Let loose on an aspirator

Back in the ‘good old days’ before GDC registration, the role of the dental nurse was seen by many as, by and large, little more than an efficient cleaner. It was a job that required ‘no previous experience’. In general, dental nurses were held in little regard, with a consequential effect on status and pay. There was little hope of a career. Training may have involved an in-house ‘professional’ approach encouraging the dental nurse to attend night school to attain a recognised qualification. At the other end of the scale, dental nurses were school leavers who were shown a surgery, shown the aspirator and simply let loose on an unsuspecting public. There was little or no understanding of the disease processes, clinical procedures or materials, and cross infection control was poor.

Today, the ever advancing tide of regulation has enveloped the area of dental nursing. The obligation is now to register the nursing team. If a dental practitioner employs a dental nurse who does not have the required qualifications and is not working towards registration they will face fitness to practise proceedings and possible erasure from the dental register.

The purpose of this article is to explore to what extent registration provides an opportunity to improve the profession as a whole, to meet the new criteria set by the GDC,1 and also to add value to your practice and increase patient satisfaction.

Dental nurse training over time

Formal training2 in dental nursing first began in the 1930s. This was the start of recognising that the role of the dental surgery assistant required a specific education which would produce a chairside assistant who could provide professional support both in terms of running the surgery and patient management.

In 1993 The Nuffield Foundation3 identified that training and regulation of dental auxiliaries was haphazard. The report suggested that the role of the dental nurse should be ‘formally reappraised, defined and nationally recognised both inside and outside dentistry’. As a result, the concept of dental nurse registration was conceived.

From DSA to DCP

The term ‘dental surgery assistant’ is no longer recognised. It has been superseded by ‘dental nurse’, a type of dental care professional (DCP). It has taken a long time to recognise the dedication, commitment and professionalism of our nursing colleagues and it is here to stay. It becomes compulsory for dental nurses to be registered with the GDC from 30 July 2008.

The GDC4 state that recognising the professional role that nurses play within the dental team will increase public confidence in the profession as a whole. The consequence of failing to comply with this new regulation is that dentists will risk their own registration.

The dedication and training required to qualify is making DCPs irreplaceable!

On the one hand dentists can view this as yet another burden but on the other hand, as a profession we can see it as an opportunity towards higher professional standards delivering better care. In any other business, one of the key factors to succeeding where others fail is valuing your staff and evaluating your staff. In the past nurses were viewed as ‘replaceable’ whereas now the dedication and training required to qualify is making DCPs irreplaceable!

In a ‘patient centred practice’, a well trained nurse is, and always has been, an essential member of the team of people looking after each individual patient. Every aspect of the nurse's role at the chairside can make the difference between a procedure running smoothly or not. A good nurse is a second pair of eyes, ears, and hands! He or she ‘pays attention’ and can therefore anticipate the patient's and the dentist's needs.

DCPs and vocational training

Recent research documented in the BDJ5 confirms how important the role of the dental nurse is in the development of the vocational dental trainee. The conclusion was that the ideal nurse should evolve from knowledgeable mentor in the early days, giving hints and nudges to enable the vocational dental practitioner (VDP) to gain in confidence, speed and skill. Ideally, the nurse would evolve as the VDP's confidence grows. So a nurse would become a partner who was ‘on the ball’, keeping apace with the needs and requirements of his or her developing VDP.

For the fledgling dentist there is no better help in their training path than the calm assistance of a skilled and experienced nurse. Their gentle nurturing and calm suggestions make all the difference between a good year and a bad one. When I personally was honoured with the award for ‘Trainer of the Year’ recently I was flattered but knew that I would not have been standing there without the contribution of my team of nurses who assist in the training of our VDPs.

Current training

There are two different ways to qualify as a dental nurse:

  1. 1

    By studying for the Level 3 NVQ in Dental Nursing which requires both practical assessment within the work environment, tutored study with an exam and presentation of a portfolio

  2. 2

    By studying for The National Certificate Examination (with or without clinical experience). It is my own belief that training for an exam in the absence of any clinical experience is pointless. Whilst I am aware that these nurses then require two years’ work experience to become registered I question the value that they would add to any practice. Ensuring that they had two years’ work experience prior to sitting the exam might be a better approach.

I believe that dental nurse registration raises the professional ‘bar’ for dentistry. It aims to maintain the high standards of the dental profession and move with the times to meet the expectations of a better informed public. Surely we can only benefit as a profession delivering skilled trustworthy care to our patients?

The future and beyond

A dental nurse is a competent team member who can organise, manage, understand and operate in the complex environment that is the modern dental practice. Dental nurses can also play a role in delivering holistic health messages to patients in issues that are very current just now, such as diet and nutrition, at a time when the Government are struggling to combat obesity, diabetes and decay.

It is an exciting time for the dental profession as a whole. It is a time to embrace the changes and look forward to future challenges, continuously striving to provide the highest standards of care as a united dental team.