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The nursing family is complicated

Marilyn Eveleigh seeks to unpack the educational, employment and regulatory anomalies in nursing roles.

Though we are one profession, the different branches of nursing, emerging employers, regulation and the culture of care can create ambiguity within the nursing family. These issues have perplexed me.

  1. The NHS employs around 320,000 nurses and midwives, 45% of the nursing workforce.  Most nurses, 55%, are employed outside the NHS. It certainly doesn’t feel like that…
  2. There are 23,000 general practice nurses and nurse practitioners. Most are not NHS employees though they are entitled to join the NHS Pension Scheme. They are employed by GP[s] who are independent contractors providing general medical services to NHS patients. Hence the freedom to determine nursing pay and conditions. Confusing but true.
  3. 43,000 nurses work in independent nursing and care homes, with 20% having a zero hours contract. Employed by thousands of private businesses they care for the most vulnerable in society yet have fractured nursing leadership and influence.
  4. Like health visiting, school nursing, occupational health nursing, district nursing, learning disability nursing and mental health nursing, general practice nursing is a specialist community qualification regulated by the NMC.  Despite their numbers and funding made available, only 10% of GPNs hold this award. I know why - but it’s outdated and short sighted that GP employers retain such control.
  5. Nurses are accountable to their employer through their employment contract. As such, the employer has vicarious liability for any act or omission of an employee. Nurses do not require separate indemnity insurance. This was an unnecessary complication for primary care.
  6. Nurses are also accountable to the NMC regulator not to abuse trust and to justify professional actions. Agency, self-employed, volunteers or nurses acting in a Good Samaritan capacity, need personal indemnity for clinical negligence claims against them. A wise investment in a litigious world.
  7. There are around 690,000 nurses on the NMC Register. The entry options are unbelievably baffling with different registrations and qualification codes, different parts of the register under public health, specialist and community headings and a recordable qualification catagory. It needs clarifying for the profession, employers and the public.
  8. NHS nursing job titles have no uniform corporate definition. Organisations allocate any title they choose to nursing posts. A 2017 study revealed 595 different titles used for 17,960 specialist posts; respiratory nurses have reported 57 different job titles and diabetes nurses identified 117. Within one trust, 226 different titles are used for nurse specialists. Job titles are no guarantee of underpinning accredited education. This is an embarrassment.
  9. From January 2019, in England only, the nursing associate is a distinct profession regulated by the NMC. They uphold the same NMC Code as registered nurses and midwives. Is this the State Enrolled Nurse by another name?
  10. Advanced nursing practice and specialisms, including the Nurse Practitioner qualification, are not currently regulated by the NMC. Numerous guidelines exist to define the education and competencies required for advanced practice. To protect the public the NMC must create a regulatory framework and protected titles. Soon.

These themes illustrate the breadth of nursing practice that continues to challenge the profession.  Frustrating as it is, I wouldn’t want to be in any other family. 

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