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False job titles: trusts admit giving ‘nurse’ badges to unregistered

Internationally educated nurse recruits at six London trusts wore ‘staff nurse’ badges before completing competency tests and receiving UK PINs, a freedom of information request has revealed. The trusts stated that this had happened between 2021 and 2023, which has raised questions about nursing roles and titles, accountability, transparency and safety. There have also been concerns whether the recruits had been given the corresponding workload of a registered nurse before being registered.
Six London NHS trusts acknowledged instances where unregistered internationally educated nurses wore ‘staff nurse’ badges between 2021 and 2023

Internationally educated nurse recruits at six London trusts wore ‘staff nurse’ badges before completing competency tests and joining the nursing register

Six London NHS trusts acknowledged instances where unregistered internationally educated nurses wore ‘staff nurse’ badges between 2021 and 2023 Picture: iStock

Thousands of internationally educated nurses (IENs) may have been using ‘staff nurse’ titles in London NHS hospitals before joining the nursing register, new data has revealed.

Six London trusts admit to incorrect use of ‘staff nurse’ badges

Six employers acknowledged instances where unregistered IENs wore ‘staff nurse’ badges between 2021 and 2023 after responding to a freedom of information request (FOI) sent to 19 NHS trusts in London.

The IENs were employed as staff and had not yet passed their objective structured clinical examinations (OSCEs) to assess their competency or received their Nursing and Midwifery Council (NMC) PINs.

The six trusts alone recruited more than 3,200 international nurses during this time.

Registered nurse Harbi Kaur raised concerns over job titles that misused the word ‘nurse’
Harbi Kaur raised concerns over job titles that misused the word ‘nurse’

Registered nurse Harbi Kaur requested the data when she became concerned unregistered overseas staff were being presented as ‘staff nurses’ and wearing the same uniforms as registered nurses on the ward where she previously worked.

Ms Kaur, who has now retired, said she raised the issue with her former employer King’s College Hospital NHS Foundation Trust (KCHFT) in 2021 and later via her Freedom to Speak Up guardian in 2022, but felt ‘brushed off’.

In its FOI response, KCHFT said IENs now had ‘transitional nurse’ badges and it was ‘currently exploring options’ for them to wear a different uniform.

Concerns over accountability for pre-registration international staff

Ms Kaur, who came to the UK from Malaysia in 1985, said she was worried about the misrepresentation of job titles and the implications for the nursing profession and careers.

While IENs may be registered in their own countries, it can take varying lengths of time for them to receive a UK PIN which is dependent on them passing the OSCE exam. Meanwhile, Ms Kaur fears IENs are given ‘the workload equivalent of a registered nurse,’ she said.

‘If something goes wrong, who is accountable if they are not held to the NMC Code but have been carrying out duties as named staff nurses? There needs to be transparency.’

Unregistered recruits given ‘staff nurse’ badges to bring down costs

North Middlesex University Hospital NHS Trust told Ms Kaur in its FOI response it had recruited 122 IENs between 2021 to 2023 and confirmed that ‘staff nurse’ was used on badges to save money.

‘Staff nurse was used as these nurses are qualified nurses in their own country and were undergoing a period of conversion to meet NMC practice guidelines,’ stated the response.

‘We also wished to avoid the cost of reissuing identification. However, these nurses were in the classroom full time undergoing training until they successfully completed their OSCE examination.’

Barts Health NHS Trust and the Royal Free London NHS Foundation Trust also confirmed incidences where some individual wards incorrectly used ‘staff nurse’ titles but both trusts said this had been rectified.

Imperial College Healthcare NHS Trust said it became aware of ‘confusion’ over badges and has taken steps to make sure that all IENs wore a badge stating ‘international nurse awaiting registration’ until receiving their PIN.

St George’s University Hospitals NHS Foundation Trust said that preregistration IENs had badges displaying ‘staff nurse’, but wore healthcare assistant (HCA) uniforms and only carried out HCA duties until they received their PINs

‘Using nurse title for transitional nurses puts patient safety at risk’

Paul Trevatt, co-founder of the nurse-led #ProtectNurse campaign to get the title ‘nurse’ protected in law, said the situation was potentially dangerous.

‘It is essential we have the right protected titles and associated enforcement powers to take effective action to protect the public and maintain confidence in the profession.’

Ms Kaur has raised her findings with the NMC, which correspond with Nursing Standard’s own recent investigation.

A spokesperson from KCHFT said: ‘Changes were put in place from the end of 2023 when all internationally qualified nurses awaiting NMC registration were given the job title ‘transitional nurse’. This is to help the public distinguish between registered and non-registered nurses.

‘Matrons, ward managers and other nursing staff are fully aware of any transitional nurses in their team and nursing duties are allocated appropriately. Only those registered with the regulator carry out full nursing duties. Transitional nurses work under supervision and the scope of their role is limited.’

Titles should reflect roles and ‘nurse’ should be protected in law, says RCN chief

In August we discovered more than 8,000 NHS staff were being employed in band 3 and band 4 roles with ‘nurse’ in their title, despite not being registered nurses.

At the time NMC executive nurse director of professional practice Sam Foster said patients should be able to assume that someone with ‘nurse’ in their job title was registered.

‘While “registered nurse” is the protected title, employers should be mindful not to inadvertently mislead or confuse people about who is providing their care,’ she said.

RCN chief nursing officer Lynn Woolsey added:IENs are valued members of the nursing workforce and make a vital contribution to our health service.

‘Employers have a responsibility to ensure that titles accurately reflect the roles that the nursing workforce fulfils in line with regulatory requirements. The title ‘nurse’ should be protected in law to prevent patients being misled by inappropriate titles and IENs should be free from exploitation within their employment.’


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