Last year some colleagues and I published a paper on the variety of job titles in nursing. It showed that there was a lack of clarity and a lot of confusion. It also became clear that some employers were asking or allowing unregistered staff to use titles that indicated a more complex level of practice and education – for example, associate advanced nurse practitioner
Does it matter what people are called as long as the job gets done? The paper was an incidental finding to other modelling work we were undertaking and so we didn’t really consider the implications of this. However the response to the research was phenomenal. To patients and staff, it mattered very much what job titles were used and how staff represented themselves – it was a matter of trust.
After the paper was picked up by the media, we were inundated with emails and messages from patients and staff who told personal stories of how professionals represent themselves matters. They were mostly stories of suffering and anguish. The incorrect advice on cancer treatment from a ‘clinical nurse specialist’, who was a support worker with no formal clinical qualifications resulted in a patient making the wrong choice of treatment and a formal complaint to the trust, causing suffering to the patient, family and support worker who meant well.
The lack of knowledge about medicines management in end-of-life care from a community matron who was an occupational therapist or the advice of a ‘school nurse’ who was in fact a teaching assistant, which resulted in catastrophic results for a family, all flooded into my inbox. One thing all of these messages had in common was that the public had all thought they were being cared for by a certain type of health professional and the subsequent ambiguity caused them to question the integrity of those who had treated them or their families. It also had caused many of them to distrust healthcare more widely.
Healthcare support workers were also expressing concerns. Many seemed to feel they were being asked to present themselves as registered nurses – particularly in the community. One sent me a photo of her ‘community staff nurse’ badge and dark blue uniform. She had three days training for the role and lasted six weeks in the job. These findings were not unique as others have similar stories to tell.
”Making job titles clearer would also help professionals communicate the value of their roles”
I hear colleagues ask if it really matters who uses what title. As long as patients get the care they need, they don’t mind who is delivering it. One of the clear themes from the correspondence we received is that, while patients don’t care much about job titles when things go well, if things go wrong people care very much about who is treating them. They feel mislead, let down and even betrayed if the person they assumed was doing one job turns out to be another kind of employee. In any therapeutic relationship, trust is key and when it is lost it is not easily regained.
In the UK the term ‘nurse’ is not a protected one but employers can help. Rationalising the myriad of job titles and introducing a much clearer framework of assigning titles for specific qualifications and skills would help. Some have done this but currently employers can advertise and employ people with job titles that confuse and mislead. Making job titles clearer would also help professionals communicate the value of their roles – currently there is very little common understanding of the many different job titles in nursing and the skills that these groups possess.
Alison Leary is chair of healthcare and workforce modelling fellow at London Southbank University.