No professional group in the UK is more trusted than nurses. The most recent Ipsos Mori Veracity Index, an annual poll on public trust in key professions, found that 95% of the public believe nurses tell the truth. Politicians by contrast come in second to last, on a mere 15%. But it isn’t just a nice add-on. Patients trust nurses to be their advocates, and at a time of unprecedented public health emergency, trust can influence life and death decisions patients might make.
However, there is increasing concern that the public’s trust could be abused by a small but vocal group referring to themselves as nurses to lend credibility to misinformation, leading to calls for greater regulation of the title of Nurse, due to a rise in people referring to themselves as nurses to spread misinformation, linked to COVID-19 and the vaccines.
‘If you don’t have protection, anyone can call themselves a nurse, because it is not illegal. You could promote antivaccine theories like the person who calls herself a nurse, despite not being a registered nurse anymore,’ said Crystal Oldman, chief executive of the Queen’s Nursing Institute.
One particularly high profile misuser of the nurse title is Kay, or Kate Shemirani, a former registered nurse who was struck off the NMC register earlier this year, after a speech at a protest rally that likened NHS nurses and doctors to the Nazi war criminals executed after World War Two. At the time, The Royal College of Nursing said it was ‘reprehensible and could put nursing staff at risk’. Despite this, Ms Shemirani still refers to herself as a nurse.
‘Legally she cannot say she is a registered nurse, which she doesn’t, but she calls herself a nurse, which she is legally able to do,’ said Dr Oldman.
‘She has led and spoken at antivaccination protests. It is really unhelpful if someone calls themselves and nurse and are potentially bringing people to harm because people believe she has the knowledge and skills of the registered nurse, which leads to people believing what she says and then acting on that, potentially coming to harm by not being vaccinated. That is just one very real example of how the term nurse is used incorrectly.’
This issue is central to the debate on how we protect the public, ensure accountability and safeguard trust in the nursing profession,’ said an RCN spokesperson.
‘For many years, there have been concerns that the lack of protection of nursing titles is a source of confusion and a risk. As a safety critical profession, a core part of nursing practice is professional identity.’
Recently, the #ProtectNurse campaign was set up by Alison Leary, professor of Healthcare and Workforce Modelling at London South Bank University. It led to a petition which has garnered over 30,000 signatures to demand that the nurse title is enshired in law.
What is a nurse?
The NMC sets out standards of proficiency which outline the expert skills, knowledge and behaviours Registered Nurses must meet and continually adhere to, in accordance with the NMC Code. These standards ensure that an individual is fit to qualify as
a Registered Nurse and can practise under that title. Standards of proficiency rightly reflect the public’s expectations of a nurse and ensure Registered Nurses deliver
safe, compassionate, and effective care.
In order to qualify and gain the right to register, Registered Nurses undergo high quality undergraduate and postgraduate pre-registration degree programmes, which are quality assured by the NMC in line with its programme standards. Once registered, revalidation is a critical part of the regulatory process, introduced to fulfil a key recommendation from the Francis Report into the failings at Mid Staffs NHS Foundation Trust. Registered Nurses must complete this every three years, to ensure they can continually update and reflect on their professional practice and strengthens public confidence in the nursing profession.
Currently in the UK, an individual can use the title ‘nurse’ without being on the NMC register, without having graduated from an NMC approved education institution, and without having gone through revalidation every three years.
Recently the issue was raised in Parliament, when an amendment to the Health and Social Care Bill was moved to protect the nurse title in UK law. ‘As we know, when someone calls themselves a nurse, that gives them a certain standing in society and people automatically think they know what they are doing,’ said Dawn Butler, MP for Brent and the sponsor of the amendment. ‘The nursing profession has some harrowing stories of parents taking advice from somebody who called themselves a nurse but was not one, and the tragic and devastating consequences.
‘It is shocking that anybody can call themselves a nurse, whether or not they have any qualifications or a first aid certificate—they may have no qualifications at all and they can call themselves a nurse.’
‘It is really important that we have the opportunity to put this right today—in fact it would be dangerous not to do so. Throughout the pandemic, people have been struck off as nurses, yet they are still using the title of “nurse” as they publicly deliver misleading and dangerous information about the pandemic. The public and patients have the right to know that the treatment and advice they receive is from a registered healthcare professional.’
Speaking against the amendment, Health Minister Edward Argar, said: ‘The title “nurse” is not protected, given that it is used across multiple professions, including dental nurses, school nurses, veterinary nurses and similar. As has been pointed out by the interim chief nursing officer for Scotland, any change would need careful consideration of the impact on other groups currently using the title “nurse” outside healthcare settings.’ MPs voted the amendment down, 304 to 240.
Although the vote in parliament prevented the nurse title from being legally protected, there is growing support behind the idea. In a recent statement, the Department of Health and Social Care spoke of the importance of well-regulated titles.
‘The protection of a professional titles is important for public protection. Protecting a title provides assurance to the public that someone using that title is competent and safe to practise,’ said a Department of Health and Social care spokesperson.
‘In order to ensure that only an individual who is registered with a regulator can use a protected title, it is an offence for a person to use a title they are not legally permitted to use or to otherwise hold themselves out to be a regulated professional.’ These protected titles include doctors and paramedics.
‘Recent high profile cases have underlined the limitations of “Nurse” not being a protected title. It is essential that we have the right protected titles and associated enforcement powers to be able to take effective action to protect the public and maintain confidence in the professions. We would welcome a further discussion with DHSC to ensure that our protected titles and enforcement powers are fit for purpose under the new legislation,’ said the RCN.
High profile political figures are increasingly taking up the idea, including former shadow health secretary Jon Ashworth. Speaking at the recent QNI conference, he said the fact that the nurse title was not protected in law was ‘staggering’, adding that some people refer to themselves as nurses even if they were unqualified or had left the profession.
‘It leads to abuse where non-registered nurses can call themselves nurses and peddle anti-vax nonsense for example,’ said Mr Ashworth.
‘It’s why we are supporting the campaign to safeguard the title ‘nurse’ in law. I think it’s really important that when we’re talking about nurses, we know we’re talking about registered nurses.’
While it is comforting to know that the public’s trust in nurses is still as firm as it has ever been, as long as the title nurse is used in bad faith attempts to spread misinformation, the need for greater legal protections for the title will remain strong.