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Unregistered nursing support staff working under specialist nurse job titles, study reveals

Research finding ‘poses a serious risk to patient safety’.
Alison Leary

Academics are calling for the protection of the nurse title following research that reveals nursing support workers are using the term 'nurse' in their job titles.

Researchers from London South Bank University (LSBU) warned that their study results may just be scratching the surface and that the issue could be even more widespread.

The LSBU study, published in the Journal of Clinical Nursing, analysed around 17,960 specialist nursing posts over a decade from 2006 to 2016 in NHS trusts across the UK.

'Serious risk'

Results of their analysis show there are 595 different specialist job titles currently in use, a practice they claim is not only confusing but poses a serious risk to patient safety.

They also assessed educational data on 8,064 posts, and found that

Academics are calling for the protection of the nurse title following research that reveals nursing support workers are using the term 'nurse' in their job titles.


Co-author of the study, and London South Bank University professor, Alison Leary.
Picture: Nathan Clarke

Researchers from London South Bank University (LSBU) warned that their study results may just be ‘scratching the surface’ and that the issue could be even more widespread.

The LSBU study, published in the Journal of Clinical Nursing, analysed around 17,960 specialist nursing posts over a decade from 2006 to 2016 in NHS trusts across the UK.

'Serious risk'

Results of their analysis show there are 595 different specialist job titles currently in use, a practice they claim is not only confusing but ‘poses a serious risk to patient safety’.

They also assessed educational data on 8,064 posts, and found that 4% (323) were recorded as holding titles such as 'advanced nurse practitioner', 'assistant nurse practitioner' and 'specialist nurse', while possessing no formal nursing qualification registered with the Nursing and Midwifery Council (NMC). These 4% were employed by NHS trusts in England and are most prevalent in London and the north east of the country, according to the study.

They were all women on pay band 3 or 4, earning in the region of £17,000 to £22,000, and worked primarily in emergency care, pre-assessment, theatres and cancer care.

The workers in the study who were registered nurses using the title 'specialist' or 'advanced' had a variety of qualifications, which ranged from none to master's degrees and PhDs.

The study report states that variation in job titles and lack of clarity ‘appear to cause confusion to commissioners of healthcare services, colleagues and employers’, adding that it is ‘likely to be misleading to patients and undermines confidence in the profession’.

Worrying discovery

LSBU professor and chair of healthcare and workforce modelling Alison Leary, one of three LSBU research staff who co-authored the study said: ‘The worrying thing is that because the titles 'nurse' and 'advanced nurse practitioner' aren’t protected, people who are not NMC-registered are able to call themselves specialist nurses.

‘People may think they are seeing a registered nurse when they are not, and this person is performing fairly complex and technical tasks such as line placement, suturing and pre-operative assessments.’

Professor Leary said she had also been regularly checking the NHS Jobs website and had found many jobs offered to band 1-4 staff that had 'nurse' in the title.

‘We do not know how widespread this is, as there are other areas such as the private sector which have not been looked at.’

She added that although the NMC has previously said the title 'nurse' should not be used in a misleading way, the regulator should go further and protect the title in statute.


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