Exclusive: NHS trusts branding care staff as 'advanced nurses'

The study of 45 specialisms has also exposed the confusing state of specialist nursing in the NHS, finding 595 different job titles which had no link to the nurse’s education level or experience.

The research has prompted a warning from the Nursing and Midwifery Council chief executive and registrar Jackie Smith, who told HSJ that NHS trusts had a duty not to mislead patients about who was caring for them.

The study, by Alison Leary, a professor at London’s South Bank University, identified 323 people who were working in specialist roles with job titles such as “advanced nurse” or “specialist nurse” despite not being registered with the NMC and lacking any advanced education. They were earning salaries of between £17,000 and £22,000.

Prof Leary said: “This was an incidental finding in our research, which suggests it is a much bigger issue than anyone has appreciated.”

A search of the NHS Jobs website during April and May this year using the search terms “advanced” and “nurse” within pay bands 1-4 revealed several roles for which registration with the NMC was not required by employers.

Prof Leary’s research, to be published in the Journal of Clinical Nursing, looked at 17,960 specialist staff from a database compiled over the decade to 2016. It showed the NHS uses 595 different job titles with no clear link between the job title and the education level or experience of the nurse.

Prof Leary said the situation was confusing and undermined confidence in the profession. She said advanced nursing should be regulated with clear standards and the title “nurse” should be protected, as it is in other countries like the USA and Australia.

She told HSJ: “Our research shows there is no relationship between job titles, qualification, complexity of practice or length of time a nurse has been practising.

“People have different job titles and practice at different levels of complexity. You might have a registered nurse on band 5 in an out of hours service being called an advanced nurse practitioner after a three day course, and then you might have someone with a master’s degree in advance practice proactively managing a caseload of patients but both will be lumped together.”

Prof Leary said it was a possibility that nurses could be asked to work beyond their capabilities because assumptions were made based on the job title. “There is way too much variation and the lack of regulation and standards is a threat to patient safety. People may not know their limitations,” she said.

In the USA, nursing bodies regulate the use of protected titles and specialist education while in Australia, nursing titles including nurse, registered nurse, enrolled nurse and nurse practitioner are all protected by law. In the UK, the title of registered nurse is protected, but the title “nurse” is not.

However, other roles such as paramedic, radiographer, occupational therapist and hearing aid dispenser are all protected titles.

Prof Leary added: “This all stems from the fact we don’t protect the title ‘nurse’ which means anyone can use any variant of it in any role. I find it amazing that hearing aid dispenser is a protected title and nurse isn’t. We also need to regulate advanced practice so that only people who meet set standards can call themselves an advanced nurse.

“Our research only looked at the NHS. We have no idea what is going on outside the NHS.”

Ms Smith added: “If individuals are calling themselves nurses and they are not on our register then from a patient perspective that is quite worrying. If they are describing someone as an advanced nurse practitioner, I would think that person was a nurse and on the NMC register.

“Employers should not mislead patients into thinking the person in front of them is a registered nurse when they are not. They have a duty to make that clear to patients.”

• Update 7 September 3pm: 

NHS Employers submitted the following response:

Chief executive Danny Mortimer said: “Employers have rigorous recruitment processes in place to know who has registration to practise as a registered nurse. We are keen to review the research by Professor Leary and share the findings with employers – it is not in anyone’s interests to have job titles which could mislead or confuse the public. 

“We look forward to the finalisation of the national work on advance clinical practice which will provide clearer standards and terminology for advanced practice roles in nursing and other professions.”