- 05 March 2019
- 21 min read
What does a Registered Nurse do?
In this article, Ruth breaks down nursing in its entirety to deliver you the key facts. Want to know about life as a RGN? Keep on reading!
In this article I will outline a few facts about UK nursing (like the number of nurses working in the UK) before exploring the headline areas (community care nursing, secondary care, mental health nursing etc).
I’ll then cover chief skill sets that are important for nurses, revalidation and preceptorships and pay.
Each of these subjects covered are dealt with in more detail in other blogs – and you can follow links to these if you wish to dig deeper!
To start, I’ll look at what it means to do what we nurses do, and why we do it.
Being a nurse is more than just a job
You become a nurse.
It is who you are.
The opportunities available are vast and the development of the profession means that the image of a woman in a frilly hat, plumping pillows is long gone.
We are highly skilled, academically capable, compassionate individuals from a diverse range of backgrounds and the possibilities of where the profession will go in the future continue to grow.
As a profession, we are facing many challenges, not least those associated with the changes in society’s demographics with our older populations but also the re-emergence of diseases and conditions once thought defeated by vaccines and antibiotics.
At the same time, we live in a world where the developments of new techniques are giving hope to patients to extend their lives and give them better quality of life.
As nurses, we get to be involved in all aspects of this.
Nursing is not an easy choice as a profession, and it does have its problems with politics and institutional behaviours that need to be challenged, but I struggle to think of many that are as rewarding.
The ability to give care and be compassionate, but to laugh, cry, share joy and sadness, and get to know the people you look after is something you don’t get in other jobs.
Every day is different.
There will be days when you feel you cannot give any more and you feel broken but then there are moments when your heart will swell with emotion because of your patients and because of a job done well.
Those are the moments that bring you back for more and sustain you.
How many registered nurses are there in the UK?
There were 693,618 nurses registered to practice in the UK across all specialisms and includes both part-time and full-time workers (from NMC data September 2018).
The UK’s National Health Service is often seen as the bedrock of what a health service, free for all at the point of delivery, should look like.
The people who are front facing with the patients are a diverse team of nurses, doctors and health professionals with all kinds of backgrounds from all over the world.
The UK’s workforce of registered nurses come from both the EU and from other countries.
There has been a significant drop in the number of nurses from the EU being registered but an increase in nurses from outside of the EU.
These 693,618 nurses work in both the private and NHS sectors.
How many nurses working in the UK are full time?
The full time equivalent (that is to say, when all the part time staff hours are added together and divided by the amount of full time contracts this would be) of all of these nurses equated to 287,100 full time nurses in 2017.
There are not enough nurses for the required NHS workforce
In 2018, there were 3,880 more nurses registered to work in the UK than the year before.
However, the requirement for nursing staff increases over time.
The NHS was reported to have 34,260 vacancies for qualified nurses in September 2017.
By September 2018 this had increased to 42,000 unfilled nursing job vacancies in a BBC report that also stated that 1 in 11 nursing posts were vacant in NHS England.
With fewer nurses in the UK being trained and remaining on the NMC register, it is not possible to visualise what working in the NHS as a front line nurse look like for us in 2020 and beyond.
What does a typical day look like for a nurse?
Nursing is an extremely diverse job and what a typical day for one nurse is completely alien to another.
Registered Adult Nurse – Community Care / Primary Care
Community nursing can encompass a diverse range of roles from district nursing to assessing patient entitlement to NHS paid care home provision to proactive admission avoidance and support services for chronic conditions such as respiratory, heart failure and hospital at home.
A District nurse may arrive on duty and their first role may be administering insulin to diabetics in the community.
Their caseload will have a variety of patients who have long term conditions which limit their ability to travel to the GP surgery to receive care for wounds, therefore, the district nursing service manage chronic wounds such as leg ulcers.
District nurses also provide end of life care for patients who have chosen to die in their own homes.
Other specialist services will carry their own caseloads and visit patients in their own homes or run support groups specific to condition management. School nurses and health visitors may be office or GP practice based dependent on their trust.
Health visitors work with children and families under the age of 5 and school nurses, between 5-18 although both work closely together and may share families if they are of a complex nature.
The focus of health visitors and school nurses is the promotion of health within the family unit.
This is both mental and physical health and the job often involves managing complex and vulnerable families who may also be subject to child protection and social services involvement.
School nurses are also involved in the vaccination programme and health promotion in the school setting.
One of our creators, Claire, has nearly finished her qualification in adult nursing - see what brought her into nursing and why she loves her role.
Registered Adult Nurse – Hospital Care / Secondary Care
A nurse working in secondary care will have a very different experience of a typical day.
A hospital nurse will most likely arrive on shift and sit in handover for up to half an hour receiving information about the patients on the ward that they will be caring for during their shift.
Once handover is finished, the tasks of drug administration and personal care for patients begins.
On an early morning shift, this can involve assisting patients with eating and drinking as well as toileting, washing and dressing.
Doctors rounds may begin which will involve the team of doctors responsible for your patients care attending the ward to review and assess them.
There may be investigations and blood tests ordered and patient observations (blood pressure, temperature, pulse, respiration rate and oxygen level) will be taken as patient need dictates throughout the shift.
Then there is writing care plans, performing assessments and making referrals to other members of the multidisciplinary team.
In a medical ward there may be procedures and monitoring to be carried out specific to the area and in a surgical ward there may be patients going to and coming back from theatre for elective and emergency procedures.
There will also be admissions and discharges to and from the ward to sort out as the day goes on.
Some wards work on a 3 shift per day pattern (Early, Late, Night – 7.5hrs, 7.5hrs, 10.5hrs), others work on a 2 shift per day pattern (Long Day, Long Night – 12hrs each).
Registered Mental Health Nurses
Like adult nurses, Mental health nurses’ roles are extremely diverse and there is no such thing as a typical day as each specialism within it is different.
Mental health units can be high, medium or low secure dependent on the types of patient and the severity of condition that is catered for.
There are also highly specialist inpatient units such as intensive care, forensic, complex needs, older age, child and adolescent, eating disorders and mother and baby.
Mental health inpatient units tend to take a less formal structure to those of general nursing and are less regimented in their patient tasks.
RMNs (Registered mental health nurses) rarely wear uniform and there is more flexibility over when tasks need to be completed.
Community mental health nurses mostly work with less acute presentations and support patients in their own homes and supported living arrangements.
They carry their own caseload and may run clinics and therapy sessions.
Crisis teams work to support patients in mental health crisis.
This can mean visiting a patient at home during the day, sometimes more than once when they are in a heightened state, in a bid to prevent admission to hospital.
This is aimed at short term intervention which can be stepped up or down depending on what the patient needs.
Registered Learning Disability Nurses
Learning disability nurses work with adults and children who are differently abled with additional needs and intellectual disability.
Learning disability nursing is very different to other branches of nursing and nurses are employed in a diverse range of environments from community to prison.
There is much less institution-based care for people with learning disabilities today with the focus being more on living within their own home with support being offered according to need.
Much like other branches though, the idea of a typical day is different for every environment.
Most learning disability nurses are community based and as such, carry a caseload of clients.
They manage their caseload and run clinics and teaching according to the specialist area they work in.
Learning disability nurses employed in general hospital and mental health environments are often called upon to provide specialist support to clients with a learning disability and to advise staff caring for them who may be unfamiliar with the client and their specific needs.
The role of the learning disability nurse is to empower their client to support them to achieve greater independence.
Learning disability nurses may have ongoing involvement with their clients and their families for several years.
If this sounds of interest to you, here's how to become an RNLD nurse.
Registered Children's Nurses
Registered children's nurses, much like the other specialisms, also work in both hospital and community environments.
Ward based work routines are very similar to those for adult nurses but parents and carers are encouraged to be involved in the care of their child.
There will be ward rounds, investigations, medication rounds and monitoring performed in the ward area as well as input from play specialists and even teachers for children admitted for prolonged periods.
Community children’s nurses often look after highly complex patients in their own homes, often managing ventilators and feeding tubes.
They are involved in the support and assessment of children and their families as having a sick child at home will affect how the whole family unit functions.
Find out what a day in the life of a children's nurse looks like with Grace, in this blog.
What kind of person and soft skills make a good nurse?
Nurses must have advanced communication skills.
Being able to listen for what is said but also what is not said during patient intervention is vital to pick up information about the person and what their specific needs are.
A caring nature is obviously a vital part of being a good nurse.
Recognising that every interaction you have with a patient can have an impact on their lives so being self-aware and emotionally intelligent are important characteristics.
Being interested in your patient and how their illness or condition affects their lives.
Not being afraid to ask questions but knowing how to broach a difficult subject is one of the many skills that nurses must learn but also come with experience.
What hard skills and qualifications are required to become a nurse?
In order to apply for a Nursing course in the UK as a direct entry undergraduate, you will usually have at least 5 good GCSE’s including maths and English and A levels grade C or above depending on the university course you apply for.
If you don’t have traditional GCSE’s or A levels, then it is worth considering a BTEC/NVQ in Health and Social Care level 3 or, as a mature student, an Access to Health and Social Care course.
Further education colleges also provide support with the transition into academia if you have been out of education for a prolonged period.
There has been the recent introduction of Nursing Associate roles which, once qualified, nursing associates perform many of the tasks that registered nurses do, under the direction of the nurse in charge.
Nursing Associate posts are sponsored by the employer, paid throughout and last 2 years.
There is then the option to go on to undertake further training and become a Registered Nurse once qualified.
Skills wise, it is useful to have spent some time working in a care or health environment before embarking on nurse training.
Undertaking a nursing degree is lengthy and there are financial contributions to be considered, so being sure that it is the correct course for you is somewhat essential.
These days it is expected that you should hold a Masters degree in order to progress into higher levels of management and clinical practice.
Having good communication skills and an open mind to what kind of things you will see and undertake is essential.
When you are attending to the hygiene needs of a vulnerable patient, your compassion and communication skills are vital to how you make that person feel.
“I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” ― Maya Angelou
Keeping your nursing registration up to date
Once qualified, it is an essential requirement that you maintain your registration.
To do this you must practice at least 150hrs per year and complete ongoing learning or Continuing Professional Development (CPD).
This is then demonstrated at the end of a 3-yearly basis by the Revalidation process.
The Revalidation process came in in 2016 as a way of ensuring that the nursing workforce was fit to practice and to provide a more stringent re-registration process.
Each year you are required to pay a retention fee of £120 to the NMC.
This ensures that you remain on the nursing register and can continue to practice as a Registered Nurse.
If you forget or neglect to pay your registration fee, then your registration lapses and it can take approximately 6 weeks to be readmitted onto the Register.
This means that during this time, you cannot work as a nurse and you may be subject to disciplinary proceedings by your employer.
Revalidation – For all Registered Nurses
Revalidation should be a process that goes on continuously rather than a piece of work hurriedly put together in the final weeks before it is due.
Over the 3 years you will need to have demonstrated that you have had 450 practice hours – i.e. Working in a nursing role, 35hrs hours of learning – of which 20 must be participatory – that is to say you must have been engaged in active learning in a classroom or discussion group.
You must also provide evidence of practice-related feedback – this could be from colleagues or patients and written reflective accounts of situations and how you learned from them.
Once this is complete, you will need to have a discussion with a colleague regarding your reflective accounts.
This can be a line manager but could also be a peer.
When all these parts are completed you will need to provide a declaration that you are fit to practice, have indemnity insurance and be signed off by a senior colleague before submitting to the NMC.
It is helpful if your sign-off is performed by another NMC registered person, but it is not essential (although slightly more complicated.)
The NMC provide a clear and useful framework that can be downloaded and saved or printed in order to make it easier to keep all these records together.
It is possible that once you have submitted your revalidation declarations that your evidence may be called for audit.
At this point you will need to send your Revalidation documents to the NMC.
I wrote a blog all about how and why revalidation makes us better nurses. Read it, so you don't find yourself fearing it as much!
Progressing your career as a nurse - Preceptorships
Once qualified, it is recommended that your employer offers you a preceptorship to allow you to consolidate your practice and develop your skills as an independent practitioner.
Preceptorships last anything between 6 – 12 months dependent on your individual needs and the environment you work in.
When you have completed your first 6 – 12 months as a qualified nurse, you can begin to look at what you would like to do.
Most nurses have an idea of where they would like to be and what area they would like to practice in.
Some may see themselves as nurse practitioners, nurse specialists or future ward managers and matrons.
There is no right or wrong and some may wish to stay as a band 5 nurse or move away from nursing altogether and into teaching or another discipline.
There are plenty of opportunities to undertake further education once qualified and many universities offer stand alone modules or further qualifications.
If you are lucky enough, then your employer may sponsor you to undertake these courses which will mean you won’t have to contribute financially and may get study leave from work.
If you are unable to receive funding from an employer, then you can apply for funding through the usual further education funding channels or finance the course yourself.
There are many opportunities to become nurse prescribers in specialities which allow you to practice without the supervision of a doctor as you are the prescribing clinician.
Examples of this are most often found in primary care and private care settings, for example aesthetic nurse practitioners, emergency nurse practitioners, community matrons, and district nurse practitioners.
Want to know what to expect from a preceptorship? Read this blog I wrote.
What kind of settings do nurses work in?
Nurses can work in a wide variety of settings.
Traditionally it has been seen that nurses work for the NHS and in care homes but as time has moved on, the benefits of having nurses take on more roles that would have been taken by doctors has been recognised.
Nurses can now undertake training to run their own clinics and perform minor surgical procedures.
They also work in the insurance industry, as expert witnesses, as drug company representatives and part of inspection teams with regulatory bodies such as the Care Quality Commission.
The nurses of 50 years ago would struggle to recognise many of the roles that nurses undertake these days.
Some may argue that these roles are not ‘nursing’ but it demonstrates how much the profession has moved on since the inception of the NHS.
Nursing skills are hugely valued and very transferable to many industries.
Life after the NHS as a registered nurse
Should you decide to leave the NHS and pursue a career away from it, then there are plenty of opportunities available to use your qualification.
It may be that you want to continue to work in frontline patient care and decide to work in a private nursing home or hospital.
There are also opportunities to work as an agency nurse where you can choose to work as many or as few hours as you would like and have a different workplace every day of the week.
It could be that you want to work in an entirely different capacity as a representative for a company that makes products such as dressings or pharmaceuticals.
There really are as many choices outside of the NHS as there are within it.
How much can I expect to earn as a registered nurse?
If you work in the NHS as a nurse then you are subject to the Agenda for Change pay scale and the pay rises are dictated by the government of the day.
The private sector generally uses the Agenda for Change as a benchmark as to what a nurse should be paid and then translate it across to their own pay system.
Currently, the pay scales are as follows:
Band 5 Staff Nurse £23,023 - £29,608
Band 6 Senior Staff Nurse/Junior Sister/Charge Nurse £28,050 - £36,644
Band 7 Ward Manager/Specialist Nurse Practitioner/Senior Sister/Charge £33,222 - £43,041
Band 8a Matron/Clinical Lead/Advanced Nurse Practitioner £42,414 - £49,969
Band 8b Service Lead / Nurse Consultant £49,242 - £59,964
Band 8d Deputy Chief Nurse £70,206 - £85,333
Band 9 Chief Nurse/Director of Nursing £84,507 - £102,506
Roles in Band 7 and under are usually subject to an unsocial hours payment for evenings, weekends and nights worked.
Staff working in London and surrounding areas are also entitled to a Higher Cost of Living Allowance and London weighting which can be up to a further £6,469 per annum in the inner London area.
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