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Fadeyi Oluwaseun
Ladoke Akintola University Ogbomosho
B.tech Marketing Management
Graduate, Nigeria.

A government resource to illustrate nursing career paths has been hastily withdrawn after leading nurses complained it showed the role of clinical nurse specialist as a band 6 job.

The infographic, which featured on the NHS Careers website, sparked serious concern in the nursing community for appearing to suggest a clinical nurse specialist was a just step up from being a band 5 staff nurse.

“There is confusion over who is doing the role of CNS with some people not even professionally registered" Alison Leary

Despite the fact that most specialist nurses are highly qualified and often lead and manage teams, it depicted the role at band 6 and on a par with being a senior staff nurse.

Nursing leaders warned the resource was misleading, “devalued” the role of clinical nurse specialist and risked deterring nurses from embarking on specialist training.

Health Education England’s chief nurse today apologised and the diagram has now been taken down in light of the controversy.

The colourful flow chart, which appeared under the heading ‘Where can nursing take you?’, set out to illustrate different nursing career paths in clinical practice, education, research and management.

For those wishing to stay in clinical practice, it suggested nurses could start off in a band 5 role before moving on to become a clinical nurse specialist at band 6 with a salary of £30,401 to £37,267.

The next stages would be to become an advanced nurse practitioner at band 7 and then a consultant nurse at band 8 or band 9.

The equivalent route for those wishing to pursue a career in management would see a nurse start off at band 5, become a senior staff nurse at band 6 before moving on to a ward manager role at band 7 and then a matron or associate director of nursing at band 8 or 9.

However, nursing leaders said labelling clinical nurse specialist as a band 6 job “doesn’t reflect reality” and created the wrong impression about the advanced skills needed.

Professor Alison Leary, chair of healthcare and workforce modelling at London Southbank University, said the graphic was confusing and misleading.

"There isn’t an agreement across the NHS as to where those nurses should sit" Crystal Oldman

Speaking to Nursing Times before the graphic was withdrawn, she said: “I think it’s very disappointing that NHS Careers and NHS England do not see the role as complex with a huge amount of clinical responsibility.”

She added: “There is confusion over who is doing the role of CNS with some people not even professionally registered but according to our data the majority are doing complex work such as managing caseloads and running services day to day.

“It seems rather at odds with the retention strategy to place this role so emphatically at a sub advanced level of practice.”

Crystal Oldman, chief executive of the Queen’s Nursing Institute, said the graphic “doesn’t reflect the reality of the specialist nurse at all” and this had “huge implications”.

Many clinical nurse specialists, such as those specialising in diabetes and other diseases, held master’s degree-level qualifications, she explained.


“A nurse asking ‘What would it look like if I became a specialist nurse?’ might look at that and be like ‘Well I won’t really be progressing with all the skills and knowledge I’ll be developing’,” she said.

“There is a real concern that those thinking about career development might think ‘Why would I bother? I will go and do something else’,” she added.

She said it was particularly worrying the graphic suggested being a clinical nurse specialist was below a band 7 ward manager role when many specialist nurses working in the community had “arguably more responsibility” than those managing teams in hospitals.

She said she had spoken to Mark Radford, chief nurse at Health Education England, this morning to raise concerns and was “delighted” when he promised to get the graphic removed.

Dr Oldman said one positive was the issue had opened up debate about the position of clinical nurse specialists amid concern about roles being downgraded and the fact banding and salaries could vary.

This was especially true in community nursing where highly qualified and experienced health visitors, district nurses and children’s nurses were responsible for highly complex patients and caseloads.

“We have listened to colleagues and apologise for any confusion" Mark Radford


“Some are actually paid at band 6 and some are paid at band 7 so there isn’t an agreement across the NHS as to where those nurses – in arguably very senior roles - should sit,” said Dr Oldman.

“We are glad we are now opening this up with HEE to have the conversation around what banding would be the expectation for a specialist nurse,” she added.

Meanwhile, the Royal College of Nursing said its chief executive Dame Donna Kinnair had been raising the issue of down banding formally with Health Education England and the chief nursing officer.


In a statement Mr Radford said he was sorry for any confusion caused by the graphic.

“We have listened to colleagues and apologise for any confusion that may have been caused over the infographic,” he said.

“It has been taken down and will be adjusted accordingly working with relevant clinical experts and NHS England and NHS Improvement,” he added.
Source: Nursing Times

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