England’s most senior nurses have encouraged directors of nursing to check whether they are employing or advertising for unqualified care staff with job titles describing them as “nurses”.
They suggested that trusts ensure that all staff titles recognised as delivering nursing or midwifery care clearly reflected their registered status and consider if the word “nurse” is used appropriately.
“Further discussion is required to look at job titles and linkage to roles and qualifications”
Letter from senior nurses
Trusts should also ensure the “correct processes” were in place on how such roles were advertised in relation to identifying their “registered status, aligned qualifications and role boundaries”.
The recommendations come in a letter sent this month by England’s chief nursing officer Professor Jane Cummings and Dr Ruth May, NHS Improvement executive nursing director and deputy CNO, according to Health Service Journal.
Dated 7 September, it was sparked by a study that found hundreds such roles in the NHS – causing concern that patients were being misled and staff could be working beyond their competence.
In particular, the study highlighted the large number of staff using titles like “advanced nurse” or “specialist nurse”, despite not having to be registered or lacking education “considered pertinent” for such a role.
The letter said: “This [study] has raised a lot of discussion within the profession and from those commenting on the profession.
“We do accept that this issue is not occurring as a deliberate act of deception. However, our preferred position is that only a [registered nurse] should have the word ‘nurse’ in their job title or in their job description,” it stated.
”The only way to protect the public is to regulate advanced practice”
The letter highlighted that the Nursing and Midwifery Council had also “reinforced” that employers “should not mislead patients into thinking the person in front of them is a registered nurse when they are not and that employers have a duty to make that clear to patients”.
In addition, the letter from the two senior nurses suggested that “further discussion” was required to look at the job titles being used and their link with qualifications.
“There has already been some work undertaken by Welsh and Scottish colleagues and it would be helpful to take this into account and build on it. We would like to open up this discussion with you at the CNO pre-summit events in the next few months,” said the letter to nursing directors.
Nurse staffing shortage is ‘top priority’ for regulator
Dr May and Professor Cummings added that “in the meantime we would suggest” nursing directors undertake the checks outlined in the letter on job titles and employment and advertising.
The study that sparked the letter was carried out by nursing workforce expert Professor Alison Leary, from London South Bank University.
Professor Leary’s research also revealed the lack of a clear framework for qualified nurses working in specialist services.
The research identified 595 different job titles in use, with no clear link between the title and the education level or experience of the staff member.
Professor Leary welcomed the move as a positive step to improving patient safety, according to Health Service Journal.
She said the basis for not regulating advanced practice was a report by the Council for Healthcare Regulatory Excellence in 2009, which said advanced practice reflected career development and was “appropriately governed by mechanisms other than additional statutory regulation”.
Professor Leary said: “Clearly that assumption is unsound for two reasons. There appears to be no association between levels of practice and education levels, and there is no relationship between levels of practice and job titles with unregistered nurses using descriptors that infer advanced practice skills. This group are currently unregulated.
“Although Health Education England is doing a lot of work on this in terms of an advanced practice framework, this will only apply to NHS employers and will presumably be guidance. The only way to protect the public is to regulate advanced practice,” she told Health Service Journal.
In the US, nursing bodies regulate the use of protected titles and specialist education, while in Australia, nursing titles are protected by law. In the UK, the title of registered nurse is protected but “nurse” is not.
Other roles such as paramedic, radiographer, occupational therapist and hearing aid dispenser are all protected titles.
As reported by Nursing Times, in October last year the Royal College of Nursing launched a pilot scheme for a voluntary accreditation scheme for nurses working in advanced roles.
- RCN to pilot accreditation standards for ANPs
- Advanced nurse register pilot started by RCN
- First wave of advanced nurses receive RCN accreditation
It marked the first time a register with standards required for advanced nurse practitioner roles had been set up in the UK.
As of this month, a total of 51 nurses have so far received accreditation for working at an advanced level of practice through the voluntary credentialing scheme, with a further 57 being assessed.