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Nursing is the most trusted profession, but anyone in the UK can refer to themselves as a nurse even if they have been struck off, have no qualifications or have been convicted of a crime, writes Professor Alison Leary.

A group of nurses and researchers are calling on government to help protect the public by changing the law to protect the title nurse:

In 2017 my research colleagues and I published a paper looking at nursing job titles in common use (there are thousands). An incidental finding was that employers were employing people with no registerable nursing qualifications, with job titles such as advanced nurse practitioner and clinical nurse specialist.

Although the term Registered Nurse is protected under the 1997 Nurses Midwives and Health Visiting Act, the term “nurse” is not protected in the UK. It’s an issue because the term nurse is the term in common usage. Other professional titles such as physiotherapist, hearing aid dispenser, dental nurse or paramedic are protected in law.

This means anyone can use the term nurse to offer services, advice or be employed as a “nurse”. The use of the term nurse is not restricted to use by Registered Nurses and can be used by many different types of worker. This includes assistive roles such as healthcare support workers or other professionals taking on “nursing” work. Those struck off or convicted can still gain employment as a “nurse”. It is increasingly used in roles where a nursing qualification is optional but this is not evident to the public (for example staff nurse, district nurse or matron would usually mean a registered nurse but with some employers this is no longer the case as hard pressed employers are opening up nursing roles to different workers in order to offset the massive deficit in registered nurses

We think the misuse of job titles is a patient safety and trust issue. It also masks significant workforce issues in health and social care. In 2019 there were over 50,000 registered nurse vacancies in England and the government undertook to recruit more “nurses”. Not defining nurse means other workers can be employed in these roles and further mask the nursing shortage.

Why does this matter?

Although other workers can provide additional services, replacing registered nurses (RNs) with other workers means that patients do not get expert registered nursing care. RNs are being replaced with other registered workers and workers such as support workers. Terming these workers as “nurses” hides the issue of gaps in the nursing workforce and patients not receiving expert nursing care which is known to have benefits in terms of issues such as survival.

The public who have contacted us feel deceived. From a patient in SW England (shared with permission):

“Was advised by Consultant to have double mastectomy… Saw so called Nurse Practitioner for prosthetics which had to wait over two months for as they'd given first set to someone else. As she handed them over in loud voice for all to hear she said: 'You're not entitled to these, do you know you're costing this department £120, you ought to pay as you chose to go London for surgery. Was ashamed and humiliated at time but that soon turned to anger… Decided to lodge complaint to Matron about this Nurse Practitioner, they came to my home and admitted she wasn't qualified…’”

This is why we feel it is important to protect the title nurse in UK law.

Professor Alison Leary PhD FRCN FQNI MBE is Chair of Healthcare and Workforce Modelling at LSBU

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