Understanding the economic reasons why nurses are paid less than temporary swabbers and swab assistants

About two weeks ago, a particular job ad by the Health Promotion Board (together with NTUC’s e2i) and went viral, but perhaps not in the way the posters intended.

The ad was for Swabbers and Swab Assistants who will be involved in performing nasopharyngeal swab procedures to collect samples to be sent to the lab for Covid-19 testing.

The job requirements seemed simple enough:

1. Medically fit with no history of chronic diseases
2. Proficient in English and Mother Tongue
3. Able to work in shifts/extended hours, over weekends, if required.

Over at the sign-up form, a 4th criteria also specified that applicants need to have attained at least GCE N Levels or Level 5 in the Workplace Literacy and Numeracy (WPLN) assessment.

The salary? An attractive $3,800 for Swabbers and $3,400 for Swab Assistants.

In comparison, according to Care To Go Beyond, a campaign by the Ministry of Health Holdings that aims to encourage more people to join the nursing profession, the median starting pay for Enrolled Nurses is $1,800 (with NITEC) while Registered Nurses have a median starting salary of $2,500 (with Diploma) or $3,500 (with Degree).

These starting salaries comprises basic salary, fixed allowances and overtime pay.

The fact that (relatively) unqualified personnel were being paid substantially higher wages than the starting salaries of nurses who had to undergo years of training caught the ire of many healthcare professionals and Singaporeans in general.

Anecdotally, some nurses posted online that even after five to six years, a nursing graduate’s salary wouldn’t even reach $3,800, which is what a Swabber would be getting.

The public outcry centered around the perceived injustice of paying people with possibly no healthcare background to do a comparatively simple procedure higher than nurses who are exposed to similar risks and have much heavier care responsibilities and are required to perform complex medical procedures.

Breaking down the Ministry of Health’s response

The Ministry of Health (MOH) issued a response, stating that: “The average gross monthly salary, after adding in allowances and bonuses, for entry-level registered nurses ranges from $3,300 to $5,200 depending on their qualifications.”

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MOH continued to say that temporary Covid-19 roles don’t provide any progression pathways, unlike full-time healthcare professionals who are “also eligible for annual salary increments as well as training opportunities to upskill themselves and develop a lifelong career as a nurse clinician, educator or leader in the healthcare sector”.

For the latter portion, the Covid-19 Swabber and Swab Assistant roles are only for a duration of six months, extendable by three months.

As we know, short-term gigs tend to pay higher, since the pool of potential applicants who would be available (and willing) to work during the stipulated period would be relatively small.

Increasing the salaries would serve to expand this pool and quickly fill critical positions and help Singapore ramp up its testing capability.

In the field of Human Resource, it is common knowledge that one would have to pay a mark-up in order to fill temp roles, and while employees might not be thrilled at the prospect of a temp potentially making more than them, they understand that it isn’t a slight on their value to the organisation.

You might also wonder about the salary discrepancy between what MOH says is the average gross monthly salary of nurses, and what is stated by anecdotal sources.

Without comprehensive salary data, it would be impossible to reconcile MOH’s high salary figures with personal experiences from the ground.

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What we do know is that while salary is one of the most important benefits of work, the monthly remuneration is just one portion of benefits enjoyed by nurses and other healthcare workers.

Aside from professional development opportunities, full-time medical staff enjoy benefits like the Annual Wage Supplement, insurance coverage and reimbursement for medical treatment, performance bonuses, maternity/childcare leave benefits, subsidy of their union membership fees, and more.

While these, and other intangible benefits, undoubtedly add to the entire package that healthcare professionals enjoy, frustration at the gap in take-home wages of healthcare workers is a concern that many would like to see addressed, along with other challenges that the healthcare profession faces, including being understaffed, overworked, and under-appreciated.

And no, clapping from homes doesn’t count.

Salary isn’t a metric for how important or noble a job is

We all probably know people personally or read about those who took a pay cut from their high-flying jobs to do something they are passionate about or to serve a cause close to their hearts.

In those cases, the low remuneration wasn’t so much as a (negative) reflection of the important and valuable work they do, but more of a reflection of economic factors at play.

This being said, a significant, sustained increase in pay and better conditions for healthcare workers will require structural fixes and policy changes that might take time to materialise.

Feeling of injustice is directed at perceived lack of tangible recognition for nurses 

At a time when nurses, doctors, allied health professionals, and healthcare volunteers are risking their lives (and the lives of their loved ones) every single day on the frontlines of the fight against Covid-19, perhaps a more appropriate response by MOH and policymakers would be to acknowledge that more can (and will) be done to give recognition and do justice to the skill, courage and sacrifices of our medical fighters.

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Beyond paying lip service to medical frontline workers, and making ‘matter of fact’ statements that medical professionals enjoy career progression and a high starting pay, misses the mark and only cause more disappointment and anger among the very people the explanation was meant to appease – especially when this it isn’t congruent with the experiences of many on the ground.

Perhaps the silver lining to this episode is public awareness that even more support should be given to nurses, and the constructive pressure this places on policymakers to find ways to make this happen – hopefully the sooner the better.

For the latest updates on the coronavirus, visit here.

This article was first published in Dollars and Sense.