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NMC registration necessary to call yourself a nurse

Only those registered with the Nursing and Midwifery Council should be allowed to call themselves nurses according to draft recommendations from the Prime Minister’s Commission on the Future of Nursing and Midwifery seen by Nursing Times.

Nursing Times understands the Commission will call on the NMC to take “urgent steps” to address public safety concerns and confusion over nurses’ roles.

For the first time, “nurse” would become a protected title, meaning that many of those working in areas such as private sector child or elderly care could no longer continue to call themselves ‘nurses’ if they did not possess NMC registration. This move could be accompanied by the standardisation of nurse job titles.

The commission also recommends advanced and specialist nurses are required to regularly provide evidence of their continuing “advanced” competencies to the NMC. That recommendation appears to hand a clear mandate to the NMC to introduce specific revalidation requirements for advanced nurses.

Additionally the commission says healthcare support workers should be regulated – a move seen as essential as NHS organisations employ more non-registered staff, particularly assistant practitioners at band 4.

However, the commission stops short of saying which regulator should do this – an omission that led to one source close to the commission to fear the question had been “kicked into the long grass”.

The report reiterates the rationale for turning nursing into a graduate-only entry profession by 2013.

Although commissioners have been wary of tacitly devaluing or undermining nurses without degrees, it recommends that a degree should be a requirement for any nurses taking on a clinical leadership or specialist practice role by 2020.

Nursing Times has been told that will include ward sisters and charge nurses, but commissioners have been keen to argue the recommendation merely reflects the current trajectory rather than a punitive “cap” on the career ladder of nurses without degrees.

The Commission’s full report – which is in final drafting stage – is expected to say that rather than being regarded as “subordinate” members of the healthcare team, nurses should assert their status as “interdependent equals” who are complementary, rather than subordinate, to doctors.

A DH spokesperson said: “The independent commission is still considering its report and recommendations on the role of nurses and midwives. It will shortly be publishing its final report.”

 

The Prime Minister’s Commission on the Future of Nursing and Midwifery

Main recommendations

  • New pledge for all nurses and midwives stating their commitment and accountability for high quality and continuously improving care
  • Protection for the title “nurse”: only those registered by the NMC should be able to call themselves “nurses”
  • Regulation of specialist and advanced practice nurses by the NMC. Consideration should also be given to requiring the same of specialist midwives.
  • Support workers – including healthcare assistants and assistant practitioners - to be regulated
  • Degree a requirement for all clinical leadership and specialist roles by 2020
  • Boost to ward sister and charge nurse role and upward review of their pay and grades
  • Framework of national nursing indicators to be developed to measure nurse quality and its impact on patient outcomes and satisfaction
  • Nurses to act as “role models” for healthy living – their employers should help them do this
  • Career structures and training that allow nurses and midwives to move between different healthcare settings, such as hospitals, community services and social care
  • Scheme to identify, train and mentor future generation of nurse leaders, ripe for “fast track” into posts
  • High level group to review options for boosting capacity of nurses to understand and influence the design of new technology and informatics
  • Everyone woman to have a named midwife responsible for coordinating her care
  • Scheme and fellowship awards to encourage innovating in nursing services
  • Marketing campaign to “paint an appealing picture” of nurse careers and opportunities and to recruit the highest calibre, diverse candidates

Readers' comments (29)

  • With regard to all and sundry calling themselves nurses its about time this was put straight.Nearly all healthcare workers think and call themselves "Nurses" without any thought that members of the public think they are fully qualified .Of course many I have worked with especially in the community enjoy being someone they are not and openly call themselves "Nurses" to fraudulently be someone they are not.This is dangerous ground and an issue that should have been dealt with long ago. The nursing school I went too may not have been at degree level on qualifying but it was made clear then that to be a Nurse was to be on the register with a valid PIN. That was 25 years ago in Bridgend South Wales!

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  • I qualified in 1972 and it was a clear requirement that to legally use the title Nurse, you had to be registered with the (as it was then), GNC.

    How many more times does the wheel need to be invented?

    Why can we not concentrate on teaching nurses to nurse in the true sense of the word?

    I truly dread old age and hospitalisation now, with the targets, short handedness and all of the other matters we read about on a daily basis.

    Not a good sitaution...

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  • When are they going to stop dressing HCAs in a nurses uniform? To make it look like there are more nurses.

    Can you imagine stopping a HCA and telling him/her to stop using the term "nurse"? There would be war on.

    How can you regulate people without any structured, formal training? There are no standards to uphold. They are working under the nurse's supervision. They can't be called into question by a body. Who wants to bet their regulator will be the NMC?

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  • It would be unreasonable of the NMC to highjack a noun that existed long before they did. One might be a 'qualified nurse' without being a 'Registered Nurse'.

    Currently, you can't be Registered without being Qualified but that might change if 'UNqualified nurses' are also required to be Registered! (and define 'unqualified please).

    M Gough, RGN, BSc(Hons), LLM (Medical Law & Practice).

    Under statutory legislation, the title 'Registered Nurse' is already protected as are other 'titles' eg. Medical doctor (many people may actually have a 'real' PhD and be 'doctors' of something or other but they may not call themselves a 'medical doctor' Yet, to be a 'medical doctor' one need not have a PhD.

    See the case of Rv Richardson (1998) where an unregistered but qualified Dentist (also a protected title) was still able to treat patients legally without committing a 'crime' - though there might have been some issues of valid consent if the patient had taken a civil suit had something gone wrong.

    Basically, the NMC are wading about in a mine-field on this one. I will watch their progress with interest!

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  • I'll have to defer to Maria Gough as being more knowledgeable on the legislation, I thought that use of the title "Nurse" whether registered or not is covered by existing legislation, this is from one of my essays :

    The Nurses, Midwives and Health Visitors Act 1997 Chapter 24 [London: HMSO, 1997] in section 13 False claim of professional qualification clearly states that “A person commits an offence if, with intent to deceive (whether by words or in writing or by the assumption of any name or description, or by the wearing of any uniform or badge or by any other kind of conduct) he falsely represents himself to possess qualifications in nursing, midwifery or health visiting”

    It seems like a technicality but maybe the loophole is that a person calling themselves a nurse without possessing qualifications in nursing could claim that they made clear that they did not possess nursing qualifications and this is what the Commission are seeking to put a stop to?

    As Anonymous 16-Feb-2010 10:09 am points out its a case yet again of re-inventing the wheel?

    As Anonymous 16-Feb-2010 12:05 pm alludes to in the eye of the public anyone in a hospital wearing something very similar or the same as a nurses uniform is a nurse!

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  • As a healthcare assistant I resent the implication that we go around pretending to be something that we are not.
    If any patient asks I will state that I am a healthcare assistant and explain what that is however I do not correct every patient who calls out nurse asking for a commode or for help finding their glasses as this would take time away from actually helping the patient. Also if they are asking for something outside my scope of practice I will tell them that I can not help them as I am not qualified but that I will find somebody who is.
    We wear different colour uniforms and so patients can see there is a difference however most do not mind who or what you are as long as you are kind and helpful and solve their problem. I even had a patient the other day saying to me ' I know you are not a nurse but I am going to keep calling you that anyway.'

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  • What does the patient call the person caring for them? If they are wearing a uniform similar to that of the qualified staff, they will often call them 'Nurse'. This is regardless of whether the carer is HCA, care assistant, nursing auxiliary.

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  • The title doctor is an academic qualification - real doctors have PHDs. The title that is given to those who hold a medical degree is an honory one.
    If a person engages in what to the public is nursing then don't be surprised if the public feel they are deserving of the honory title Nurse.

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  • Anonymous | 16-Feb-2010 5:48 pm you are correct. The 'medical doctor' is a Medical Practitioner, and many forget it is an honour for them to be called doctor,; the honour does not belong to the patient to call them doctor.
    Originally the terms "master" and "doctor" were synonymous, but over time the doctorate came to be regarded as a higher qualification than the master's degree.
    As has been stated previously, the title Nurse is already enshrined in law. I qualified RGN in Scotland in 1978 and it was made clear then that only those on the register were entitled to call themselves nurse.

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  • What do highly trained, experienced and qualified nurses call themselves if they are working outside direct patient care and unable to meet the NMC criteria to stay on the register. Many of us trained and qualified as State Registered nurses before the UKCC and NMC and worked extremely hard often at great personal and financial cost to qualify. Many of us, through no choice of our own, are unable to maintain registration. Does this mean we no longer have a profession and can no longer call ourselves nurses. Perhaps there should be a distinction between registered practicing clinical nurses and non-registered, non-clinical practicing nurses who are on a career break, undertaking family duties or working in other areas where all their acquired skills are still being utilised such as research, book authorship, nursing journalism, legal nursing, consulting, etc.

    This also gives rise to another question that if one has to leave the register for any reason and wishes to re-register a training course is required. This may require a clinical placement to undergo this course and the need to find an employer. However, if one requires registration for other posts such as self employment and one of the occupations listed above it seems of little practical value and probably not even possible to undertake such a course. One really does not need to spend time learning how to take blood pressures again and learning about a local NHS trust or other unrelated procedures offered on such a course when one is working towards a PhD for example.

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  • This is similar to the situation a few years back when the Engineering Council wanted make the title 'engineer' protected. It failed on the grounds that the term was in widespread general use, also the word predates the Engineering Council, referring specifically to those who controlled weapons (which were called engines)

    Registered Nurse is protected, but the term Nurse is used too widely for it to become protected, e.g. in a vet practice, in a dentist, in childrens' nurseries etc. Nurse also predates the requirement for registration, referring to the person who looked after young children.

    I feel the NMC, like the Engineering Council, are being snobby.

    Personally I hate the term unqualified staff when referring to HCA/Nursing assistants/Auxillary Nurses, I much prefer the term unregistered (which they are) to unqualified (which they are not).

    From a former engineer (not Engineering Council approved)

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  • What do patient understand by the term "Nurse"? I work on a very busy surgical ward and about 90% of the patients would tell you a nurse is the person caring for them regardless of qualification. HCAs work very hard and are under appreciated. Why should they not be recognised for there nursing skills. RGNs spend a lot of time with paperwork and less time bedside caring.

    Maybe the roles need to be reclassified, there is a very large gap between the RGN and HCA maybe the old role of SEN should be reintroduced, and we go back to having auxillaries.

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  • Qualified School Nurses are permamently in this situation where the 1st aider in the school is known as the 'school nurse' Causes lots of problems

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  • Anonymous | 16-Feb-2010 10:09 am

    I qualified in 1972 and it was a clear requirement that to legally use the title Nurse, you had to be registered with the (as it was then), GNC.

    How many more times does the wheel need to be invented?

    Why can we not concentrate on teaching nurses to nurse in the true sense of the word?

    I truly dread old age and hospitalisation now, with the targets, short handedness and all of the other matters we read about on a daily basis.

    Not a good sitaution...


    In answer to this comment above and mine of 16th February, 16.47pm, I qualified in 1978 also with the GNC and was given to understand that my hard earned qualification was for life or at least to the end of my career. I agree that we need to validate qualifications regularly and demonstrate that our skills and knowledge are right up to date and we remain fir for practice but I never dreamed that my qualification and or title could simply be taken away from me because I do not hold a post that is directly related to bedside nursing or practical patient care.

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  • CORRECTION TO COMMENT ABOVE - MY COMMENT SHOULD READ 16th Feb 2010 7:47 pm and not 16:47 pm - apologies

    Anonymous | 17-Feb-2010 4:18 pm

    Anonymous | 16-Feb-2010 10:09 am

    I qualified in 1972 and it was a clear requirement that to legally use the title Nurse, you had to be registered with the (as it was then), GNC.

    How many more times does the wheel need to be invented?

    Why can we not concentrate on teaching nurses to nurse in the true sense of the word?

    I truly dread old age and hospitalisation now, with the targets, short handedness and all of the other matters we read about on a daily basis.

    Not a good sitaution...


    In answer to this comment above and mine of 16th February, 7:47pm, I qualified in 1978 also with the GNC and was given to understand that my hard earned qualification was for life or at least to the end of my career. I agree that we need to validate qualifications regularly and demonstrate that our skills and knowledge are right up to date and we remain fir for practice but I never dreamed that my qualification and or title could simply be taken away from me because I do not hold a post that is directly related to bedside nursing or practical patient care.

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  • If I had known when I qualified with the GNC and faithfully reregistered with the UKCC and then the NMC regularly as directed only to find I may no longer be able to call myself a nurse if my registration is allowed to lapse I would not have invested all my time, study and higher education in nursing, I would have chosen another profession where one is more valued and better by its regulatory body instead of always feeing under threat by all their negative changes

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  • anyway nursing is the nature of a task, job or activity being carried out it is not the name of an academic qualification. one may have a diploma, degree or certificate in nursing and one may simply be at home nursing a sick child or relative, pet or animal! so why all this fuss about a label or symbolism, or semantics.
    Greater preoccupation with the concept that patients are central to care is needed
    rather than always hammering nurses and messing around with abstract theories and wasting more precious resources such as time, money and qualified staff sitting in offices instead of using their skills at the bedside, etc.

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  • never mind we can add to the list
    ex-nurse, ex-wife, ex-daughter-in-law, ex-mother-in-law and even ex-mother, ex-daughter, etc. etc, (and at the expense of being brief and non-repetitious, this equally refers to the male sex).

    ...and all because one hasn't washed and powdered enough bums or made enough beds during the last registration period

    doctors/medical practitioners on the other hand who are not currently working in a clinical area do not suddenly become ex-doctors - they are permitted to keep their status and title along with which goes the respect of an adulating public

    perhaps one should not worry so much, after all a friend warned that in 'polite society' one should not admit to being a nurse. Nobody, she said, would wish to invite a nurse to make up numbers at a dinner party or other social occasion - boring conversation - far more preferable are those who work in finance or the legal or medical professions as they are far more glamourous and deemed as successful - people want to meet others who are successful in their jobsand thus their private lives as well!

    at least i am still entitled to call myself infirmière diplomierte so all is not lost and the title in Europe is held in far higher esteem than that of nurse. In French nurse means someone who works with newly born babies - usually young girls, and does not command the same degree of respect as infirmière.

    Getting back to 'serious' again, wouldn't it be a more fair system if there was an additional part to the nurses' register based on qualifications for those who wish to remain on the register but are not directly concerned with practical patient care but still highly value their work and their profession. A practical part of the register could still concentrate on the safest and highest quality of care for patients even more than they do now but without making all nurses feel that they are potentially poor carers or at worse criminals.

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  • What do patient understand by the term "Nurse"? I work on a very busy surgical ward and about 90% of the patients would tell you a nurse is the person caring for them regardless of qualification. HCAs work very hard and are under appreciated. Why should they not be recognised for there nursing skills. RGNs spend a lot of time with paperwork and less time bedside caring.

    Maybe the roles need to be reclassified, there is a very large gap between the RGN and HCA maybe the old role of SEN should be reintroduced, and we go back to having auxillaries.

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  • "...On 4 November 1854, Florence Nightingale arrived in Turkey with a group of 38 nurses from England. Britain was at war with Russia (the Crimean War 1854-1856) and the conditions in the hospitals were very bad. Hundreds of soldiers were injured in the fighting. In those days, hospitals were very basic and there was not a lot of food and medicine to give the soldiers .."
    From Florence Nightingale | The National Archives - Related web pages
    www.nationalarchives.gov.uk/education/lesson40.htm

    I wonder did anyone think to ask...are you registered ?, qualified ?, what type of nurse are you?. No me thinks not!, we sometimes lose sight of the BIGGER picture with all the snobbery and politics now attached to nursing.
    The government through the SHA has provided money to chosen PCT's to train up unregistered staff to a level of recognized competence by individuals attending university to complete a foundation degree over a 2 year period,once achieved the job title of Assistant Practitioner has been given with a pay Band 4. This pre-nursing qualification can then be used towards gaining a full degree if the individual so wishes.
    In my view as a qualified assistant practitioner, yes, I do think there should be a registration for those who have undergone academic training, owning knowledge and skills benefiting both nursing staff and the care of patient's.

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