The following information concerns ‘people who can perform nursing functions’ in America, a précis of information provided by The information is self explanatory, detailing the qualifications, expected competencies, and salaries of three grades of ‘people who can perform nursing functions’. In reality there is a blurring between LPNs – Licensed practical nurses, and Medical Assistants (MAs), and in many cases the distinction may be one of terminology.

The 1-2 year LPN and MA training courses are templates that the UK government plan to use to extend their one year (pre-nursing), ‘care assistant’ scheme. In America, median annual wage for LPN’s/MA’s is approximately 66% of that of Registered Nurses. Registered Nurses achieve specialization through work experience or by pursuing professional certification in a given field, but this route is becoming open to LPNs/MA’s. The implications are obvious, and the UK government is fully aware of the American trend of using more ‘people who can perform nursing functions’, rather than nurses. when people speak about nursing shortages, they are not speaking about a shortage of actual nurses. They are speaking about a shortage of people who can competently perform nursing functions.

The matamorphosis of the NHS, led by an American, will specifically seek to cut wage bills by employing ‘people who can perform nursing functions’. Hospital managers and care home owners will feed into their computer models the skills necessary to produce the desired outcome at the cheapest rate. To not realise this is foolish.

There will still be degree nurses, but far less of them. There will still be lecturers involved in ‘training people to perform nursing functions’, but not many based in universities. Hospital Trust managers will use in-house training as a means of reducing training costs.

The NMC are only concerned with whoever performs nursing functions to be registered, and to have to pay an annual subscription, to help pay their £25 million a year fat-cat wage bill. The RCN are only concerned with membership subscriptions, whoever pays them is irrelevant.


REGISTERED NURSES – require an associate’s degree in nursing (ADN) or a bachelor’s of science in nursing (BSN), and to pass a national examination – the National Council Licensure Examination (NCLEX-RN).

LPNs – Licensed practical nurses. They are graduates of a one-year program offered by either a vocational/technical school or a community college. LPNs must pass a computer-based, national examination called the National Council Licensure Examination-Practical Nurse (NCLEX-PN). LPN scope of practice is defined by the nurse practice act in the state in which the LPN practices. In Texas and California, LPNs are known as LVNs (licensed vocational nurses).

MEDICAL ASSISTANTS (MAs). MAs are currently in high demand and that trend is expected to continue for quite some time. According to the United States Department of Labor, it is estimated that of the 20 fastest growing occupations in the United States, at least half will be in a medical related field. Within the next decade, the employment of MAs is expected to grow by 31%, which is 20% faster than the national average. There are approximately 540,000 MAs practicing in the U.S. today. By 2020, this number is predicted to increase to 690,000 with more than 60% working in private practices. The only prerequisite for entering this field is that a high school diploma or an equivalent, such as a GED, is required. However, an increasing number of employers now prefer or even require an applicant to become a certified medical assistant. There are many certificates that require you to complete a one or two-year formal training program.


Recording vital signs, weight, and height.
Preping patients, equipment, and rooms for medical procedures.
Providing assistance to doctors during medical procedures.
Cleaning and sterilizing instruments and equipment.
Explaining treatment procedures to patients.
Preparing and administering medications as directed by the physician.
Collecting specimen samples for testing.
Drawing blood or venipuncture.
Removing sutures.
Authorizing prescription refills.
Helping physicians examine and treat patients by providing them with instruments or materials.
Completing supportive tasks during examinations, such as giving injections.
Changing sterile dressings on wounds.
Operating electrocardiograms or X-ray machines.
Performing routine laboratory tests.
Interviewing patients to obtain medical information.
Recording a patient’s medical history.
Documenting information in medical records (such as test results).

Some of the tools MAs must be familiar with include, but are not limited to:

blood pressure measuring equipment
hypodermic needles

LPNs and MAs are both required to complete a year of formal education at a community college or through an online education provider. Both have the option of extending this training by an additional year if they like. Tuition at a two-year community college varies from state to state, but typically costs between $2,300 per year for in-state residents. This is the model which the UK will adopt. Hospital Trusts, for instance, will sponsor candidates in return for them working a guaranteed period on a contract that repays the cost of training.

Associate degrees are designed to prepare graduates for entry level RN jobs. The curriculum focuses on basic level nursing classes, covering medical surgical nursing, pediatric nursing, maternal and newborn nursing, mental health nursing and the fundamentals of patient care management. Students also take classes in nutrition, statistics, medical terminology, anatomy and physiology, and microbiology. Approximately 60 percent of all RNs graduate from associate degree programs.

Although a MA performs a comprehensive assortment of clerical, clinical and administrative tasks, nurses have a greater variety of clinical specialties open to them. Nurses achieve specialization through work experience or by pursuing professional certification in a given field, such as Medical-surgical nurses: Medical-surgical nurses provide care to adult patients who are hospitalized with any number of disorders, from acute injuries like broken bones, to sudden illnesses like infectious diseases, to chronic illnesses like diabetes and coronary artery disease. In the UK, as in America, such specialisation will be extended to those who have trained to perform nursing functions.

In 2010, the median annual wage for all RNs was $64,690. The median annual wage for LPNs was $40,380. The current ratio difference remains the same.

As recently as 15 years ago, physicians’ offices were primarily staffed by nurses. Today, that is no longer true. Over half of the nation’s 527,600 MAs work in practitioners’ offices.

MAs can be paid less than RNs and LPNs, so this represents a huge cost savings to these health care providers.

It’s worth remembering, however, that when experts speak about the nursing shortage, they are not speaking about a shortage of actual nurses. They are speaking about a shortage of people who can perform nursing functions.

Depending upon the state in which they practice, MAs can perform most nursing functions. In economic terms, therefore, they are a perfect low cost substitute for nurses.

In plain terms, the SEN is making a comeback, but called by a different name.
lenin nightingale 2015



  1. Many SENs were excellent nurses. As a student I learned so much from them.
    My sister became SEN trained at Great Ormond Street & I will honestly say she was a better nurse than me or another sister who was SEN and converted to RGN or my brother and a sister in law both RGNs.
    This government will always go for the cheapest option and try to get every last drop of blood from them
    I would welcome the SEN back providing their training was as rigorous as the old SENs and their boundaries of work was clearly documented

  2. Thanks Ann. It should be if incorporating all the above skills- let’s hope with experience at the reigns–

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