Does the title 'Registered nurse in learning disabilities' still reflect what we do?

There are no plans at present to change the title of RNLDs. The thoughts expressed here are not intended to be implied as the 'right' thoughts or the only thoughts. We are very keen to hear others views. If you would be interested in sharing your views from your role or your perspective please email a 250 – 750 word response to jonathan.beebee@rcn.org.uk with a photo and we will post this as a blog to add to the debate.

In the 104 years of RNLDs we have changed our name roughly every 30 years:

• 1919 – Mental deficiency nurses
• 1940s – Mental subnormality nurses
• 1970s – Mental handicap nurses
• 1990s – Learning disability nurses.

These changes reflect the changes to societies values and practices at the time.

In the last 40 years societal and values-based changes have been happening at pace. In 1988 there were around 35,000 learning disability hospital beds in the NHS in England. Today there are around 2,000 learning disability hospital beds (NHS Digital). Unsurprisingly, as a result we have seen a significant decline in RNLDs employed by the NHS. 

Alongside this, in recent years we have seen fantastic movements in co-production, involving people with lived experience in service development and design. This has resulted in amplifying the voices of those involved to ensure their views are considered, rightly increasing the need for all services to listen to those who receive their support. But perhaps this has been at the expense of those without a voice whose lives and experiences are often very different and are likely to have very complex health needs that cannot be met by primary and secondary care services alone. 

We have also seen a great increase in awareness of 'neurodiversity' in the last 10 years or so, and how this language has given neurodivergent  people, particularly those without a learning disability, a voice and an identity. It could also be said that this has been at the cost of hearing the voices of those with learning disabilities, particularly those with severe or profound learning disabilities. 

Since the term 'learning disabilities' was first used in the 1990’s there has been ongoing confusion from the public on what the term actually means. It is often confused with 'learning difficulties' and primarily understood as a challenge with educational attainment. Some would argue that in the 21st Century the term 'learning disability' is dated as it reflects a societal value placed on achieving academia, which is a social construct, and explains very little about the person. 

Today, there remains a huge need for learning disability nurses to enable primary and secondary care services to effectively meet the needs of people with learning disabilities and to provide specialist learning disability nursing interventions in assessing and addressing health and social care needs. Yet at the same time, RNLDs also work in other settings where they are not solely supporting people with learning disabilities. 

Some learning disability nurses work in autism services, and some autistic people may struggle to see how a learning disability nurse can help them when they do not have a learning disability them self. Some learning disability nurses work in acute hospital settings and have had to overcome significant barriers to prove their worth and ability to undertake the role. We often hear about RNLDs denied interviews due to misconceptions about our ability to administer medications or carry out other nursing interventions. In this regard, being titled a 'learning disability nurse' can pose barriers to career opportunities and deny the application of our skill set where it could be hugely beneficial. 

Other non-learning disability settings RNLDs work include (but are not limited to):

• prisons
• dementia services
• stroke services
• epilepsy services
• acquired brain Injury services
• children's services
• mental health services
• social care services.

Recruitment challenges are also meaning that sometimes RNLDs can be substituted with other health professionals. This potentially risks diluting the value of our unique offer. This could lead to the perception that, if other health professionals can fill our vacancies, why do we need for roles to be specifically for learning disability nurses?

People with learning disabilities continue to need, and deserve, access to registered nurses who are specifically trained to meet their complex health needs. But as specialist learning disability health services have declined, the numbers of learning disability nurses has reduced, and the application of our skill set has broadened. In order to maintain our support for people with learning disabilities do we need to broaden our offer? Can we broaden our offer and remain called “Registered Nurses for Learning Disabilities”? If we change our title how do we protect our vital role for people with learning disabilities? If we change our title, what would we change it to?

As a suggestion, Registered nurse in neurodisability appears to fit with contemporary practice. The term 'neurodisability' is aligned with the growing awareness and acceptance of neurodiversity and neurodivergence. The use of 'disability' in this title reflects that not everyone with neurodivergence needs our support, health services need to be finite, and our skills are needed by those whose neurodivergence (or society’s response to their neurodivergence) has a disabling impact upon their lives. 

A learning disability is a type of neurodisability. Yet, the term 'neurodisability' broadens our offer to people who experience autism, stroke, dementia, cerebral palsy, epilepsies, motor neurone disease, ADHD… (the list could go on and on). This broadens our offer to all health and social care services, yet continues our commitment to the people with learning disabilities we are named as being skilled in supporting now.

Perhaps someone considering nursing would be better able to conceptualise what a neurodisability nurses' role is compared to a learning disability nurse? Would acute hospital services question less a neurodisability nurses nursing skills in the same way as we are often judged as learning disability nurses?

Additionally, there are already neurodisability services. If you conduct an internet search for 'neurodisability services' you will see many examples, usually of children’s services that support people with autism, learning disabilities, cerebral palsy, or other similar conditions that are not using the words 'learning disabilities' and do not have to employ learning disability nurses. Perhaps this movement has already begun?

So is it time we discussed whether the title 'Registered nurse in learning disabilities' still reflects as a profession what we do?