Career pathways for dental nurses

There has never been a more exciting time to enter dental nursing, writes Kate Craig.

In her letter in the launch issue of Vital, dental nurse Gemma Jones asked whether there is a structured career path for nurses like her who wish to further their careers while staying in nursing.

While the natural route for progression may seem to be hygiene or therapy, these days there are many options open to nurses who wish to expand their roles without leaving behind their chosen career.

Pam Swain, Chief Executive of the British Association of Dental Nurses, says 'There is no structured path for dental nurses at the moment but things will change with the introduction of statutory registration and its subsequent requirement for cpd.'

There are a number of areas of responsibility within a dental practice in which dental nurses can develop, says Pam, including additional duties in a specialist practice, senior dental nursing and practice management.

There are also opportunities within the community dental service, personal dental service, dental access centres, general district hospitals, dental teaching hospitals, armed forces, industry, the prison service and the education sector.

New roles

The role of a dental nurse is no longer static as new opportunities continue to arise.

I did not realise that once I had perfected the skills to which I had been introduced that day I was at the end of my chosen career path... 30 years on, career paths for nurses are diverse and exciting.

'In 1972 when I began my career in dentistry as a 16-year-old school leaver I can clearly remember my thoughts after my first day, during which I had been shown charting, mixing and how to boil instruments,' says Glenys Bridges, a former dental nurse and managing director of the Dental Resource Company. 'I thought "I'm a dental nurse now". At the time I thought that was a good thing, I did not realise that once I had perfected the skills to which I had been introduced that day, I was at the end of my chosen career path. But now, 30 years on, career paths for nurses are becoming more and more diverse and exciting.'

Care co-ordinators

A new career choice for nurses is the care co-ordinator path. 'Nurses with an interest in oral health promotion and customer care can make a tangible difference to public relations, patient education and practice profitability,' says Glenys.

The role of care co-ordinators is to present to, discuss with and mediate with patients about prescribed treatments, so that patients can make informed choices. 'Practices with care co-ordinators in place have seen massive benefits through patient's enhanced perception of the level of care provided, job satisfaction for the team and income for the practice,' says Glenys. It is this increased income that means it is viable for practices to employ an additional member of staff so that care co-ordination can be a standard feature of general practice.

Oral Health Educators

Ann Felton, who teaches oral health education for ohe southwest distance learning school, agrees career opportunities for dental nurses have developed significantly in recent years. 'Time was (not so long ago) when a dental nurse was just that - for time immemorial, but now there are other interesting pathways to follow, which can lead to career progression,' says Ann.

The need for prevention is now widely accepted and many practices are setting up dedicated preventive units as a result. Ann has seen many nurses go on to study to become oral health tutors. 'I often receive reports from former students who are running preventive dental units in their practices and gaining enormous satisfaction from this,' says Ann.

Trained Oral Health Promoters (or Educators) can use their knowledge in the workplace to help patients achieve optimum dental health or find jobs in the local community. Within the CDS they not only work on an individual patient basis but also visit schools and care homes and give oral health advice to various target groups.

'Many nurses decide to study as hygienists/ therapists, who themselves are specialised oral health promoters and Schools of Hygiene and Therapy are usually impressed by applicants who have undertaken Oral Health Education or Promotion Certificates before applying,' says Ann. Many practices now allow OHEs to see patients on a one-to-one basis.

NVQ Assessors

The introduction of the Oral Healthcare NVQ has led to another new role for dental nurses, as NVQ assessors. The assessor's role is to act as an independent unbiased person who ensures the trainee dental nurse is competent in their area of work. They assess the performance criteria within the workplace that the students must undertake. Nurses may also become dental tutors or trainers involved in the set up and delivery of the NVQ or the National Certificate.

The role of internal verifier is another new role resulting from the introduction of the NVQ. Internal verifiers sample portfolios of students who are studying for an NVQ to ensure assessors have made a valid decision on the work.

While these new roles offer increased opportunities for career development, there are also many existing areas for diversification within general dental practice.

Senior dental nursing

As larger practices are becoming more common, experienced dental nurses are often being asked to take on extra responsibilities. The role of a senior dental nurse may include allocating nurses to surgeries and tasks, monitoring leave and responsibility for continuing professional development of the team.

Practice management

The role of practice manager is particularly important within bigger practices. Practice managers may be experienced dental nurses who have moved into a management role or may be recruited from outside. Practice managers ensure the efficient day-to-day running of the practice and have responsibility for the general management of practice staff, the finances, the premises and equipment, the marketing and the training of the team. Practice managers are also involved with ensuring health and safety standards and staff selection and retention.

Specialist practice

There is much scope for nurses in specialist practice. Nurses are required to perform extended duties in the specialist areas of orthodontics, radiography, sedation, implantology, cosmetic dentistry, endodontics and special care in specialist practices. See box (below) for further details.

The community dental service (CDS) and personal dental service (PDS) can also offer a variety of careers for nurses.

The CDS was established primarily to provide dental care for patients who are unable to register for treatment in general practice and to provide care for adults and children in priority groups with special needs. The main areas of activity are paediatric dentistry, special needs dentistry, health promotion and the undertaking of epidemiological studies. CDS clinics often provide dental services that require special skills and nurses with NEBDN Sedation, Oral Health or Special Care Certificates are in demand.See Box 2

Hospitals

Nurses may also develop their careers within hospitals that offer dental treatment - district/ general hospitals, dental teaching hospitals and postgraduate teaching hospitals. Nurses working in district or general hospitals would be expected to undertake postgraduate training in the appropriate discipline. Within teaching hospitals, nurses may act as co-ordinators in a specialist field. A senior dental nurse would take overall responsibility for the day-to-day management of a particular field. A new post, Director of Dental Nursing, is being developed within the dental nurse workforce.

Armed forces

Nurses looking for something completely different could consider a career within the armed forces. The employment of dental nurses in the armed forces is different from that in civilian life. Personnel assisting the dentist are termed dental clerk assistants. See at the Dental Defence Agency website (www.mod.uk/dda/employment.htm) for details.

A new era

With the range of post qualification courses, diversity in working environments and newly emerging roles for nurses it seems there has never been a more exciting time to embark on a career as a dental nurse.

'There has been a great deal of activity since the Nuffield Report,' says Pam Swain. 'With upcoming statutory registration and verifiable cpd for dental nurses, nurses are demanding more respect than ever before. Dental nursing is not just a stepping stone to a career in hygiene or therapy, but provides a career path of its own.'See Box 1

Box 1: Further information

• Care Co-ordinators: For information on the BTEC qualification for care coordinators call DRC on 08700 664 398.

• Oral Health Education: Contact Ann Felton, OHE Southwest, for information on distance learning for oral health education, www.ohesouthwest.org

• BADN: The BADN has national groups for specialist areas and local groups, study days and conferences to support members. Contact BADN, 11 Pharos Street, Fleetwood FY7 6EU. Tel 01253 778417. Fax 01253 777268.

• For detailed information on career pathways see the upcoming book Advanced Dental Nursing edited by Professor Robert Ireland, ISBN 1405 109238, Available May 2004. Blackwell Munksguard, price £29.50.

Box 2: Specialist practice

Implantology

This is a rapidly developing area where the patient has a metal or ceramic implant inserted into the bone with a fixed or removable bridge or denture attached. The dental nurse may be required to assist in the surgical placement of the implants or prostheses, patient management and appropriate oral health care maintenance.

Cosmetic dentistry

Cosmetic dental practices specialise in advanced restorative procedures including veneers, multiple crowns and bridges. The nurse needs a working knowledge and understanding of the techniques and materials involved.

Endodontics

These practices specialise in single and multirooted root canal therapy with possible surgical intervention frequently using clinical microscopes. The nurse needs to be familiar with current endodontic techniques and materials and to be able to assist appropriately at the chairside.

Sedation

Sedation is often offered as an alternative to general anaesthetic since the withdrawal of GA from general practice. The nurse who is the second appropriate person is required to have undertaken recognised sedation training.

Radiography

Dental radiography is an important aspect of dentistry with regard to diagnosing the cause of dental problems. A post qualification certificate in radiography enables dental nurses to take radiographic projections commonly used in dental practice.

Orthodontics

These may be specialist referral practices or general dental practitioners offering orthodontic care using fixed or removable appliances.

Special care

Special care dentistry aims to secure the oral health of people with disabilities where an interprofessional approach is required to deliver care in a holistic way.

Qualifications required for nursing in specialist practice are detailed in the upcoming book, Advanced Dental Nursing edited by Professor Robert Ireland.