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Stephen Turner British Dental Journal 2012; 213: E2

Editor's summary

It was never going to be easy, or popular, and so it has proved. The mandatory registration of dental nurses was an issue that had been hotly debated for many years before becoming a reality in the summer of 2008.

The concept of the dental team requires a professional approach from all members if it is to have any real meaning at all. Parallels with medical practice are of course always to hand and the public expectation that those treating and caring for their health should be properly trained, regulated and subject to continuing education is not surprising. Similarly unsurprising is that the central problem identified from dental nurses in this research was the cost of registration.

However, it is also the cost in time and money of continuing professional development (CPD) that causes grievances as well as the lingering overall concern that as a group dental nurses are still not properly regarded as being professionals. In fairness, it has to be said that these are still very early days. It would have been so instructive to have been able to have referred to similar research undertaken in 1925, just four years after similar registration was implemented for dentists, even though it took another seventy plus years to attach CPD as a further condition. One suspects that similar disgruntlements might have been voiced then.

Perhaps the central point that we should take from this valuable study concerns the way in which we in the dental team treat and regard our dental nurse colleagues both amongst ourselves and also publicly. Self-respect grows from mutual respect and the values of professionalism and life-long learning will take many more years to become as commonplace and accepted as for other longer-term, existing professional groups.

All this notwithstanding, addressing the issue of the registration costs for arguably the least well paid members of the team should be rekindled as an important priority. It is one that would be demonstrative of the type of professional solidarity which it would be laudable for the rest of the team to support.

The full paper can be accessed from the BDJ website ( www.bdj.co.uk ), under 'Research' in the table of contents for Volume 213 issue 2.

Stephen Hancocks

Editor-in-Chief

Author questions and answers

1. Why did you undertake this research?

We were very aware that despite some controversy surrounding the 2006 changes to GDC regulations which made dental nurse registration and CPD mandatory, no independent representative studies of the experiences and views of dental nurses had been published in the following five years. As dental nurses are the largest single group of GDC registrants, we thought it important to follow up concerns that were expressed at the time of the 2006 changes that dental nurses might consider leaving the profession as a result. Nurses' reports of the views of dentists they work with may also reflect on how well the dental team as a whole are responding to the new arrangements.

2. What would you like to do next in this area to follow on from this work?

We have an opportunity to follow up this study (and parallel surveys of dental hygienists, hygienist-therapists, and technicians), by examining the actual pattern of attrition from these professions. We are also hoping to obtain funding for a more in-depth view of dental teams by interviewing dentists, hygienists, hygienist-therapists and nurses and patients in selected areas of employment.

Commentary

Since 2008, dental care professionals (DCPs) are required to register with the GDC and complete a minimum number of verifiable and non-verifiable CPD hours over a five-year cycle in order to maintain registration. In this study of 267 dental nurses, approximately two thirds of the dental nurses endorsed the general principle of registration. However, only just over a half of those who responded to the postal questionnaire endorsed the principle of compulsory registration.

There was a strong negative feeling on the cost of registration, with only 6% endorsing the current fee level and 88% of all negative comments regarding registration being related to costs. A comparison was drawn between the cost of registration for general medical nurses, which is considerably lower than dental nurses. Consideration could be given to the cost of registration for dental nurses and perhaps a fee structure that incorporates allowances for dental nurses working on a part time basis could be put into place.

A large majority of dental nurses that responded felt that the CPD they had carried out had not affected their role or status within the team or enabled them to do their job better. Perhaps disturbingly, 22% of those questioned intended to leave the profession. Rather than being related to costs of CPD or registration, intention to leave the profession appeared to be related to age, greater dissatisfaction with physical working conditions and opportunities to progress.

In our opinion, this study demonstrates the importance of creating a supportive environment for dental nurses within the team and the need to recognise and appreciate the professional status of this DCP group. Helping dental nurses to access CPD and select the most appropriate form of CPD to enhance their professional development and allowing them to use their skill set may lead to greater job satisfaction and higher standards of patient care. The authors rightly point out that dental nurses are an invaluable asset to the dental team in the role of providing high quality patient care.