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Nursing, Midwifery Practice Development Unit: Standardising job roles and titles in nursing -

CPHVA Response

August 10th 2001

1.0 The CPHVA welcomes this as a preliminary piece of work to bring some focus to the content of nursing roles, but suggests that the project will require considerable work before completion. Also, it is stated that the driver for this paper is to minimise the plethora of nursing titles that are "confusing and unfair to the public". Therefore, it would be useful to know what, if any, investigative work had been done to ascertain where the difficulties lie in the interpretation and perceptions of this by the public? For example, one might assume that much of the public are probably familiar with the term district nurse, school nurse, nursing sister or staff nurse? Without this deeper understanding proposed changes might not achieve the outcomes which are desired.

1.1 Given the diversity of practitioners working within the community the titles offered sound very clinically concentrated. As the current political thrust is towards prevention, promotion and public health, proposed titles must reflect this as part of a process to change the culture of the NHS and the public’s perception of it as an ‘ill-health service’. Clearly, the paper appears to ‘fit’ nurses with a clinical focus most easily and it is disappointing to note an apparent lack of attention as to how these might relate to primary care. Indeed this is a significant weakness and it may be necessary to consider acute and primary care separately with further steps going on to seek commonality. This would recognise the differences in accountability, competency, role and function that results because of different ways of working within the community.

1.2 The issue of job titles will be a pivotal part of the Agenda for Change process so it is essential that there is clarity and consistency to ensure success. How is this piece of work integrated to support the broader strategic objectives that relate to Agenda for Change? Clearly the issue of competencies raises issues that are an integral element in the pay progression process which may be part of Agenda for Change. In order not to undermine this process, they should not be applied in a way which cuts across the provisions in the Agenda for Change requirements. Therefore, it is essential that the outcomes that emanate from the Standardising job roles and titles paper are consistent with the Agenda for Change outcomes.

1.3 As many community nurses, health visitors, practice nurses and school nurses require a specialist practice qualification (SPQ) to work within the community where will they fit – Level 3? And if you combine SPQ with a ‘team leader’ function, which level then? . How also to distinguish between health visitors, district nurses and school nurses who hold caseloads and those who may hold corporate caseloads? Given your definitions and my understanding of the role of the majority of nurses within the community this would put them on level 3 or 4, never anything else?

Following that argument where will Community Practice Teachers/ Practice Educators sit? Perhaps this is less of an issue within the acute setting because work is undertaken usually within one building or location with the student having the support of a team on site, whereas within the community work tends to be more isolated in nature having to exercise more autonomy.

1.3 The NMPDU must employ a degree of sensitivity in this exercise, which for some may feel threatening. Clearly for many their professional title brings with it an identity. Recently this has been demonstrated by health visitors in expressions of anxiety and anger at the omission of the title ‘health visitor’ in policy documentation with no with rationale stated. This has led to some professionals articulating feelings of redundancy and of their contribution to the NHS being undervalued. However, some of the suggestions presented as possible titles for community nursing were: 

‘Co-ordinator’ is suggested instead of ‘team leader’: for example, within school nursing teams there can be three members all equally qualified but each with different specialist responsibilities. If there was a designated ‘coordinator’ rather than ‘team leader’ it was felt that this title would eliminate the hierarchical element and describe most accurately the function.

Apparently, within Dumfries and Galloway, they have dropped the title ‘team leader’ eighteen months ago and resorted to the title of Nurse Manager which it was felt more accurately describes the role. This role is remunerated at an ‘H’ grade.

The District Nursing title was felt to be descriptive, but this title does not ‘fit’ with other nurses within the community and health visitors. It is suggested that ‘Community Practitioner’ or ‘Community Health Nurse’ would be potentially useful options. There was support for the title ‘Community nurse’ to remain for staff nurses. However, due cognisance must be given to the emerging ‘public health nurse’ title as described in Nursing For Health and how the piece of work undertaken by NMPDU relates to the work completed by Healthworks UK.

The use of the term ‘Nurse practitioner’ in the document was surprising given the ambiguity that surrounds the term, in the variation in educational preparation, scope and competencies required by a range of nurses who use it. If this becomes a standard term I suggest that attention be given to articulate specifically what the core requirements of the role attached to the title ‘nurses practitioner’ would be and what it is not. Within the remit of nurse specialist titles the term nurse practitioner indicating their place or remit appeared to be a popular option. The term ‘clinical nurse specialist’ was not so popular as it did not reflect the emerging public health thrust.

1.5 Table 1: describes a framework illustrating the level of functioning and responsibilities of each title is clear. However, it might be expected that a nurse consultant might operate at a more strategic level than is described:

‘Provide mentorship and supervision’: Yes, but at this level perhaps the focus should also be on the development of systems of supervision and support within the organisation, hence developing the capacity within the workforce.

Active involvement in practice & development’: I agree, but again the nurse consultant this be considering these issues in a strategic manner, developing workforce capacity, linking practice to academics and facilitating practitioners.

‘Communication at strategic level’: needs to emphasise the need to engage the workforce and to make clear the communication is a two-way process up and down, i.e. partnership.

Diagram to illustrate proposed model of core job titles for nursing: Again the examples given appear to be most relevant to the acute setting and do not translate so easily into primary care.

Section 1.4 - The use of the term ‘therapeutic’ seems vague. Perhaps you need to be more specific about what this will mean in practice? For example, does this include engaging in dialogue with colleagues, developing an understanding of the roles of professional colleagues, etc

Section 1.5 - Suggest the phrase ‘provide health information to patients in a comprehensible manner’ is amended, ‘provide health information in a manner which can be understood and delivered in a manner that is relevant to them’

Section 2.3 - ‘monitoring workload’. Should this be ‘developing systems to monitor workload’

Section 2.4 - Teamwork rhetoric sound great but someone operating at this level must be giving cognisance to developing methods to monitor how effective their approaches are?

Section 2.5 - ‘Professional role in developing, in partnership with other, systems for clinical supervision and mentorship’

Section 3.1 - ‘general practice level’ might be ambiguous. Is this the practice only or LHCC?

Section 3.2 - ‘provision of information’ suggests merely a transfer of information, which has been proven not to be a particularly effective tool in changing behaviour. Need to find a phrase that evokes a more active process, which engages the patients/ public in determining their needs and solutions.

Section 3.3 - needs to place an emphasis on facilitative styles of management that are capable of engaging all levels of staff to illicit their working knowledge in determining strategies and developing corporate ownership – partnership.

Section 3.4 Suggest ‘dissemination’ rather than ‘provision of specialist information’. Arguably the charge nurse should be identifying not only leaders but individuals with a range of qualities who have qualities that will enrich the profession, e.g. research skills, teaching skills, etc.

Section 4.2 - the term ‘higher order’ is used throughout the document. This seems to be rather ambiguous terminology, if it refers to strategic suggest you stick with that term?
It is inferred within this section that the nurse consultant will undertake clinical nursing. This is unlikely to be relevant to all nurse consultants depending on the setting and speciality. Suggest that the nurse consultants maintain a strategic focus with active operational links with colleagues.

Section 4.4 - ‘focus on experienced colleagues’. Agree that there needs to be mechanisms for professional development and progression, however length of service is not always directly correlated with ability or flair. Suggest ‘develop systems for mentorship and clinical supervision’.

Section 4.5 - Include a bullet including sentiments around: ‘ Disseminate process and outcome indicators of projects which have been successful so that may be rolled into mainstream, and also problem areas’.

Professional Officer, CPHVA

August 2001