Nursing and allied professions

There is currently a shortfall of full-time nurses in the NHS, and recruiting is down by one-third on figures for the late 1980s; since many nurses work part-time, the actual shortage is worse. It is likely that there will be full employment in this field in the foreseeable future, as people live longer and improvements in medical science mean that more can be done to help them. Health spending is due to rise considerably over the next five years.

There is no such thing as a 'typical' nurse; they are employed in a wide variety of roles and in many different places. Nurse consultants are highly qualified and experienced individuals. Some registered nurses (RNs) will be close to nurse consultants in terms of specialisation and employment, while others will be newly qualified after a three-year course. Health care assistants also play a huge role in delivering health care, and the system would collapse without them.

Nursing in the Services
All trained Service nurses are qualified RNs at least, and enlist with similar entry qualifications to their civilian counterparts. After recruit training they undertake the full three-year diploma training or, depending on their qualifications, the four-year degree at the Defence School of Health Care Studies, University of Central England in Birmingham. They can then take post-registration courses in a number of different subjects, and apply for a commission after a minimum of two years as a staff nurse.

Service health care assistants and medical attendants could gain entry into a nursing course through one of the routes described later in this article, or they could apply to transfer into their Service's nursing branch. Qualification and entry requirements are the same as for applicants from outside the Services.

Health care assistants
Health care assistants are not professionally qualified, although they will have completed secondary education and have numeracy and literacy skills. Many will hold or be working for NVQs at Levels 2 or 3. Work environments will vary from acute hospitals, including large district general hospitals, community hospitals, work in the community, perhaps attached to a GP's practice, and nursing homes. The role will include delivering basic nursing care, supervised by professional nurses.

Professions allied to medicine (PAMs)
PAMs are not nurses, but they work alongside them to benefit patients. They include physiotherapists, radiographers, occupational therapists, orthoptists, chiropodists and dieticians. Hospital pharmacists, and speech and language therapists are slightly different again. Universities and colleges run courses for people who are looking to become qualified as PAMs; a little research will soon provide information about entry standards, but they are broadly similar to those for nursing. PAMs in the Services are medical branch specialists and each specialisation has its own entry criteria; most require people to be qualified before joining.

Getting qualified as an RN
The entry requirements for nursing courses set by the Nursing and Midwifery Council (NMC) (formerly UKCC) are five GCSEs at grade C or above, or a Vocational A-level or the equivalent NVQ at Level 3. Many institutions also require English, maths or even a science subject. Some hospitals will train unqualified people up to this standard and continue to pay them a salary while they qualify. It is also possible to take an 'Access to Higher Education' course, or pass the NMC written entry test for mature people.

All RNs have either a Diploma in Higher Education or a degree in nursing. Diplomas qualify people for one of the four nursing branches: adult, mental health, learning disability or child health. To become a midwife (as a first qualification) requires a separate three-year diploma, or an 18-month add-on for RNs.

Anyone looking to enter a nursing programme should contact NHS Careers or the equivalent, or look through the prospectus of any trust or university of interest. Application should be made through the Nursing and Midwifery Admissions Service (NMAS), which will also provide information about all nursing HE courses.

Degree programmes often combine practical ward time with nursing theory or health care studies. Entry requirements may be considerably higher than for the diploma, and most courses will also lead to a nursing or midwifery qualification.

Nursing students often undertake a longer academic year in order to complete the practice placements. Nurses do not have to pay tuition fees and those doing diplomas receive an annual tax-free bursary with other allowances for older people and those with dependants. Degree students can apply for a means-tested bursary and a student loan.

The course
The three-year nursing programmes are divided equally between theory and practice. The first year of the course is the 'Common Foundation Programme', and this is taken by all students, regardless of branch choice. It includes core issues and topics in a wide variety of care environments. The second part, the 'Branch Programme', concentrates on specific branch subjects and contains practice placements. Potential students choose the area of nursing they wish to work in, with branch choices being made before the start of the course. Programmes generally allow Accreditation of Prior Learning (APL).

At the end of the programme, newly qualified RNs will probably have a three-month period of supervised practice when they start their first real job. First steps after qualification will usually be spent in the specialisation developed during the second part of the training programme.

Returning to nursing
People who are already trained nurses but who have taken a career break can take a 'return to practice' programme of at least five days (most are longer) that is approved by their National Board. State enrolled nurses (SENs - registered nurses Part 2) can return to work after similar retraining or they can elect to upgrade to RN through a conversion course. Financial help may be available.

Employment as a nurse
Even if a permanent job is not available or not wanted, part-time positions and job shares are now very common. Most hospitals and a number of nursing homes run nurse banks, a useful way of testing the environment while also earning, while a number of employment agencies specialise in nursing and allied professions.

All professional nurses registered with the NMC are legally required to re-register every three years, and must also state that they have updated their knowledge and skills base. People should note the names of new health organisations in all areas of the UK; some of these bodies are still not fully established.

The Royal College of Nursing (RCN) is the largest nursing union in the UK and, effectively, is the voice of nursing. It represents all levels of the profession, and it works with government, patients' organisations, other unions, and professional and voluntary bodies.

UNISON is the major trades union involved in health care, and many nurses belong to it as well as, or instead of, the RCN. It also represents other grades of health worker as well as a wide range of public employees in other sectors.

Pay rates
Some nursing pay rates are:
• health care assistant £9,000 to £14,890
• newly qualified RN £14,890
• experienced staff nurse £19,220
• senior ward sister £25,350
• clinical specialist nurse £30,000
• nurse consultant £42,000
• PAM £15,350 to £26,550
• hospital pharmacist £16,360 to £45,250.
All will be paid more in London and most will earn an extra £2,000 for working unsocial hours.

Further information

Nursing careers
Nursing and Midwifery Council, 23 Portland Place, London W1B 1PZ Tel: 020 7637 7181 (Registration: 020 7333 9333) Fax: 020 7436 2924 Website: www.nmc-uk.org
NHS Careers, PO Box 376, Bristol BS99 3EY Tel: 0845 6060655 Website: www.nhs.co.uk/careers
NHS Education for Scotland, 22 Queen Street, Edinburgh EH2 1NT Tel: 0131 2267371 (Careers: 0131 2252096) Fax: 0131 2259970 Website: www.nes.scot.nhs.uk
Health Professionals Wales, 2nd Floor, Golate House, 101 St Mary Street, Cardiff CF10 1DX Tel: 029 2026 1400 Fax: 029 2026 1499 Website: www.wnb.org.uk
Northern Ireland Practice and Education Council for Nursing, Midwifery and Health Visiting, Centre House, 79 Chichester Street, Belfast BT1 4JE Tel: 028 9023 8152 Fax: 028 9033 3298 Website: www.n-i.nhs.uk

Qualifications
Universities and Colleges Admissions Service, Rosehill, New Barn Lane, Cheltenham GL52 3LZ Tel: 01242 227788 Fax: 01242 544960 Website: www.ucas.com
Nursing and Midwives Admissions Service, Rosehill, New Barn Lane, Cheltenham GL52 3LZ Tel: 01242 544949 Fax: 01242 544962 Website: www.nmas.ac.uk

Associations
Royal College of Nursing, 20 Cavendish Square, London W1G 0RN Tel: 020 7409 3333 RCN Direct: 0845 772 6100 (members only) Fax: 020 7647 3552 Website: www.rcn.org.uk
Chartered Society of Physiotherapy, 14 Bedford Row London WC1R 4ED Tel: 020 7306 6666 Fax: 020 7306 6611 Website: www.csp.org.uk