Unlocking CNN careers: the gates to career progression for CNNs within the NHS appear to be locked, with few opportunities for promotion and little motivation to train and develop.
Subject: Primary nursing (Management)
Primary nursing (Services)
Nurses (Training)
Nurses (Supply and demand)
Child care services (Human resource management)
Employee promotions
Author: Ly, Kin
Pub Date: 10/01/2009
Publication: Name: Community Practitioner Publisher: Ten Alps Publishing Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2009 Ten Alps Publishing ISSN: 1462-2815
Issue: Date: Oct, 2009 Source Volume: 82 Source Issue: 10
Topic: Event Code: 200 Management dynamics; 360 Services information; 280 Personnel administration; 600 Market information - general Computer Subject: Company business management; Company personnel management
Product: Product Code: 8043100 Nurses; 9918530 Employee Promotion NAICS Code: 621399 Offices of All Other Miscellaneous Health Practitioners SIC Code: 8322 Individual and family services; 8351 Child day care services
Organization: Government Agency: United Kingdom. National Health Service
Geographic: Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom
Accession Number: 209163250
Full Text: Band-5 community nursery nurse (CNN) roles, offering leadership opportunities, have been established in some primary care trusts (PCTs). But despite interest from many CNNs in routes to progress their careers, these remain scarce within the NHS. According to Unite/CPHVA's CNN Forum, there are a very small number of senior CNNs in England, and no record of them in Scotland, Wales or Northern Ireland.

A reason to train

Margaret Turner-Bone is one of the UK's few band-5 CNNs, and states: 'No matter how much extra training a CNN undertakes, it is not recognised and she will continue to be paid at the rate of a band-4 nurse. This could deter CNNs from undertaking any sort of extra training that could be of benefit to the wider community.'

Unite/CPHVA CNN Forum chair Barbara Evans notes: 'Some PCTs have created band-5 senior CNN roles, with greater leadership responsibility, and this includes supervision and mentorship. However, PCTs are providing nowhere near enough of these roles. A CNN would need to change jobs or leave the NHS entirely if they wanted more opportunities for career progression.'

She adds: 'Some CNNs have applied for other childcare roles in Sure Starts and children's centres. Often, there is less responsibility, they are paid at a higher rate, and there are more chances for promotion to children's centre manager. These centres are usually managed by local councils, but the lack of opportunity is a major problem within the NHS.'

CNN leaders

Theresa Taylor was appointed as a band-5 senior CNN after NHS Ealing recognised a gap in its community health service. She states: 'There was an increase in CNN applicants, who were needed to help target the large numbers of hard-to-reach families in Southall neighbourhood. The trust therefore developed the senior CNN role in order to deliver induction training to new CNNs and to help provide a universal family programme.'

Theresa provides support and advice to band-4 CNNs, health visitor assistants and the children's services team. She provides supports to CNNs in cases where there may be a complaint, and represents them in senior management meetings.

Theresa has helped in the redesign of community services in NHS Ealing and has developed CNN competences framework at a strateg level. She also mentors, supervises and provides personal development plans and appraisals for CNNs and health visitor assistants, conducts risk management assessments, assesses health services and interviews for new posts.

She notes: 'There is less health visitor input due to staff shortages and because they have large caseloads to manage. In this instance, collaboration between the senior CNN and health visitors is important. Senior CNNs are not used to replace health visitors in any shape or form--essentially, we help to enhance their role.'

Margaret Turner-Bone agrees: 'Senior CNNs usually mentor, train and supervise other CNNs, which relieves some of the pressure that health visitors experience. But only a few PCTs have employed a senior member.'

Theresa states that her PCT has decided to roll the senior CNN role out across the whole of Ealing. She says: 'NHS Ealing recognised the necessity and benefits of having a senior CNN,and the PCT has so far employed two more senior members. In addition, other trusts have shown an Interest and I have spoken to a number of Other PCTs about my role.'


Although Margaret Turner-Bone was appointed as a band-5 CNN, she says: 'Such opportunities for CNNs usually only come by chance--there is no standard route for career progression.'

For her, it was after being appointed as a healthy weights project lead at NHS Sefton. She notes: 'There was a lack of availability of health visitors at the time that the trust was recruiting for this post. The PCT therefore decided to open the position to those who had the relevant experience. I was appointed to the role because I carried the relevant skills, knowledge and experience, having worked in this area alongside a health visitor in the past.'

Barbara Evans stresses the significance of employing senior CNNs: 'As well as providing induction training, supervision and advice, senior CNNs would be able to effectively push forward the community nursery agenda and represent the service. Senior CNNs will no doubt provide the necessary support, especially in health visiting and skill-mix teams.'

Registered service

Many CNNs seem to support the idea that the service should be registered, emphasising possible outcomes such as post-registration training.

Margaret Turner-Bone states:

'Community nursery nursing should be a registered service. This would provide a standardised route into community nursery nursing and it could even open up more opportunities for us to progress our careers, where post-registration training could be considered.'

Concerns have been raised that a nursery nurse with insufficient training in child care and early years education could consider themselves to be a CNN.

Margaret Turner-Bone states: 'Because community nursery nursing is not registered, many people can undergo any childcare training and then call themselves a nursery nurse.'

She adds: 'But this does not necessarily mean that they have the relevant skills and knowledge to work in the community.'

Training and conduct

The Qualifications and Curriculum Authority recommends four qualifications for community nursery nursing, providing the necessary theoretical and practical training in child development:

* Diploma in child care and education (DCE) awarded by CACHE (previously the NNEB) and the HNC in child care and education (Scotland)

* Level 3 BTEC national diploma in early years, awarded by EDEXEL

* NVQ Level 3 in early years and education, awarded by City & Guilds,

CACHE, EDEXEL and the OU. Barbara Evans comments: 'Unite/CPHVA has developed a voluntary CNN code--but this is only voluntary. Not only could registering the service provide a recognised level for training and raise the professionalism of community nursery nursing within the NHS, it could provide greater protection for the public.'

She adds: 'Nurses and midwives have a professional code of conduct that they must adhere to and are held accountable to, and if community nursery nursing was registered, then the service could be better regulated. This would mean that CNNs, who often work in skill-mix teams and make home visits, could be held accountable for their actions or omissions, and not just delegated to.'

New handbook

The Unite/CPHVA CNN Forum has developed a new handbook for CNNs that points to information on leadership, record-keeping, lone working and clinical supervision, as well as advice on tasks such as infant massage and therapeutic play.

Margaret Turner-Bone states: 'The handbook can be used as a reference point, which CNNs can dip into for information. There have been many books published on child care, but this handbook compiles all of that information into one book.'

She adds: 'There is something in here for everybody and it could be used to inform and further reinforce the roles of CNNs.'

The new handbook will be launched at Unite/CPHVA annual professional conference on 14 to 16 October in Southport.

It is clear that there are few existing opportunities within the NHS for CNNs to progress their careers, despite the benefits associated with employing senior CNNs. The outlook appears to depend on whether the leadership shown by some trusts in developing these roles is replicated by others.

Further information

* The new CNN handbook is due to be launched at the annual conference, and will be available from Unite/CPHVA

* To access the voluntary CNN code of conduct, see: www.unite-cphva.org then click on 'Professional groups' and then 'Nursery nursing'.

Kin Ly

Assistant editor
Gale Copyright: Copyright 2009 Gale, Cengage Learning. All rights reserved.