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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 have numerous ambiguities and complications.

·       The NHS employs around 320,000 nurses and midwives. But most nurses (55%) are employed outside the NHS. 

·       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 GPs who are independent contractors. Hence the freedom to determine nursing pay and conditions.

·       Independent care and nursing homes employ 43,000 nurses, with 20% having a zero hours contract. They care for the most vulnerable in society yet have fractured nursing leadership and influence.

·       Like health visiting, school, occupational health, district, learning disability and mental health nursing, practice nursing is a specialist qualification regulated by the NMC. But only 10% of practice nurses hold this qualification.

·       Nurses are accountable to their employer through their employment contract. As such, the employer has liability for any act or omission. Nurses do not require separate indemnity insurance. Nurses are also accountable to the NMC regulator not to abuse trust and to justify professional actions. But agency, self-employed, volunteers or nurses acting in a good samaritan capacity need personal indemnity for clinical negligence claims.

·       The options for entry onto the NMC register are baffling with different registrations and qualification codes.
This needs clarifying for the profession and employers.

·       NHS nursing job titles have no uniform definition. Organisations allocate any title they choose to nursing posts. A 2017 study revealed 595 titles used for 17,960 specialist posts; respiratory nurses have reported 57 job titles and diabetes nurses identified 117. Job titles do not reflect accredited education. This is an embarrassment.

·       Advanced nursing practice and specialties are not regulated by the NMC. Numerous guidelines exist to define the education and competencies for advanced practice. To protect the public, the NMC must create a regulatory framework and protected titles.

These conundrums, frustrating as they are, also illustrate the breadth of nursing practice. I wouldn’t want to be in any other family. 

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