Image: Jelena Ćirić | Iceland Review

The Flight of the Nurses

 In Magazine, Magazine Intro, Society

Words by Anna Marsibil Clausen

Photography by Golli

Her workday always started at home, technically speaking, as the job calls for special preparations. She applied the standard makeup – dark lashes, pink lips, rosy cheeks – folded her long, blonde hair into a neat bun, and made sure her nails were properly polished. Then, before heading out the door to the flight shuttle, she slipped on the bright purple uniform.

Hildur Ýr Hvanndal was used to uniforms. She wore one regularly throughout her student years when, as a part of her nursing education, she worked in the pulmonary ward at the National University Hospital of Iceland. Upon graduating in the summer of 2016, however, Hildur chose a form-fitting stewardess skirt and heels over loose scrubs and Birkenstocks. At least 12 out of her 70 classmates did the same, she says.

“There are fewer hours and higher wages when the daily allowance is factored in,” Hildur says, referring to the extra pay flight crews receive during a stopover. “Working in the hospital also comes with so much pressure. Whereas the plane doesn’t take off without a full crew, the hospital is often understaffed and that is extremely difficult and exhausting.”

Iceland has a shortage of about 570 nurses according to a 2017 report by the Icelandic National Audit Office. In 2016, 9% of registered nurses were living abroad and 10% were believed to be working outside the field. The Icelandic Nurses’ Association points to two major events as the cause of the brain drain the profession has seen over the last decade. First, the banking collapse of 2008 caused hundreds of nurses to seek employment in Norway. Then, following the rise of tourism, nurses took to the skies.

A healthcare system up in the air

The latter trend was first officially documented in 2014, when a survey found that a fifth of nursing students planned on becoming flight attendants following graduation. While neither Icelandair nor WOW Air responded to Iceland Review’s requests for the number of registered nurses within their ranks, healthcare administrators, doctors, nurses and flight attendants have repeatedly noted the trend in the media over the last few years – with growing concern.

“Nurses who become flight attendants report overall higher wages, less work for the same money, more flexible hours, and better perks,” says Birna G. Flygenring, assistant professor at the University of Iceland’s Faculty of Nursing who has conducted research on the subject. She says the first two years are a crucial time for new nursing graduates, who describe the job as both physically and psychologically demanding. This increased stress can lead to fast burnout. “They are always running around, don’t get enough time to adjust, and are afraid of making mistakes,” she says. “They often have to take on more responsibility than they can handle this early on.”

Reports of brain drain, underfunding, broken medical equipment, and even mould in hospital rooms have been prevalent in the Icelandic media for a few years. The nursing shortage, however, is a worldwide phenomenon and something of a vicious cycle. Fewer nurses lead to bigger problems within healthcare which in turn leads to tougher conditions for the remaining nurses, who are then more likely to quit or crack under the pressure.

Eva H. Ólafsdóttir, the Nurses’ Association’s advisor for wages, terms, and rights says exhaustion is a mounting concern. “It’s expensive when people burn out on the job,” she says. “You lose them to other jobs or even to illness which is costly for society and it’s becoming increasingly common.”

From hospital floor to airplane aisle

It seems obvious that nurses make good flight attendants. They are used to caring for all sorts of people and are trained to keep a cool head in emergency situations. Hildur’s education has come in handy on more than one occasion; in fact, she feels like she is expected to take control when a passenger falls ill. “I think others on the crew feel safer when there is a nurse on board,” she says. “Even though everyone has first aid training, the [nursing] education is a big advantage.”

Thankfully, none of the emergencies Hildur has dealt with on board proved life-threatening, though she says chest pain, hypoglycaemia, and fainting are common. She had frequently faced more difficult situations at the hospital, where the work environment served to prepare her for her job as a flight attendant in unexpected ways. “People are familiar with how little space there is on airplanes – often it’s no better when you are trying to take care of patients in hospital rooms that are too small, filled with all kinds of pumps and monitors, and maybe you are even trying to get past it all to do an electrocardiogram,” she says. “I’ve totally had to crawl on the floor.”

Hildur is currently on maternity leave. She quit flying at week 17 of her pregnancy, as regulations require, and went back to the pulmonary ward where she will work until her baby is born. Of course, she wants to put her education to use and grow as a nurse – she really enjoys the work despite its pressures. Even so, she imagines she might return to the skies, purely for the higher wages.

“Even if it’s rewarding and you feel like your work is worth more as a nurse than a flight attendant, the pay is just so important – at least for me,” she says, adding that idealism isn’t worth the substantial pay cut. “You want your wages to be in line with your education, and there are very few of us who feel that’s the case.”

A generational shift

One of the arguments used to justify lower wages on the public versus the private job market is that government workers receive better benefits, especially when it comes to retirement. Large portions of flight attendants’ earnings, such as daily allowances and transportation reimbursements, aren’t factored in when it comes to calculating parental leave or illness and pension benefits. In Iceland, around 95% of nurses work in the public sector. While job benefits make a difference, Eva believes individuals tend to focus on their pockets now rather than on the future. “People under 40 aren’t all that concerned with their pensions,” she says.

Young people today are also less likely to commit to one career track or workplace than previous generations. In fact, nurses aren’t the only ones finding relief from demanding jobs in the air. Iceland Review’s sources note a high number of police officers and teachers joining the industry as well, especially during the summer months. According to Birna, it’s normal for young people to jump from one job to another “like an artic tern between rocks.”

Most Icelanders under 40 grew up as lyklabörn (latchkey kids). Since both of their parents worked outside of the home, they were left to fend for themselves between school and the end of the work day. Birna says these younger generations crave a better balance between work and family life. “Young people aren’t ready to sacrifice it all for their jobs,” she says. “This doesn’t mean that they aren’t hard workers, they just have other values.”

Women make up 98% of registered nurses in Iceland. Those who choose airlines over hospitals are mostly young women, often with young children. Helping the sick, dying, and elderly means working nights, weekends, and holidays – a tall order for those with young families, though the same is true for serving passengers aboard a plane.

As Eva points out, however, the airlines still offer a better deal, with fewer hours for more money. “A full-time nurse may work 20 days a month while flight attendants work ten and obviously it’s easier to get a sitter for ten days than 20.”

Putting on the oxygen mask

While no one expects 100% of nursing graduates to end up working in the Icelandic healthcare system, the National Audit’s report describes the current situation as dire. Not only is the present lack of nurses of great concern, but a fifth of working nurses will reach legal retirement age in the next three years. Additionally, the report says, higher rates of lifestyle-related diseases and an aging population will likely place even more strain on the system.

Hildur and Eva agree that healthcare administrators are doing what they can given the current situation, but that it can’t be rectified without greater financial support from the government. The Nurses’ Association has suggested a reorganisation to make room for more nursing students. Eva says there also needs to be a greater reward for working night shifts and holidays, a demand which is sure to come into play when the association starts renegotiating the nurses’ contract early next year. It’s not enough to educate more nurses, Eva says: they also need a reason to stay.

“We want to do everything we can to get people back, but everyone needs to make their own choices,” Eva says. “Much like on a flight, before we can help others we must take care of ourselves.”

Read the full article in the latest issue of Iceland Review Magazine. Subscribe here to get the magazine delivered to your door.

Iceland Review is the longest-running English-language magazine presenting Iceland’s community, culture, and nature – since 1963.

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