approach there is a significant role for dental nurses with patient facing skills.

Health Education England (HEE) has responsibility for workforce planning but has so far declined to focus on dental nurses' training and development of an attractive and supported career structure. The changing patterns of oral disease and ageing population should make this a priority area for commissioners of training and the profession.

Providing accurate and timely advice to potential applicants wishing to join our profession is a role we all share. Advice on our websites, visiting schools and colleges, providing work experience and raising the profile of dentistry to policy makers and the media is key.

The realities of UK healthcare provision, and most notably NHS services, is harsh though. Repeated pay freezes across the NHS and ongoing efficiency savings have taken a heavy toll on the sector. Dental team staff pay data from the Inland Revenue shows increases year on year, whilst in contrast average dentist pay continues to fall due to inadequate rises in NHS fees.

British Association of Dental Nurses

Jane Dalgarno, BADN President, comments:

BADN Salary Surveys show that a Registered Dental Nurse with more than ten years' dental nursing experience, who has worked for the same general practice employer for more than ten years, and who works more than 35 hours per week, is likely to be earning between £15k and £20k per annum. (The 2016 BADN Salary Survey will be held online later this year.) Out of this, around half are expected to pay their GDC registration fee and their CPD costs, and of those respondents who are BADN members 94% pay their own membership fee (and indemnity).

In the past, BADN has worked with the BDA to produce annual dental nurse salary guidelines, which indicated the minimum an employer was expected to pay a dental nurse. However, this was discontinued with the introduction of the National Minimum Wage (NMW), partly because of the NMW and partly because the guidance was often misinterpreted by employers and, therefore, often did not achieve the desired outcomes.

BADN is willing to work with both the BDA and/or dental employers on producing broader and more comprehensive guidance on the calculation of dental nurse salaries, taking into account the broad range of dental nursing roles and working environments.

Should readers wish to discuss this further, President Jane Dalgarno would be happy to do so and may be reached at president@badn.org.uk.

The Society of British Dental Nurses

A range of comments and opinions were provided by The Society of British Dental Nurses and its members. An article about this new organisation also appears this October in BDJ Team.

On low wages:

Salaries vary across the dental settings and particularly across general dental practice. Some dentists do pay their dental nurses an acceptable salary; many do not. Wages are low partly because they have always been low; some dentists will always try and pay the minimum wage and some dental nurses may feel that they can't get a higher wage elsewhere. Some dentists don't appreciate the value of a well-trained dental nurse or make full use of dental nurses' skills; therefore they don't see the need to pay for skills not used.

As the dental nurse apprenticeship is offered and the qualifications achieved are less than those of degree students, salaries remain low. There seems to be an abundance of students willing to take on apprenticeships on leaving school.

Much is related to the historical position and hierarchical stance between dentist and nurse. Nurses have a much wider scope of practice [now] and have a greater role to play; after all, dentists cannot work without a dental nurse.

There is a fractured dental nurse community; those in the trusts appear to get better salaries than those in general practice as they are paid according to what was the agenda for change banding, whereas general practice nurses have no pay scale.

However, there are some really good dentists out there and many look after the whole team.

On what dental nurses can do to achieve a wage increase to recognise their professional status:

We need to empower dental nurses; this is paramount and they need to have a voice. We need to draw attention to this big group of hard working DCPs who are all too often undervalued.

In order to achieve an increase in wages and recognition of their professional status, dental nurses can gain extra skills, but also influence everyday practice to ensure use of these additional skills and raise the value of skill mix.

Dental nurses should act professionally at all times and take on more responsibilities within the team so that the dentist appreciates the need to retain them and reward them appropriately. They could also persuade dentists that post qualifications and additional duties should be financially rewarded. It is the responsibility of the dentist to make use of these skills and qualifications in improving the quality of patient care.

Dental nurses need to have more communication with patients so that dentists realise that well trained dental nurses have a positive effect on retaining patients, attracting new patients and reducing the potential for patient complaints.

Dentists should also be encouraged to develop dental nurses as trainers within the practice.

There needs to a review of the basic level of dental nursing and progressive levels that are not only recognised and respected but that are attached to a pay scale and a wider scope of practice.

General comments:

I have seen many changes in attitude and a shift in dental nurse training, CPD, registration etc, but still wages remain low in many general practices. It is pointless having a gold standard practice with staff who are undervalued, unsupported and paid unfairly – have we learnt nothing from the Francis Report 2013?

It is about changing the mindset of dentists so that they realise that the responsibilities and contribution of the dental nurse are as important as any other member of the team and that their impact on the smooth running of the practice and the quality of patient care is critical to the continued and future development of the practice.

Dental nurse educators

Rebecca Cox, Online Training Co-Ordinator at the Dental Team Education Centre (DTEC) in London comments:

If you look at the scope of practice against the role of a dental nurse I think the wages are fair. I obviously cannot comment on the all salaries but I believe it depends on where in the country you work and which type of practice you work in. But then compare dental nurses' salaries to a therapist or dentist and the dental nurse is paid [a] very low [wage]. You should really pose this question to GDPs!

Once a dental nurse holds a registrable qualification they can complete post certificate training courses or extended duties or choose a different path altogether, for example become a dental nurse assessor or a tutor dental nurse; they can also choose to become a dental therapist or orthodontic therapist which is again a lucrative career move. Although these options are very competitive.

We have been known to debate the area of pay in the classroom. Whenever I see my (online) students pay is always discussed. Normally the discussions start around how much of a pay rise a nurse will receive on passing the exams (NEBDN National Diploma). Or how much private patients have had to pay for treatment (such as implants).

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In my personal opinion, dental nurses are paid low (minimum wage) [salaries] because they tend to be younger coming into the profession (as trainees). They are then given the incentive of passing an exam to get a pay rise. There will always be dental nurses coming into the profession who are happy to be paid low wages as it is a very satisfying job. So for the nurses who move on to other roles or change profession completely there always will be job hunters willing to accept low pay.

I also think that the annual retention fee (ARF) for dental nurses are fair although I do think that there should be an option to pay by direct debit monthly or even quarterly. The GDC should take into consideration part time workers also. If you compare what we have to pay against dentists then it is in line with our role at £10 a month. The indemnity is very cheap as you can pay this monthly.

We also have to then pay out for our CPD. Again I have heard that some practices do this as a package and are willing to give nurses time to do it and pay for the training. I have also heard that some nurses have to pay everything and do CPD in their own time.

Kim Childs, a dental nurse and tutor (and due to start OHE training) from Torrington comments:

From a personal point of view I work for an independent surgery and have to say they have been fair with my own pay scale. I do, however, feel for other nurses as am aware that the pay scale does not reflect the responsibility/training and CPD that you have to adhere too.

I'm afraid I can't see a reason why the pay scale is so low; again the amount that we have to do and the fact that we have to be registered should in its own right reflect the pay of a professional, not that of an unskilled worker.

I know that there has been much said in jest about going to work in a supermarket because supermarket workers get paid more than we do! (Not to underestimate the roles in the supermarket, more the fact that we have to be qualified.)

Most student nurses look forward to qualifying because it usually does incur a pay increase but in most cases this seems to be only to the minimum wage if they are apprenticeship candidates or just above for regular nursing staff.

Pay is always such a taboo subject and we all feel that we deserve a decent rate of pay – I do not feel that this is always the case when it comes to nurses and what is involved in our role.

There are ways of increasing the pay but that always involves further training/education/qualification in specialist subjects which again does not often reflect the amount of work involved to the pay increase ratio.

Have any of the comments in this article changed the way you feel about being a dental nurse? Has your view been represented? Send a letter to BDJ Team at bdjteam@nature.com or comment on our Facebook page, www.facebook.com/bdjteam.