Nursing in the United Kingdom
Nursing in the United Kingdom is the largest health care profession in the country. It has evolved from assisting doctors to encompass a variety of professional roles. Over 700,000 nurses practice,[1] working in settings such as hospitals, health centres, nursing homes, hospices, communities, military, prisons, and academia. Most are employed by the National Health Service (NHS).
Nurses work across all demographics and care areas: adults, children, mental health, and learning disability. Nurses work in specialties across medicine, surgery, theatres, and investigative sciences such as imaging. Nurses also work in sub-specialities such as respiratory, diabetes, cancer, neurology, infectious diseases, liver, research, cardiac, women's health, sexual health, emergency and acute care, gastrointestinal, infection prevention and control, neuroscience, ophthalmic, pain and palliative, and rheumatology.[2] Nurses often work in multi-disciplinary teams, but increasingly work independently.
To practise, all nurses and nursing associates must be registered with the Nursing and Midwifery Council (NMC).[3][4]
Dental Nurses, Nursery nurses and Veterinary nurses are not regulated by the Nursing and Midwifery Council and follow different training, qualifications and career pathways.
Licensure[edit]
To practise lawfully as a registered nurse, the practitioner must hold a current and valid registration with the Nursing and Midwifery Council. The title "registered nurse" can only be granted to those holding such registration; this protected title is laid down in the Nurses, Midwives and Health Visitors Act 1979.[7]
Nursing values[edit]
Many government reports address nursing, including:
In addition there have been a number of non-governmental reports from the Royal College of Nursing, including:
Additional reports relating to nursing in the UK include:
Roles[edit]
Non-registered staff[edit]
Non-registered staff typically working in direct patient care (often on wards), performing tasks such as personal care (washing and dressing), social care (feeding, communicating to patients and generally spending time with them) and more specialised tasks such as recording observations or vital signs (such as temperature, pulse and respiratory rate, or TPR) or measuring and assessing blood pressure, urinalysis, blood glucose monitoring, pressure sores (see Waterlow score) and carrying out procedures such as catheterisation and cannulation).
Some unregistered staff work as phlebotomists, ECG technicians, and smoking cessation therapists beyond the hospital. Others expand their ward-based role to include such tasks. Few areas of nursing cannot be legally performed by suitably trained non-registered staff. They legally must be supervised (either directly or indirectly) by a registered nurse.
In 2019 it was reported that mental health support workers were increasingly covering shifts because of the shortage of mental health nurses.[58]
Non-registered staff have various job titles such as "clinical support worker", "care assistant", "nursing assistant" and "healthcare assistant" (HCA). Typically they are on pay band 2 or 3, although senior healthcare assistants can be on band 4.
Asessment tools[edit]
Holistic assessment[edit]
Activities of daily living –
Richmond Agitation Sedation Score (RASS)
CAM-ICU - Confusion Assessment Method for the ICU
Pain assessment[edit]
Wong Baker Faces –
PAINAD –
Critical Pain Observation Tool (CPOT)
General assessment tools[edit]
Waterlow score –
MUST – Malnutrition Universal Screening Tool
The Nursing and Midwifery Council has a specific process for inducting Registered Nurses trained outside UK / EU. Prior to October 2016 an outside UK RN would have to undergo an Overseas Nursing Program known in short as the ONP. The ONP had to be undertaken by the candidate after NMC makes necessary checks and issue the candidate with a decision letter stating that the person may join a university to undertake the ONP. However, due to shortage of nurses and NMC striving for gold standards in nursing they have now updated their new process to a two part test of competence. The first part is called CBT and Part 2 (objective structured clinical examination (OSCE).[71] The process includes an English language test which has been criticised as discriminatory because it demands an academic standard of reading and writing that many native English speakers could not meet. This means at least 3,000 qualified nurses from India who are already in the UK are not on the register, and so are paid less for similar work.[72]
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Protests[edit]
NHS Student protests #BursaryorBust[edit]
In the November 2015 spending review,[78] George Osborne stated that he would remove the NHS Student Bursary from 2017. This prompted several Nursing students to organise a political demonstration with other healthcare students at King's College London outside the Department of Health in December 2015 which was attended by several hundred supporters. Kat Webb also decided to start a petition on the government's e-petition site, which received over 150,000 signatures[79][80]
The student bursary debate has been raised in parliament at Prime Minister's Questions, and is the subject of the 'Early Day Motion (EDM) 1081 – THE NHS BURSARY', which was sponsored by Wes Streeting MP.[81]
Nursing research[edit]
For the full article see also (Nursing research)
Nursing research provides evidence used to support nursing practices. Nursing, as an evidence-based area of practice, has been developing since the time of Florence Nightingale to the present day, when many nurses now work as researchers based in universities as well as in the health care setting.
Industrial action[edit]
Whilst nurses are not known for striking or taking industrial action, there have been many occasions when nurses have gone on strike, often over pay and conditions. The Royal College of Nursing had a no-strike policy for 79 years until 1995, when the policy was dropped due to pay disputes at the time.[88]
In 1939 rallied together as it was reported in the Daily Mirror that many nurses were leaving the role and were enduring financial hardship.
In 1948, following the establishment of the NHS, nurses realised that their pay had decreased, which led to strike action.
In 1962 many nurses marched to Trafalgar Square as part of pay disputes under the banner of "Empty Purses Mean Less Nurses".
In 1970 many nurses protested at pay and conditions.
In 1973 it was reported that over 7,000 nurses marched in Sheffield.
In 1974 several protests took place by nurses over pay and conditions.
In 1976 many nurses took part in a low pay strike.
In 1982 there was a National Health Service day of action with 120,000 workers marching at various locations around the country including many nurses.
In 1988 Nurses went on strike in 1988 over pay and proposed changes to the NHS.
In 2011 Unison nurses protested and marched over pay.
In 2014 Midwives and some nurses went on strike over pay.
In 2015 nursing students protested outside the Department of Health over the removal of the NHS student bursary.[89][90]
In 2016 nursing students marched to Downing Street to protest over the removal of the NHS student bursary. The protest was attended by Shadow Health Minister Heidi Alexander MP, Wes Streeting MP, Representatives of UNISON, Unite the Union and Royal College of Midwives.[85]
Nursing in the UK has been represented across popular books, television and films, including: