This week the Guardian’s Health Professionals blog published a piece by Professor Alison Leary about the proliferation of titles in and around nursing and the issues that it raises. You can read it here. She has also published her research into this in more detail here. The subject crops up regularly on Twitter and there have been reports on Professor Leary’s work in the popular nursing press. In my own conversations with colleagues we talk about whether the time has come for the title ‘Nurse’ to be protected, so that it cannot be used by someone who hasn’t undertaken the required three-year Bachelor’s degree programme and be subject to statutory regulation. Many people mistakenly believe the title is protected, but in fact it is ‘Registered Nurse’ that has protection – but that isn’t the title in general and colloquial use. There is also a view that protected title isn’t necessary – usually citing the view that no-one worries about Tree Surgeons or Drain Doctors or that if we protect ‘Nurse’ does this mean that Dental Nurses couldn’t use the title or Vet Nurses? There is an exasperation about these comments that indicates that this is just nursing being ‘precious’ – again.
So, why is the proliferation of titles associated with nursing an issue? First, for those who make the perfectly reasonable point that ‘no-one bothers about confusion between Doctors/Surgeons and Tree Surgeons or Window Doctors’ – it kind of misses the point. You are unlikely to meet a Tree Surgeon and a clinical Surgeon in the same garb in the operating theatre and therefore confuse them, and the same applies to your Drain Doctor – they are unlikely to be attending to you in a clinical situation alongside your physician. Similarly, you would be unlikely to find yourself having to distinguish between a Registered Nurse and a Veterinary Nurse practising on a hospital ward (one hopes).
Professor Leary’s point is a more sophisticated one. There are care support workers in clinical situations working alongside Registered Nurses, with job titles that include the word ‘nurse’, responding to being called ‘nurse’, wearing similar uniforms, and sometimes giving the impression that they can offer the same level of care and have the same knowledge and skill as a Registered Nurse. This is a very different situation and obviously has the potential for misunderstanding and confusion. Unless the difference between a Registered Nurse and a support worker is made very clear to the patient then there is a danger that the patient/client/vulnerable person or their relatives may make an assumption about the expertise of the person providing assistance. Patients have to put their trust in the ability, the competence and expertise of those providing care and treatment, and a recognised, socially meaningful title plays a part in underpinning that trust. Any lack of clarity is at best unfair and confusing, and at worst deceptive and dangerous.
Neither Leary’s article nor this blog is about attacking support workers and the important assistive work that they do, it is pointing out the ambiguity inherent in the NHS’s use of job titles which helps neither the support worker nor the Registered Nurse and may well confuse or mislead the people in their care. Openness and transparency is the issue here, and ultimately patient safety.