Prior to statutory registration, extended clinical duties for dental nurses were often discussed; as it was felt further career opportunities for dental nurses were required, that did not involve the dental nurse stepping away from the chairside. Since the inception of the GDC’s Scope of Practice (SoP) document in April 2009, extended duties courses are growing in number across the UK, thus providing opportunities for dental nurses to develop further knowledge and new skills in extended clinical duties. Some of the duties listed below have been available to dental nurses for sometime through the NEBDN Post certificate qualifications*.
The Scope of Practice document clearly lays out the extended duties that a dental nurse can be educated and trained to undertake, these are:
Additional skills a dental nurse could develop during their career include:
- Further skills in oral health education and oral health promotion*
- Assisting in the treatment of patients who are under conscious sedation*
- Further skills in assisting in the treatment of patients with special needs*
- Intra-oral photography
- Shade taking
- Place rubber dam
- Measuring and recording plaque indices
- Pouring , casting and trimming study models*
- Removing sutures after the wound has been checked by a dentist
- Applying fluoride varnish as part of a programme which is overseen by a consultant in dental public health or a registered specialist in dental public health
- Constructing occlusal registration rims and special trays
- Repairing the acrylic component of removable appliances
- Tracing cephalographs*
Additional skills on prescription
- Taking radiographs to the prescription of a dentist*
- Applying topical anaesthetic to the prescription of a dentist
- Constructing vacuum formed retainers to the prescription of a dentist
- Taking impressions to the prescription of a dentist or a Clinical Dental technician (CDT)
After qualification and GDC registration there are various opportunities for dental nurses to undertake Continuing Professional Development (CPD). Some choose to work towards formal qualifications, these are offered by various awarding bodies e.g. The National Examining Board for Dental Nurses (NEBDN), Faculty of General Dental Practice (FGDP), City & Guilds, University of Bedfordshire, University of Kent and various dental hospitals. The qualifications undertaken by a registered dental nurse will be determined by the career pathway they choose.
NEBDN Post Certificate Qualifications
The National Examining Board for Dental Nurses has a suite of post certificate qualifications for dental nurses. At present NEBDN offer the following:
- Oral Health Education – suitable for dental nurses who are required to offer oral health advice to patients under the direction of a dentist. The Record of Experience (RoE) consists of 3 parts. Part A, a minimum of 20 log sheets, which include the care of 10 individuals seen on at least two occasions. The student is required to target at least six of the specified patient group. Part B, two expanded case studies must be completed from the log sheets. The case studies must cover a topic from the ranges provided by NEBDN. Part C, U-using a set proforma the student is required to plan, produce and evaluate a display/exhibition. There is a 90 minute written exam and 20 minute oral exam.
- Dental Radiography - suitable for DCPs who are required to x-ray patients under the direction of a dentist. The Record of Experience (RoE) consists of 50 log sheets of various radiographs, 3 expanded case studies and a written exercise on the taking and processing of lateral oblique radiographs. The written exam last 1 hour and consists of negatively marked MCQs.
- Dental Sedation Nursing - suitable for dental nurses who assist in the surgery during routine conscious sedation. Candidates must be engaged in this type of work on a routine basis as completion of a RoE, which includes 25 sedation log sheets and 25 recovery log sheets as well as 2 expanded case studies. This has a 90 minute written exam and 20 minute practical oral.
- Special Care Dental Nursing - suitable for dental nurses who assist with people whose health and social care needs may require special oral health care provision. Candidates again must be engaged in this type of work routinely as completion of a RoE is required. The RoE includes 20 log sheets and 3 expanded case studies and evidence of competence e.g. CPR and manual handling.
- Orthodontics - suitable for dental nurses who assist in orthodontic procedures. The RoE consists of 50 log sheets, 2 expanded case studies and evidence of competence in clinical photographs, cephalometric tracing and casting study models. The written exam lasts 90 minutes.
Access to NEBDN post certificate qualifications must be made through an NEBDN accredited centre. All applicants must be registered with the GDC.
NEBDN also offer opportunities for dental nurses to become a member of their panel of examiners, in order to apply they request applicants are qualified for a minimum of 4 years and are involved in the training of dental nurses towards the National Certificate exam.
NEBDN continue to develop their suite of awards and plan to offer qualifications in Implant dental nursing, they also have plans for extended duties modules in impression taking and application of fluoride.
Further information on NEBDN post certificate qualifications and other opportunities NEBDN may have can be found on NEBDN's website .
Some dental nurses choose a career pathway in dental nurse education, in the past a dental nurse undertaking this role may choose to gain a qualification, however it was not deemed as necessary. However, in order to meet quality assurance set out by awarding bodies it is essential for those who choose this career pathway to embark on the qualification that supports the role they undertake.
PTTLS – Preparing to Teach in the Lifelong Learning Sector – this award covers the basics of teaching in continuing and adult education - including how to plan sessions, motivate learners and use a variety of assessment methods. Further information can be found on the City & Guilds website.
PTTLS is the first step for any dental nurse who wants to become a dental nurse tutor, however at present this qualification is adequate for those supporting student dental nurses in the work place, however a coaching or mentoring qualification would greatly benefit those undertaking this role. Work is being done by various organisations and awarding bodies to provide such a qualification.
Further study in teaching and training can be undertaken and this can be either the Certificate or Diploma in Teaching in the Life Long Learning Sector; however many DNs choose to move on to higher education (university) qualifications, such as the HE Certificate in Education. Some then go on to achieve a First Degree in Education, such as the BEd or a Masters Degree in Education MEd. The University of Bedfordshire now offers a Post Graduate Certificate in Dental Education, which can be the first part of a Masters Degree. Such qualifications are those whose main job role is that of a dental nurse tutor, as extensive evidence of work based learning in the classroom is required.
The NVQ primary qualification has also provided a route into training for DNs, with the need for NVQ assessors and internal verifiers. The qualifications to support these roles (A1 and V1 awards) are available through a number of awarding bodies and training providers.
The National Education Group is a sub-group of the BADN and its purpose is to offer support and networking opportunities for those involved in dental nurse education. Further information available from the BADN website.
It has been said that 'dental nursing should evolve in a way that promotes parity with nurses in general medicine'.1 But how different are these two professions at the moment and can they be compared at all? Is dental nursing as attractive a career as general medical nursing? By looking at two case studies – a dental nurse and a general medical nurse – who are a similar age, this article considers the differences in education, funding, remuneration, ongoing training, recognition, career aspirations and job satisfaction.
See Boxes 1 & 2
Emma Lomas (EL) is a 25-year-old Dental Nurse from Whaley Bridge in Derbyshire. She has worked at Sett Valley Dental Practice for four years and had two previous dental nursing jobs. She completed her National Certificate in dental nursing at Manchester University, where she attended a part-time evening course for a year, working full-time during the day and funding herself. She lives with her partner.
Emma is currently studying 'A' level Psychology by correspondence and hopes to study the subject to degree level. She plans to continue working in her current role for the immediate future.
On the job
Emma works 34 hours a week, set hours. She gets 20 days' holiday plus bank holidays. There are 10 people on her team. Emma preferred not to disclose her salary.
Natalie works 37.5 hours a week, doing shifts so the hours vary. She gets seven weeks' holiday per year, including bank holidays, but sometimes has to work on bank holidays. Her team is made up of 30 nurses and numerous multi-disciplinary team members. Her current salary is £20,000 per annum.
Do you think you are paid fairly for the amount of work you do?
NH: No, considering the amount of responsibility I have.
Are there any opportunities for promotion/development within your team?
Do you think there is a shortage of jobs in your profession?
EL: Yes, in my area anyway.
NH: Yes, even though they always seem to be 'crying out' for nurses. The NHS is just cutting back on jobs all the time.
Do you think there is much competition for dental/nursing jobs and do you think it would be difficult to find a new job should you want to move?
EL: It wouldn't be difficult to move at the moment now that registration has been introduced and there aren't that many qualified nurses in the area.
NH: There is a lot of competition, especially as a newly-qualified nurse. There aren't even enough jobs for all those graduating. It's perhaps a little less difficult once you are more experienced.
A typical day
What sort of tasks do you spend the bulk of your time doing?
EL: Patient care is our main priority, making sure people are relaxed and happy. The other things that take up most of our time are cross infection control, and cleaning.
NH: The list is endless: caring for patients, administering medication, doing dressings, pre- and post-op care of patients, documentation, assisting patients with all the activities of daily living.
Do you have much interaction with other staff?
EL: I work one-to-one with a dentist all day every day, but working for a small company the whole team does work together quite closely too.
NH: Loads; it's the only way to get the job done.
How much interaction do you have with patients?
EL: Besides the dentist the dental nurse is the person who mainly deals with the patient; in the chair most patients turn to the nurse for comfort.
NH: Constant, although I do get the feeling that the more senior you become, the less time you get to spend with them.
Do you have to do a lot of paperwork?
EL: No, just writing up notes and typing the occasional referral letter.
NH: Yes, there's a lot!
What is your favourite part of being a dental/nurse?
EL: Having a close working relationship with someone is nice – working one-to-one with someone all day. It's also nice seeing all the patients, especially regular attenders who grow to know you. I would say I love 90% of my job, I really do enjoy going in every day.
NH: The fulfilment and feeling of knowing you've helped someone and been appreciated.
What do you dislike most about the job?
EL: The occasional patient who likes to blame us for the change in dental charges.
NH: The responsibility and constant time pressures. I also hate being frontline staff and taking the 'flack' for the NHS and the whole NHS team.
Why did you choose to work in dental/nursing?
EL: I was made redundant from an office job and applied for a temporary position as a dental receptionist. It just led from there really, helping out in the surgery covering for holidays.
NH: It just really appealed to me, caring for people.
Do you consider your job to be a stepping stone in your career or just something you will do for a while?
EL: I have always thought I would want to continue working as a dental nurse but I'm not sure. It is definitely my chosen career for the time being though. I really enjoy my place of work and have some great friends there; it is a wonderful atmosphere – just not great pay!
NH: There are endless opportunities to progress in my career. The possibilities are almost never-ending!
There are endless opportunities to progress in my career. The possibilities are almost never-ending!
Is there scope for you to specialise in another area of the industry you work in?
EL: Yes, I could become a dental therapist or hygienist, but it is a full-time university course and with owning a home now, I can't afford it.
NH: Lots [see previous].
Is there a job or place of work you are aiming to work in at some point in the future?
EL: At the moment I am perfectly happy where I am.
NH: A&E is my immediate goal. In the more distant future, who knows, maybe something like practice nursing.
Training and CPD
Natalie achieved a BSc (Nursing) and Emma gained her National Certificate (NEBDN).
How was your course assessed?
EL: Through coursework and exams.
NH: The course was modular and was assessed through essays, exams, coursework and presentations. I also had to pass practical placements and be assessed clinically.
What did you enjoy most about your course?
EL: Learning aspects of the job that I don't necessarily come across in the surgery on a day-to-day basis.
NH: The combination of theory and practical work – the teaching methods really made me want to learn.
What did you find most challenging about your course?
EL: Having to learn 100 different instruments for the exam, and then only being questioned on 20 of them.
NH: Having enough money to survive while studying a very emotionally and physically challenging academic course.
Have you undertaken much continuing professional development (CPD) since qualifying?
NH: Yes, it's ongoing – courses, revision sessions, extended role training like taking blood and life support.
Who funded this training?
NH: My workplace.
Were you allowed time off work to attend the courses?
NH: Yes, although some takes place on the job.
Do you find it difficult to access further training/CPD?
NH: No, not at all. We have a practice development facilitator who encourages CPD.
Are you expected to do more CPD than you have time or money for?
NH: No, I just find it hard when I'm expected to do on the job training when I already have enough work to do in my shift. More time to learn on the job would be useful.
Do you think the role of dental/nurse has the respect it deserves within the dental/medical profession?
EL: No, as until registration you never had to be qualified to work as a dental nurse and I think that speaks volumes. You can't just apply to be a [general medical] nurse with no previous qualifications and start the job straight away. Dental nursing is a tough job; we have to run around after both the dentist and the patients and earn a relatively small amount of money, and most people believe all we do is sit down and pass things (my partner included).
NH: Sometimes, not always. Maybe to the general public.
Are you a member of any associations?
NH: Yes, the Royal College of Nursing (RCN), and automatically, the Nursing and Midwifery Council.
[To EL only] Were you on the Voluntary National Register of dental nurses?
EL: Yes, and I'm going through the process of registering with the GDC at the moment.
[To EL only] Do you think registering with the GDC is a good idea, and how have you found the process of registering?
EL: I think like everything it has pros and cons. On the one hand we will finally have the recognition as qualified nurses, which is what I think a lot of dental nurses want, but on the other hand we will be in such a position that if we see our employer do something wrong and don't report it, we can be struck off the register. One of my colleagues remarked that we would be better off stacking shelves in a supermarket: more money; less chance of being sued.
One of my colleagues remarked that we would be better off stacking shelves in a supermarket.
The registration process is a slow one but with so many nurses waiting to be put on, it's going to take time.
Would you recommend dental/nursing as a career?
EL: Yes, I think for the right person dental nursing is a fantastic job. You meet some wonderful people and it is really pleasing to complete long treatment plans on patients who thought they were too nervous to go through them. Watching people relax in your care is really rewarding.
NH: I would, as long as you know what you're getting in to. As a general rule it is great; there are so many opportunities and ways to progress – potentially anywhere in the world! If you can get through the three-year degree that's the hard bit over. The variety of my job means I never get bored and my shifts go quickly. I am accountable for everything I do, so it can be very stressful at times, especially with time pressures and the general public's expectations of the NHS. But someone saying 'thank you' makes it all worthwhile.
Emma and Natalie both love their nursing roles, but whereas Natalie is all set to stride through the ranks of her profession for many years to come, Emma is less sure where her future lies. Despite the shortage of jobs for Natalie, it would seem that she is strongly supported by the industry in terms of funding, on-the-job training and opportunities for advancement. Emma, on the other hand, had to fund her own course, is yet to attend CPD courses since qualifying and is still considered even by her own partner to 'just sit down and pass things'. With these issues to contend with as a dental nurse, it is a good thing that Emma is so enthusiastic about her job. Hopefully as registration continues and the role of the dental nurse is given the respect and support it truly deserves, the patients to whom she is so devoted will not lose her to the local supermarket!
See Box 3
What do you like the most and the least about your career as a dental nurse?
Do you have any concerns about your future in the dental industry?
Send your views and experiences to e-mail: firstname.lastname@example.org.
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