Today’s general practice team includes a wide range of job titles, including those of registered nurses. But do patients understand who is who, and the differences between the various roles? Registered nurse Reena Patel says that we must be clearer with patients about job titles, and take more time to explain who is caring for them and their scope of practice.
In primary care, I feel that it is easy to inadvertently mislead patients about who exactly they are seeing when they attend for an appointment.
For example, a clinical room door in a GP practice may be labelled as the doctor’s room or the nurse’s room. However, that room may be being used by a physician’s associate or a nursing associate to see patients that day.
A patient may ask the reception team to book with a ‘nurse’ for a blood test, but is booked with a phlebotomist.
Or a receptionist may say to a patient that they are ‘booking you with the nurse’ when, the patient is instead booked with a healthcare assistant.
Does any of this matter? After all, the patient is seeing a trusted member of the MDT, aren’t they, even if they are a little in the dark about their experience and qualifications?
Let’s consider job titles in a bit more detail.
The titles of registered nurse, midwife and nursing associate are registered with the Nursing and Midwifery Council (NMC), and reflect different roles and duty of care. This does not mean any one role is any more or less important than the other, but it does mean that they each do a very different job.
Other members of the team in primary care, including healthcare assistants and phlebotomists – making up the core foundation of the nursing team – and physician’s associates and GP assistants, are not currently regulated, with liability for these roles falling to GP partners.
The question is, whose responsibility is it to be transparent and honest with patients, to not mislead patients, carers and other healthcare professionals? Is this miscommunication a matter of patient safety or clinical governance and CQC?
In the past year, newspaper headlines have put the relationship of medicine, nursing and the law into focus, such as the shocking Lucy Letby case.
There is now an ongoing debate around the physician’s associate role, raised by both the public and the medical profession. In one case a patient who was misdiagnosed thought she had received a diagnosis from a doctor, rather than a PA. In response, the BMA has said that the title of physician associate is ‘highly misleading and confusing’ for patients.
It is clear that the nursing team need to be equally careful to ensure that patients are clearly informed about who they are speaking to in a consultation.
The take-home message is that the title of registered nurse is protected in the UK, and it is a criminal offence for any person to practise as a nurse without being registered as one, or to falsely claim to be qualified or registered.
Is it probably only a matter of time before the NMC and the Royal College of Nursing (RCN) intervene, in the same way as the BMA has, before miscommunication around nursing titles becomes a hazard.
Therefore, we should:
- Always introduce ourselves with our name and correct title to anyone when working within the NHS and wear a photo ID where possible.
- Remember that clarity and transparency about roles are a legal requirement during any communication with patients e.g. from receptionists to healthcare professionals.
We are obliged to comply with the patient’s choice – if a patient requests to book ‘with a nurse’, for example, they should be booked with a registered nurse.
However, where a request for the nurse appointment is specific to a task that other members of the MDT can carry out, then this should be offered as a first line option – to be carried out by an HCA, phlebotomist or a nurse associate, for example – and inform the patient who will be performing this.
If we are educating professions working within the NHS about the different roles, titles and qualifications, then it also becomes our duty of care to educate the public and patients. Otherwise, the trust and faith people have in any NHS will be lost.
Ultimately, it is about working as a team of healthcare professionals to provide both safe and effective care that is sustainable, effective, efficient, feasible and ethical.
Reena Patel is a general practice nurse specialising in diabetes; nurse facilitator at Leicester, Leicestershire and Rutland ICB; and nurse representative for the RCGP Faculty Board in Leicester City.