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What’s in a name: should nursing job titles be regulated?

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In a survey of respiratory nurses, 173 respondents self-reported 57 different job titles. This article argues that the surfeit of job titles in nursing is an issue and discusses how it can be addressed

Abstract

The profusion of job titles used in nursing creates confusion, undermines post-registration education, hampers career progression and obscures the value of specialist and advanced roles. This article illustrates the situation using the example of respiratory nursing and calls for regulation to address the issue.

Citation: Kelly C et al (2019) What’s in a name: should nursing job titles be regulated? Nursing Times [online]; 115: 5, 52-53.

Authors: Carol Kelly is reader in respiratory care and head of department at Edge Hill University; Wendy Preston is head of nursing at the Royal College of Nursing and chair of the Association of Respiratory Nurse Specialists; Natalie Harper is consultant nurse at the respiratory department of Dorset County Hospital Foundation Trust.

  • This article has been double-blind peer reviewed
  • Scroll down to read the article or download a print-friendly PDF here (if the PDF fails to fully download please try again using a different browser)

Introduction

The multitude of job titles used in nursing has long been a contentious issue. It is a consequence of the development of advanced and specialist practice, which, although something to celebrate, has also led to confusion and misconceptions about roles (Barton et al, 2012). Leary et al (2017) found 595 titles in use in 17,960 specialist posts in the UK, while Grundy-Bowers et al (2018) found 226 titles for nurse specialists and practitioners in one trust.

This variety of titles can be confusing particularly for patients. The titles themselves were found to have little – if any – relationship to education. This, in turn, undermines post-registration education and hampers professional progression, both for individuals and for specialist and advanced nurses collectively. Titles such as ‘advanced nurse practitioner’ were not entered on the appropriate part of the register (Grundy-Bowers et al, 2018; Leary, 2017), compounding confusion and posing a potential safety issue.

This situation is not specific to the UK, although there are differences between countries. In Canada, a lack of understanding of roles and titles may contribute to ambiguity about nurses’ scope of practice (Donald et al, 2010). In the US, postgraduate titles are protected and linked to educational attainment. In Australia, nursing titles are protected by law (Leary et al, 2017).

This article presents the landscape in respiratory nursing to illustrate the plethora of titles used in the UK.

Respiratory nurses’ titles

In 2017 the Association of Respiratory Nurse Specialists (ARNS) commissioned a study to identify research priorities for respiratory nurses. The secretariat used email and social media to invite all ARNS members, along with nurses from the British Thoracic Society and Primary Care Respiratory Society, to participate in an online survey.

Data on job titles was collected during the first round from 173 respondents, who reported 57 job titles (Table 1). In the published findings (Kelly et al, 2018), titles were grouped into 10 categories to make the data easier to read – a pragmatic approach that hid the extent of the variation. We are disseminating this data to raise awareness of the issue and inform future strategies and policy.

table 1 self reported titles

This snapshot of respiratory nurses’ job titles comes from a relatively small sample, so the actual variation in titles may be even larger. It portrays a single specialty, in which the workforce essentially performs similar roles. The myriad job titles have evolved because, in the absence of regulated titles, employers effectively make them up. Unfortunately, regulatory bodies seem to have little appetite to address the issue at present.

Without a central framework, specialist nursing roles have become disparate in their remit and descriptor. It is hardly surprising that evidence about their effectiveness is lacking and that their value is questioned (Kelly et al, 2018).

Harmonising and credentialing

A harmonisation of titles could introduce clarity and possibly enhance patient safety (Leary et al, 2017); this has been undertaken locally with some success, with the effect of highlighting the value of specialist roles (Grundy-Bowers et al, 2018; Pearce and Marshman, 2008).

The NHS Long Term Plan mentions credentialing as a way of enabling clinicians to demonstrate areas of competence, and announces the publication of standards in 2020 (NHS England, 2019). There are now national strategies to standardise advanced practice (NHS England, 2019; Health Education England, 2017) and the Royal College of Nursing has produced standards outlining the competencies of advanced nurse practitioners (RCN, 2018). However, there is much work still to be done at government and regulator level to mandate them, and collaboration between education providers, employers and funders is needed.

Value of specialist roles

The role of specialist nurses will become ever more important as the population living with long-term conditions increases. However, over half of the 457 respondents to a survey of respiratory nurses (Yorke et al, 2017) said they were planning – or eligible – to retire in the next decade. It is therefore crucial to implement strategies to recruit and retain specialist nurses.

It will be important to present evidence of the effectiveness and cost-effectiveness of specialist roles. The future vision for NHS services critically features nurses and nurse-led services, so the workforce needs to be developed in a manner that supports this vision and we need to advocate for nurses who are experts in their fields.

Conclusion

Specialist nurses are highly valued by patients and, as we face the impending crisis in nursing recruitment generally, it is now imperative that the issue of role titles is prioritised. This will provide clarity and inform the development of future career choices and pathways. 

Talking points

  • The surfeit of job titles in nursing has been a bone of contention for years
  • It has resulted from the development of advanced and specialist nursing roles
  • Multiple job titles compound confusion around nurses’ roles and obscures the value of specialist roles
  • Harmonisation and credentialing are two ways of addressing the issue
  • The surfeit of titles must be tackled to provide clarity in the context of the nursing recruitment crisis
  • Acknowledgements – The authors would like to thank the authors of the original Delphi study and the Association of Respiratory Nurse Specialists.
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