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