As of 2018 there were 17,174 Learning Disability Nurses registered with the NMC in the UK. This article focuses on various aspects of what it means to be a Learning Disability Nurse in the UK in the hope it will help more people choose this career pathway and find their perfect learning disability nursing jobs.
After discussing pay within the private and public sector and discussing the differences between working as an LD Nurse in the NHS compared to the private sector, Lauren looks at a ‘typical’ day in the life of a Learning Disability Nurse.
She then explores the career options available to Learning Disability Nurses, her own passion for care and why she loves being an LD Nurse. This also gives her scope to delve into some of the challenges LD Nurses face from time to time.
For further interest, we take a look at the current state of LD Nursing within the UK, and what the future of this sector looks like.
Learning Disability Nurse and Social Worker
Lauren first worked with children who have Learning Disabilities whilst studying classical civilisation in Leeds. After seven years of working in care, she realised she wanted to take her passion further and qualify at a professional level. Extremely passionate about giving the people she works with as much independence as possible, Lauren is very keen to encourage anyone with an interest in care to consider Learning Disability Nursing as very positive a career choice.
The starting salary for a Learning Disability Nurse in the NHS is £24,214. You will enter at NHS band 5 and that’s the current pay rate for Band 5 Nurses with no years experience. From April 2020 to April 2021 the starting salary for a Learning Disability Nurse with no years experience will be £24,907.
In the NHS, a Band 5 Learning Disability Nurse earns between £24,214 and £30,112 per year depending on experience (the lowest figure is for less than 1 year’s experience, the highest is for 7 or more years’ experience).
Often within an NHS ward, you will be with at least one other Nurse working with an assigned group of patients or service users each shift. However, the pay is the same while working on a ward, in the community, respite services, or even outpatients. More information about where an LD Nurse may work is in the section below about the types of positions available.
Private sector pay rates for Learning Disability Nurses range from £24,000 to £34,000 (according to historical data on Nurses.co.uk.) Yes, private sector Learning Disability Nursing salaries can vary widely!
Private sector LD Nurses often work in private care homes, and may involve having more responsibility such as being the only Nurse on shift in charge of a team of Support Workers.
For more general information about Nursing salaries go to our Nursing Pay Guide.
If a role you are applying to has a higher than usual salary, double check the level of responsibility you will be expected to take on and whether you judge this will be within your capabilities. This is important not only for your own PIN and safety, but also the well-being of service users and other staff.
At interview when they ask if you have any questions, be specific with your own questions so you have all this information. Sometimes, private companies advertise for Learning Disability Nurses to work with people whose main diagnosis is a Mental Health condition.
Although there are similarities between Learning Disability Nurses and Mental Health Nurses, think about whether your knowledge and skills would be a good fit for the service users and company before taking the role on. Personally, my final year placement was in a Mental Health ward for people with Learning Disabilities, and I loved it – it all depends on the specific environment you will be working in.
Nurses.co.uk lists vacancies in the NHS and private sectors. Browse vacancies on this site, and create an account today so you can use our interactive CV tool to start building a professional CV - be ready for the moment you’re in a position to kick start your LD career.
Rather than pursuing a career in the NHS some Nurses prefer to work for an agency. This is where you sign up and register with an agency and then work shifts on their behalf. These can be regular shifts at the same workplace, or ad hoc – meaning you go where and when you are needed.
Some people prefer this freedom, and it also means you may have a choice of shorter shifts or long days (twelve hours). Fans of agency work tend to love the flexibility it offers and it can suit Nurses who need more control over their hours so they can start a family.
Yes, generally you will earn more money working for an employment agency than working as an employee within the NHS. The pay for nursing agency staff is around £25 per hour.
The key benefits of agency work are the higher pay, getting to work in a variety of places and practice skills, and also meeting lots of service users and staff. The drawback of agency Nursing is that you may be required at very short notice – sometimes on the day. It can also be challenging going into unknown situations where you don’t know the service users very well.
For sure, for some Learning Disability Nurses agency work provides the ideal environment: they love the increased pay, the flexibility and the fact one day can be very different to the next.
NHS Professionals is the NHS’s own ad hoc workforce. It has been built as a first port of call for when Trusts and wards are short-staffed. NHS Professionals is therefore a huge staff bank for the NHS. It represents some of the benefits of agency work such as flexible hours, while still allowing you to work solely for the NHS.
More important than pay is finding the right workplace for you. It does sound clichéd, but working for a lot of money in an unsuitable environment will not only make you feel miserable in the long-term, it could also affect your Mental Health and ultimately not provide service users with the enthusiastic LD Nurse you could be, and they deserve.
There’s huge choice when it comes to work settings for LD Nurses. Yes, the main choice is between the private sector and the NHS. But each of those types of employer offer a wide variety of environments, such as respite, the community, hospital wards, and residential homes.
That’s where the similarities end though.
There are a lot of differences between public and private sector work for LD Nurses when it comes to pay, conditions of employment, hours worked, and levels of responsibility.
For instance, I was offered a six-week preceptorship with one company of care homes for people with Learning Disabilities, while another organisation only offered a week of shadowing.
Some companies do have their own in-house training which is excellent, and covers much the same as an NHS Trust. Others focus on online platforms, or are constantly developing their in-house training in an effort to raise standards. Some private companies offer the minimum legal sick pay, likewise with maternity and paternity rights.
Remember - research all your potential employers
As always, do your research. There are some excellent employers out there who regularly achieve CQC Outstanding and are committed to offering excellence to service receivers and staff alike. For instance, listen to this podcast of me interviewing Angela Fletcher who’s a CEO of a fantastic site in Scarborough.
As I said above, subtle differences between not just the private and NHS sector, but also between different NHS Trusts and private companies themselves, can usually be picked up while applying. They can form a good basis for asking questions during interviews to ensure you understand the company or Trust you are applying for, and making sure it is right for you. If you do not feel comfortable discussing some of these issues at interview, make sure you read any contract thoroughly, and ask for clarification if needed. Or you could send an email after an interview, with a couple of follow-up queries.
Due to the variety of settings a LD Nurse can work in, a typical day can be difficult to define. However, I shall have a go!
Most ward settings – Mental Health units, respite services, general Nursing wards – have a similar structure to their day.
The shift begins with handover, where the previous staff give important information about what has happened during their shift. This could include appointments that day, and will include mentioning each service user with a summary.
Medication rounds tend to happen either in the early morning, or lunchtime if night staff do the morning medication at the very end of their shift.
LD Nurses will write morning notes for each service user, as well as following up on information from handovers such as doctors’ appointments, anything new Support Workers have noticed during personal care, or sometimes information from service users themselves.
After lunch and lunchtime medication, afternoons may involve activities for service users. This is especially likely in care homes. If a unit has an entertainer coming in, this is most often in the afternoon. An LD Nurse is responsible for ensuring service users have enough medication, unless the service user has capacity to do this themselves. Therefore the afternoon may give them the chance to go over medication stocks, and order new ones.
There may be weekly tasks such as checking wheelchairs, beds, and other equipment important for service users.
On a ward, there is often also a weekly ward round where a doctor arrives to assess each service user, and act on any concerns from the Nursing staff. LD Nurses are therefore responsible for ensuring they have accurate information for passing on to the doctor – there is often a ward round book where staff write their concerns throughout the week.
Late afternoon, around tea time, is when there is usually another medication round. This could also be a time to write afternoon notes for all service users. Notes may need to be written throughout the day, depending on how detailed the workplace or individual service users require them.
At the end of the shift is another handover, where again information is passed on to the Nurse and staff to ensure continuity of care for service users.
There are many different settings an LD Nurse could work in, just as there are many different places people with Learning Disabilities may visit, work, or live.
Many Learning Disability Nurses work in specialist care homes, or those for people with dementia. They also work in specialist Learning Disability units, such as respite and Mental Health wards for people who also have a Learning Disability.
LD Nurses also work in general units where people with Learning Disabilities may or may not be regular service users. For example, as a Nurse on a neurological unit, although I rarely encounter people with specific Learning Disabilities I do work with people who need to be assessed under the Mental Capacity Act, and require clinical skills for their PEG and tracheostomy tubes.
More and more, general Nursing settings recruit Learning Disability Nurses as a specialist for when people with Learning Disabilities use their services. An example of this is A & E, where the specific skillset of LD Nurses are recognised during what is potentially a very stressful time for anyone – especially someone with a Learning Disability.
Community Learning Disability Nurses - work with people who may be living independently or with support in their homes. They may need specialist help with PEG feeds, diabetes or epilepsy management, or the occasional visit to ensure continuity of care. A community LD Nurse can also liaise with other healthcare professionals, and organise referrals for particular health or social issues.
Other employment opportunities include working in research, either at universities or in hospital settings. Often, in hospital settings LD Nurses have completed additional qualifications in clinical skills like administering IVs and cannulas. For research, nursing degree qualifications such as a Masters (MSc) or even PhD may be required.
There are several reasons I love being an LD Nurse! Most of all, I love working with people who have Learning Disabilities, working with them in partnership to try and solve big issues together like housing and accommodation, behaviour support plans, alternative methods of communication, nutrition, and getting people on the correct and best medication if necessary.
We also work together on the smaller, day-to-day issues like what activities someone would like to do that day, whether they would like sugar in their tea, or choosing which clothes they would like to wear. Promoting independence for people with Learning Disabilities is so often about choice, and making sure they can understand and partake in choices which affect them.
I like learning from people who have Learning Disabilities, who are often ‘experts by experience’. This means it is the person who is experiencing the Learning Disability who will often know the best route for their care, and can take part in discussions related to their care. If they are unable to take part, it is my responsibility to organise a mental capacity assessment to not only confirm this, but also ensure all decisions made on behalf of the person are in their best interests. There are legal areas around this, and it is up to me to ensure everyone involved implements the law, in doing so ensures the person with Learning Disabilities is at the centre of decisions and can partake as much as possible.
There are many other aspects I love about Learning Disabilities Nursing, such as meeting new people, discussing new innovative ways of promoting independence, and sharing my enthusiasm with others who will hopefully then also become interested in working with and promoting the rights of people who have Learning Disabilities.
There are many challenges facing Learning Disability Nurses, some of which are shared with other branches of Nursing. These include working long hours, staff shortages, violence from service users or their families, and Mental Health issues such as stress.
The government has recognised some of these issues, launching The General Practice Nursing Plan in 2017, and the NHS Long Term Plan (2019) to look at funding, improving ‘joined-up’ care for service users, and tackling staff retention and recruitment over the next ten years.
As well as these, Learning Disability Nurses face their own specific challenges. Since 2010, there has been a 40% drop in specialist Nurses (read our survey on the NHS Staffing Shortage and Workforce Crisis), exasperated by the removal of government funding for training in 2015.
People with Learning Disabilities can struggle to communicate their needs, which can lead to them displaying behaviour which challenges services and those supporting them. It is estimated around 10-17% of people with Learning Disabilities display such behaviour (NICE guidelines). This is a challenge for the Learning Disability Nurses working with them, as they need to implement support plans which protect the service user, their families, and those who work with them. Nurses often work long-term with service users, and this can lead to stress and physical injuries.
Another challenge is gaining respect from the Nursing profession itself. Despite being registered with the NMC, the same as Adult Nurses, Children’s Nurses, and Mental Health Nurses, Learning Disability Nurses are often called upon to defend their place in the professional workplace. Their skills are questioned, such as why they may not have in-depth clinical skills such as IVs, cannulation, catheterisation, and phlebotomy. This is disingenuous because, although Adult Nurses will usually have had more contact with these procedures during their placements, it is not until they are qualified that they also need to do extra training to perform them on service users.
So-called ‘soft’ skills like communication, empathy, and time management are highly prioritised in all Nursing, but can be particularly important working with people who have Learning Disabilities. However, they are not always valued as highly as they deserve.
Likewise, knowledge of laws like the Mental Capacity Act, Care Act, and related policies are essential for LD Nurses. But LD Nurses sometimes have to justify their relevance to the people they are supporting if working in a general setting.
These challenges can be disparaging, however they can be overcome if LD Nurses are confident in their skills and knowledge, and role in supporting service users. By serving as an advocate for the importance of LD Nursing, and the rights of service users, we can become an important and integral part of providing holistic, person-centred care.
2019 marked a special year in Learning Disability Nursing, as it was 100 years since the first training course was introduced in 1919. This was the first Nursing course specifically for Nursing students who gained a certificate in ‘mental deficiency’ Nursing – a sign of how far we have come in recognising the rights of people who have Learning Disabilities, and also a reminder of how important it is to keep advocating and including people with Learning Disabilities in issues that affect them.
The biggest threat to this in modern Learning Disability Nursing is staff shortages. This begins in training Nursing students at universities, with a lack of funding leading 50% of courses thinking about discontinuing their Learning Disability Nursing courses. A lack of action could cause a 25% shortfall by 2020 in the NHS in England.
Only 3% of registered Nurses are Learning Disability specialists, with a lack of clear career progression cited as a significant difference between LD Nursing and other branches. However, this is partly remedied by the existence of a scholarship to complete the Leadership Programme for Learning Disability Nurses, by Health Education England and the Florence Nightingale Foundation.
It can be challenging to ensure all people with Learning Disabilities get the support they need. This is especially true for people with milder Learning Disabilities, who may be skilled in masking their difficulties but consequently find it difficult to self-advocate or access the right support (Public Health England, 2013). This has a knock-on effect on a lack of funding, as if these people are not accounted for in terms of their needs, they are not going to be included in funding reviews and applications. A Learning Disability Nurse working in a mainstream setting such as a GP surgery could, potentially, spot signs of someone with a mild Learning Disability and use their skills in carrying out a more accurate assessment of their true needs, allowing them to access support should they want to.
A big plus in modern LD Nursing is that people with Learning Disabilities are no longer confined to institutions, their life chances and experiences limited, along with peoples’ expectations of them. As people with Learning Disabilities may be living in supported living, independently, working, volunteering, studying – this also opens up opportunities for the myriad of places an LD Nurse might also be found. Only 20% of LD Nurses work in the NHS (according to the RCN, 2019), while the other 80% can be found in the community, prisons, education, private companies, and Mental Health settings.
The crisis in university places for Learning Disability Nursing has been met with dismay, however there are plans to try and counteract the potential damage. This is in the form of a £2 million investment in 2019/20 from Health Education England. Instead of focusing on undergraduate courses, this funding will go towards apprenticeships for Nursing associates who would like to become Learning Disability Nurses, new post-graduate and undergraduate Learning Disability apprenticeships, and an awareness campaign.
LD Nurses themselves will continue to advocate for people who have Learning Disabilities. This will tend towards working in the community, following the closure of specialist inpatient units such as Calderstones Learning Disability Hospital, and a drop of around 70% of inpatient beds reserved for people with Learning Disabilities. This was driven by the shocking paper, ‘Winterbourne View – Time for Change’ (NHS England, 2014), which among other things drew attention to the institutionalised nature of some residential homes, in this case serving as a breeding ground for abuse.
In theory, as inpatient services reduce, support in the community and transitions from inpatient care to more appropriate placements will take place. LD Nurses will be at the forefront of this changeover, supporting people with Learning Disabilities and their families to ensure high standards are maintained. Those who still require high levels of support will have access to it, but as part of living in a home rather than hospital or institution.
In reality, the role of the Learning Disability Nurse remains as an essential and strong advocate for people with Learning Disabilities and their families, to hold the government and local authorities to account in ensuring appropriate alternative provisions are available for service users to make a successful transition.
There is a lot to think about when becoming or working as a Learning Disability Nurse. Ultimately though, the issues covered in this article lead back to what all LD Nurses, working in all environments, are striving towards – working with other health professionals, families, and service users themselves to promote the rights, health, and value of people with Learning Disabilities, and ensuring they are listened to and included in decision-making.
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