Nursing in the United Kingdom
Nursing in the United Kingdom is the profession of registered nurses and nursing associates in the primary and secondary care of patients. It has evolved from assisting physicians to encompass a variety of professional roles. More than 780,000 registered nurses practise in the UK, working in settings such as hospitals, health centres, nursing homes, hospices, communities, military, prisons, and academia. Many are employed by the National Health Service.
Nursing is split into four fields: adults, children, mental health, and learning disability. Within these nurses may work within specialties such as medical care or theatres, and may specialise further in areas such as cardiac care. Nurses often work in multi-disciplinary teams, but equally work independently, and may work in supporting sectors such as education or research.
The UK-wide regulator for nursing is the Nursing and Midwifery Council, and all nurses and nursing associates must be registered to practise. Dental Nurses, nursery nurses and veterinary nurses are not regulated by the NMC and follow different training, qualifications and career pathways.
History
Registration and regulation
There are currently two levels of nursing registration in the UK: registered nurses and nursing associates. To practise lawfully as a registered nurse, the practitioner must hold a current and valid registration with the Nursing and Midwifery Council.Nursing and Midwifery Council
The core function of the NMC is to establish and improve standards of nursing and midwifery care to protect the public. It achieves this by placing registered nurses on a state register, which anyone can search. As of March 2024, there were 826,418 registered nurses, midwives and nursing associates on the NMC register.The powers of the NMC are set out in the Nursing and Midwifery Order 2001.
Membership of the council comprises 6 lay and 6 registrant members appointed by the Privy Council, including at least one member from each of the four UK countries. The registrant members consist of nurses, midwives and nursing associates. The lay members currently include people with diplomatic, legal and business backgrounds.
Register
The NMC register is split into three main parts: Nurses, Midwives and Specialist Community Public Health Nurses. Within the registration it contains several "sub-parts" and qualifications e.g. sub part 1, sub part 2.Revalidation is a requirement for all NMC registered members to revalidate every three years in order to ensure their registration can be renewed. Revalidation was introduced in April 2016.
Code of conduct
The Professional standards of practice and behaviour for nurses, midwives and nursing associates, known as the Code, was revised in 2018, replacing earlier publications in 2015 and 2008. The NMC code presents the professional standards that nurses, midwives and nursing associates must uphold in order to be registered to practise in the UK.Nurse title
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.
However, until recently the title "nurse" was not legally protected, so anybody could call themselves a nurse. In response to a campaign led by Alison Leary and Paul Trevatt, the Brent East MP Dawn Butler successfully introduced a bill in Parliament in February 2025 to protect the title of 'nurse'. It was agreed it would be introduced via minor changes to the Nursing and Midwifery Order 2001.
Legislation
Government legislation governing nursing in the United Kingdom includes:- Health and Care Act 2019
- Nurse Staffing Levels Act 2016
- Nursing and Midwifery Order 2001
- Nurses, Midwives and Health Visitors Act 1997
- Nurses, Midwives and Health Visitors Act 1992
- Medicinal Products: Prescription by Nurses etc. Act 1992
- Nurses, Midwives and Health Visitors Act 1979
- Nursing Homes Act 1975
- Nurses Act 1943
- Royal National Pension Fund for Nurses Act 1936
- Nurses Registration Act 1919
Education
Non-registered staff education
Training is not mandatory for most people undertaking non-registered staff roles such as Healthcare Assistant. But the majority of NHS employers use "in-house" training for such staff, including induction programmes and ongoing education to achieve a recognised qualification. Some collaborate with local education colleges for theoretical input, and may award a recognised qualification. Some NHS employers ask for some type of health or social care qualification for recruits: for example, an SVQ/NVQ or HNC/HND under qualification names including health care, social care, and health & social care.Pre-registration degrees
began in 1990 and was designed to move nursing education from hospitals into universities. Prior to Project 2000, nurse education was the responsibility of hospitals and was not based in universities; many nurses who qualified prior to these reforms do not hold an academic award.From 2011, students studying a pre-registration nursing programmes in Scotland were required to complete a degree. Since September 2013 all UK pre-registration nursing programmes are at degree level. Some Higher Education Institutions offer a graduate entry course for nursing. This is for students who have already gained a degree in another subject and want to register as a nurse. It is undertaken over two years. It is also possible to complete nurse registration through the nursing degree apprenticeship route, where students are sponsored by their employer.
Format
Nursing courses adopt a 50/50 split of learning in university and in practice. Nursing courses usually take three years and 4,600 hours.The first year is the common foundation program, which teaches basic knowledge and skills required of all nurses. Skills include communication, taking observations, administering medication, and providing personal care. The remainder of the program consists of training specific to the student's chosen branch of nursing. The four branches of nursing training offered at university level are:
- Adult nursing
- Child nursing
- Mental health nursing
- Learning disabilities nursing
Midwifery education
Student Bursary
Student nurses in England and Wales receive no bursary from the government to support them during their nurse training. Diploma students in England receive a universal bursary of £6,000–£8,000 per year, while degree students may qualify for a means-tested bursary. Degree students are, however, eligible for a student loan, unlike diploma students. Wales, all student nurses receive a bursary in line with the English diploma course. In Scotland, nursing students receive a bursary of £10,000 per year. All student nurses in Wales study, initially, for a degree, but may choose to remain at Level 2, thereby achieving a diploma rather than a degree.It was announced in the Chancellor's Spending Review of November 2015 that from 2017 the NHS bursary would be removed for future nursing, midwifery and allied health professionals in England. Welsh and Scottish students remain unaffected.
Post-registration education
In order to remain registered with the Nursing and Midwifery Council nurses in the UK are required to revalidate their registration every three years. Criteria to meet revalidation include having completed 450 hours of practice in the previous three years.Nurses can add certifications in areas such as cannulation, venepuncture, intravenous drug therapy, and male catheterisation are common among many others, such as Advanced Life Support.
To become specialist nurses or nurse educators, some nurses undertake further training above bachelor's degree level. Master's degrees exist in various healthcare related topics, and some nurses choose to study for PhDs or other higher academic awards. District nurses and health visitors are also considered specialist nurses, and to become such they must undertake specialist training.
All newly qualifying district nurses and health visitors prescribe from the Nurse Prescribers' Formulary, a list of medications and dressings. Many of these nurses undertake training in independent and supplementary prescribing, which allows them to prescribe most drugs in the British National Formulary. This has been the subject of debate in medical and nursing circles. As of 2012, more than 25,000 Nurse Prescribers had been qualified.
Overseas nurses
The Nursing and Midwifery Council has a specific process for inducting Registered Nurses trained outside the UK. 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, owing to a shortage of nurses and increasing standards in nursing a new process was introduced to include two part test of competence, including an OSCE. The process includes an English language test, the standards of which have been criticised for being too high.
Roles
Non-registered staff
Non-registered staff typically working in direct patient care, performing tasks such as personal care, social care and more specialised tasks such as recording observations or vital signs or measuring and assessing blood pressure, urinalysis, blood glucose monitoring, pressure sores.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 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.
Non-registered staff have various job titles such as "clinical support worker", "care assistant", "nursing assistant" and "healthcare assistant". Typically they are on NHS Agenda for Change pay band 2 and progress to band 3 pay after further training.