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Claudine Wetherall: 'Protect the "nurse" title to boost the status of the profession'


The image of nursing is at an all-time low, says Claudine Wetherall

In 1997, it was a matter of public protection; in 2010 it was an “urgent” recommendation. Yet, here we are in the wake of one of the profession’s most difficult periods, and we are still no nearer to having the title “nurse” protected in the UK.

For those who think that this does not matter, or that this is a distraction from the real issues within nursing, it might be worth pausing to consider where we are.

The image and status of nursing in England are at an all-time low, with a constant drip feed of poor press, culminating in the damning Francis report. The public is losing trust in the profession and nursing is in danger of becoming an unattractive career choice. In tandem with this, the NHS is undergoing fundamental changes that are underpinned by a cost imperative.

While roles of healthcare assistant colleagues are continuing to develop and expand, there is still no sign of regulation or mandatory registration that the majority want, deserve and are prepared to pay for. This is taking place in an arena of chronic confusion where it seems that the public, some sections of the press and other professions are bemused by the plethora of titles (and uniforms) used by “nursing staff” and are unclear who does what.

“Protection of the title “nurse” will ensure everyone has a common point of reference, so it is clear to the public that a “nurse” is someone who meets standards and not a general term for someone delivering care in healthcare settings”

To address the issues that have befallen nursing, a necessary starting point is clarity, because there are no winners in the current situation. Nursing knowledge and practice appears to be seen as something that can be packaged up in competency bundles and delivered by well-meaning but unqualified staff. The logical extension of this is a reduction in numbers of registered nurses (4,837 since 2010), a diluted skill mix and recurrent questions about the need for degree-level nurse education. HCAs are often put in a position of working beyond their scope of practice with minimal training or support, which is both unfair and unsafe. Then there is the overarching concern of protection of the public.

The title “nurse” is protected in other countries, for the simple reason that the public has a fundamental right to know the role, responsibilities and qualifications of those delivering their care and advising them about their health. They need to know that these people are prepared and educated to a nationwide recognised standard and are registered, regulated and legally accountable for their practice.

Protection of the title “nurse” will ensure everyone has a common point of reference, so it is clear to the public that a “nurse” is someone who meets standards and not a general term for someone delivering care in healthcare settings. This too will make it much clearer to identify where problems are arising and guide action.

Protecting the title would also recognise the value of nursing knowledge and skills and the importance of these. Evidence shows greater numbers of registered nurses in clinical areas improves outcomes.

It is time to revisit the necessity to protect the title “nurse” in the UK. This is vital for the student undertaking degree courses often at great personal and financial cost, for the HCA in the unenviable role of managing public expectations, and for the registered nurse, who needs to show ongoing professional development to remain on the register, who is accountable for their practice and their delegation decisions to unregistered colleagues.

This is not a matter of division or blame but transparency. Protection of the public is at the heart of the Francis report. Clarity around those who are looking after people is a basic right and must be a fundamental starting point. If it is good enough for the public of Australia, Canada and the US, then surely it is good enough for us.

Claudine Wetherall is lecturer adult nursing at Anglia Ruskin University


Readers' comments (52)

  • tinkerbell

    well said Claudine, we are heading towards becoming an endangered species.

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  • It is also time that nurses stay firm in the position as patients' advocate.
    Managers are always trying to get between the nurse and his/her patient thus resulting in poor care management, and Consultants are NOT getting involved if it is not directly linked to their work.

    The other day a Consultant was telling off the nurse for a patient being far too long on the ward after being medically fit to leave the ward. This Consultant would have liked if that nurse dropped all the toileting and washing that morning to sort out the discharge of the one patient.
    As there was not sufficient carers to do the basic the nurse was having to do most of it herself.
    These Consultants have a lot of power in their hands to change things, but they chose not to get involved with root causes outside of their medical rounds.
    I feel that at the end of the day the patients are under the care of the Consultants and they should ensure that their patients are getting the best from basic care upwards.
    Nurses on the other hand must stand by their patients and ensure they always have good basic care. Protect your name Nurses.

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  • Well stop moaning about Consultants for a start!!

    Nurses are the ones who have the power and the numbers to deal with this, but don't. Nurses are too cowardly to behave as the patient advocates they are always claiming to be. If they really were, then things would be very different within the NHS. It is always someone else's fault or someone else's job to fix it. It's up to nurses to fight for Nursing. No point in have protected status for a title if you haven't earned it.

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  • I have been a firm believer of this idea for some time. The title "Nurse" needs to be protected so that the public can be confident that we have been trained to a high level and are closely regulated by one body. I truly believe you should not be able to call yourself a Nurse unless you hold current NMC registration for example Dental Nurses should not hold that title it should be Dental assistant.

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  • Anonymous | 18-Jun-2013 6:31 pm

    maybe registered nurse or some other title to distinguish them from other types of nurses because i am not sure you can take the title of 'nurse' away from other professions whose job is also 'to nurse' patients of different kinds and have probably used this designation for a very long time

    for example

    vetinary nurse
    dental nurse
    nursery nurse

    just as medical practitioners don't have the exclusive right to the title doctor.

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  • What a stupid and meaningless discussion! It isn't what you call yourself, it's what you do that's important. In fact it is everything.

    Anonymous | 18-Jun-2013 6:31 pm

    How many of these nurses "trained to a high level" and "closely regulated by one body" were around whilst hundreds died in appalling circumstances in the Stafford Hospital?! Yeah, let's 'protect' that.

    Give yourselves a slap in the head and wake up. No wonder nursing is in a dreadful state.

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  • Nurse is both a noun and a verb. Noun (definition) A Nurse is a formally educated person trained to care for the sick and infirm. Verb (definition) to tend and administer to sickness and infirmity. So by the very definition of the words it would be wrong to say that a veterinary nurse is not a nurse just because his/her patients are animals and so on. A carer would not be a nurse by the noun definition but would nurse when defined by the verb (Confusing to say the least).

    I am totally in agreement with the person who said that us nurses are cowards. We are many and instead of using this to our advantage and standing up together for each other and what we believe in, we prefer to complain and foster a culture of 'one upmanship' and back stabbing. I believe we are our own worst enemies. As a community nurse and practice nurse, I have sat through many handovers - meetings listening to nurses trying to outdo each other. As a practice nurse, I was bullied by more senior practice nurses when I tried to introduce some newer evidence based care into the practice. This has not been only my experience but I have heard these type of stories over and over again. Why are we so unsupportive of each other? We could really have a voice if we just stuck together.

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  • tinkerbell

    I agree, we are our own worst enemy, united we stand, divided we fall. Come on let's stand alongside each other and be 'awesome'. We don't need to compare ourselves to anyone else, we are nurses and it is our profession we are defending. We need to get the young uns on board and hand over the baton to the next generation,

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  • I think we should protect the title "Anonymous" because if we all use it, then anyone can claim the title and where would that leave us?
    How will the millions of people who want to share their voice and opinion do this if they don't have access to the title "Anonymous"!?
    No...enough is enough..i haven't worked and studied for years and years and years and years and years to call my self anything daft like 'Studelicious' or 'Nurse' or 'human' or 'Health Care Proffesional' it is!

    Then I can say what I want with no accountablity or thought to the matter!


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