Many years ago when I first qualified as a nurse, I received from the registration body of the time a shiny enamel badge. Although it was a bit of a nuisance trying not to lose it, it was a physical sign to the world, and to me, that I was a registered nurse.
Three long years of training were over, and I had something to show that I was somehow transformed into a new creature who was capable of many things and would be able to deliver high standards of care to all who would come in my path. Fortunately, there were restraints in the form of the nursing hierarchy and of course the registration body to keep me reined in and protect the unsuspecting public from a slightly over-zealous care giver.
In more recent times, the Nursing and Midwifery Council (NMC) has decided that to protect the public, it is desirable to re-examine the format of the register. It wants to ensure that nurses have the necessary ‘continual professional development’, and that when care is delivered, it is planned and documented in an efficient manner.
The simplest way of explaining the register is that it is divided into three parts. Part one contains the names of nurses who deliver care on a one-to-one basis, whether in hospital or the community part two is for midwives who look after mothers and babies and part three is for health visitors, school nurses and occupational health nurses who deliver care to individuals, but also to groups or populations, some of whom they might not actually meet. An example of this is an occupational health nurse who may after assessment, set up a hearing conservation programme in a noisy factory. This needs to be performed to high standards, but there may not be the opportunity to consult each individual to agree the programme of care.
This is perhaps an over-simplification of the NMC’s initiative, but it sets out the rationale for the new register. After a few initial blips, most of the individuals who were due to migrate to the third part of the register managed to end up in their new home. So a rather grand, if unwieldy, new title was introduced: specialist community public health nurse.
But does it do what it says on the tin? Does it protect the public? Do most of the registrants on this new part of the register understand the demands now placed on them in terms of continuing professional development and how they ‘prescribe care’?
Interesting questions. I have heard colleagues express concern that the entry requirements to the new register are too light. There are some who would argue that those without a degree or diploma should not be on the register. My personal view is that all those who work with ‘populations’ should be doing so on the same level. If the aim of the change was to enhance public protection, then it is unacceptable to have an RGN without an OH nursing qualification doing exactly the same job, but who has a lesser burden of accountability.
If we accept this, then we should be doing more to ensure that everyone working in the area can move with this register. It is not a qualification – a shiny badge that we can wear as we strut around the workplace. It is a set of demands that we perform to an acceptable standard. It would be unheard of for midwives or health visitors to have RGNs do their job, so surely occupational health is at least as demanding, if not more so?
The NMC, however, does not seem to share this view. In fact, led by the masses of health visitors who make up the majority of registrants on this part of the register, it has embarked on a new programme of training that will make it more difficult for nurses to obtain a registered OH qualification. Demands, for example, that students are supernumerary, and a higher standard of training for mentors (with associated employer costs), place the traditional self-funding, distance learning course under some threat. Already a few nurse education providers have put technically based courses in place that allow nurses to focus on practical skills, but do not meet the requirements of protecting the public.
The end result is that in taking a one-size-fits-all approach to training – meaning the health visiting model – there are likely to be fewer OHNs working to the enhanced standards. This means that the public who receive care in the workplace lose out, occupational health loses out, and the universities lose out.
So you might not have a shiny new badge, but you do have something even more important: you have a vote on who should be on the NMC. Use it wisely, as we need more occupational health representation on the regulatory body.
Kevin O’Connor RNLD RGN SCPHN (OH) BSc (Hons) MSc, is head of occupational health at Northern Health and Social Care Trust, and a co-opted committee member of SOHN.
Nursing and Midwifery Council (2006/08) Support Learning and Assessment in Practice NMC Standards for Mentors, Practice Teachers and Teachers
By Kevin O’Connor, head of occupational health, Northern Health and Social Care Trust