What’s in a name? – nursing job titles

What’s in a name when it comes to nursing job titles? Actually quite a lot, according to new research.‘Variation in job titles within the nursing workforce’, published in The Journal of Clinical Nursing this week, warns that nearly 600 specialist job titles now in use is confusing the public, medical professionals and commissioners of healthcare services. More importantly, the frequent use of ‘advanced’ to describe nurses without specialist qualifications could undermine public confidence in the profession and even compromise patient safety

The report is the result of research produced by a team at London South Bank University (LSBU) who analysed in detail a cohort of around 18,000 (17,960) specialist nursing posts over a ten-year period (2006-2016) within NHS trusts across the UK.

The International Council of Nurses recommends that advanced level nurses who often prescribe drugs and manage a caseload have obtained at least a Masters degree level qualification. But, of 8064 posts looked at, for which educational data was obtained, 323 (4%) were recorded as holding titles such as ‘Advanced Nurse Practitioner’ and ‘Specialist Nurse’ while having no formal first level nursing qualification registered with the Nursing & Midwifery Council (NMC).

This four per cent group of unregistered nursing support workers employed by NHS trusts in England are most prevalent in London and the North East of England.

In this group that were not registered with the NMC all of the low paid workers featured in this sample (100 per cent) were women earning in the region of £17-22k (Pay band 3 and 4). Of these, the majority use the term ‘Advanced Nurse’ or both ‘Advanced’ and ‘Nurse’ in their job title. Examples include, ‘Advanced Practitioner’ which was the most common (83) followed by ‘Specialist Practitioners (69) and ‘Advanced Nurse Practitioner’ (52). They primarily worked in emergency care, pre-assessment, theatres and cancer care.

These job titles were cross-checked further on the NHS Jobs website during April-May 2017 using the search terms ‘advanced’ and ‘nurse’ (and applying a pay band 1-4 filter) revealed advertised posts for which registration with the NMC as a registered nurse was not required.

Those who were registered nurses using the title specialist or advanced had a variety of qualifications which ranged from none to Masters and PhDs.

As there is currently no regulation of specialist advanced nursing practice in the UK employers and post holders drive the labelling of posts. The report recommends that harmonisation would help to curb the unnecessary proliferation of nursing job titles, introduce much needed clarity and possibly enhance patient safety.
The report also suggests that regulation of protected job titles is particularly important for the international community in countries outside of the UK that are developing these roles.

Alison Leary, LSBU Professor and Chair of Healthcare and Workforce Modelling, one of three LSBU research staff who co-authored this report said: “What the results of this study clearly show is that advanced nursing practice needs regulation to help protect the public. Lack of consistency has implications for the wider perception of advanced specialist practice in the worldwide community and the workforce more generally.
“If the current system is allowed to continue unhindered, then there is a real risk posed to patient safety. Public trust also risks being undermined by NHS trusts applying professional job titles to low-paid carers who are not fully qualified nurses.

“In some instances, there is evidence that these post holders are being expected to treat members of the public and are missing diagnoses altogether, which could lead to patients becoming seriously ill or worse.
“This study also demonstrates that previous assumptions by the Council for Healthcare Regulatory Excellence that advanced practice labels are associated with career progression are unsound and should be addressed by the regulator.
“The lack of a common framework across England is an issue. Future role development and education from a common framework should be considered.”