Nurse training and retention: time to act

Nurse training and retention: time to act

Nurse training and retention: time to act

by Cary Cray-Webb and Molly Sibson

When we started writing this article we thought it was going to be a quick summary of the qualification routes into dental nursing, and some ideas about further training. As we talked it through we realised that training for dental nurses does not just affect the nurses themselves, but also the businesses and surgeries they work for.

We believe, based on our own professional experience as nurses, that one of the biggest business issues affecting dentistry at the moment is the high turn-over of staff, particularly nurses with less than five years experience. Here are some of the reasons why we think this has come about.

As Roy Castle would say… (i.)

Becoming a dental nurse is not something you do on a whim. There are two-years of training involved. Whichever qualification route you choose, you have to do a lot of studying and a great deal of hands-on, chair-side nursing. You definitely need dedication. Here-in lies the first problem.

We ask student nurses and apprentices to do a lot of learning. And it is a lot. Added to this, your typical 18-year-old may have viewed an apprenticeship as a purely vocational course away from the constraints of the University book-learning approach. We know that it’s not the case. and expect them to get to grips with a highly technical job requiring deep knowledge of biology and anatomy. How often is this made clear in the recruitment process?

Part of the problem here is that people working within dentistry have ‘self-selected’. We have no problem with learning technical skills and academic topics, so it never occurs to us that others might.

Seemed like a good idea at the time

Another part of the problem is how selection and recruitment processes are managed by dental practices. Few dental practices have someone trained in recruitment and HR available to manage and conduct interviews.

Attracting candidates in the first place is also a bit hit and miss. Cary made a deliberate ‘grown-up 40-something’ decision to retrain as a nurse and found dental nursing through her research of available training courses.

On the other hand, Molly ‘fell on her feet’ into the profession as a teenager. As she says; “I was desperate for a job. Someone I knew asked me if I’d be interested in a job as a trainee dental nurse at their practice and I applied. I wasn’t really aware of dental nursing as a profession before that.”

Word of mouth still seems to be the biggest way of attracting trainee dental nurses. Perhaps the profession overall needs to do a better job of helping people joining the job market understand what we do.

From an employer’s perspective, it is also important that the candidate goes away from (and preferably comes to) the interview knowing exactly what is involved. It is far better (and cheaper) to eliminate all candidates from the interview process than to select someone who later decides it’s not for them and leaves. A little extra effort and time here would definitely help.

All roads lead to Rome

The main qualification for a dental nurse is a Level 3 diploma or equivalent. These can be gained through a number of routes. In our cases, Cary self-funded a night-school course and took a National Examining Board of Dental Nurses (NEBDN) diploma, while Molly went through the National Vocational Qualification (NVQ) route as a trainee, paid for by her employer of the time.

Access to training is also important. Interesting initiatives include {my}dentist’s in-house academy gaining accreditation from the NEBDN. Plus, a range of ‘apprenticeship’ schemes that share the training costs between the government, employer and student and result in an NVQ Level-3.

Training these days can be delivered through on-site classes at college, or through distance learning. Each of these routes requires differing levels of commitment from the student, employer, tutor and assessor if the student is to be successful.

Based on the schemes we’ve seen, the NEBDN diploma places more emphasis on the medical and anatomical aspects, whereas NVQ courses spend less time on these subjects but compensate with topics related to running the practice, such as how UDAs work etc.

Muck and bullets

One issue we’ve both seen with apprenticeships, in particular, is on-boarding the new students. Getting the details of the work across to a potential 18-year-old trainee is difficult.

The first impression many recruits have is that the job is very glamorous – a little bit of assisting the dentist and quite a lot of sitting around. But when they are asked to start acting as THE nurse in surgery, it quickly becomes apparent that this isn’t so.

A lot of what the nurse does goes on when the patient isn’t in the surgery, so the first exposure to that work is critical

It’s also true that when you get two nurses in a room together conversation quickly turns to bodily fluids, and dental nursing is no exception – you can’t be afraid of a bit of blood and puss. We’ve both come across trainees and apprentices who couldn’t get past this.

Which way did they go, Joe?

Students working on a distance learning course are definitely at a disadvantage. Although they have access to their assessor, they don’t build a strong relationship because there is a lack of regular contact, so assessments become more stressful and it feels harder to get additional support. They are also more reliant on the goodwill of experienced work colleagues.

Some of the in-house arrangements by organisations like {my}dentist will be interesting to watch as they develop. At the moment courses with regular attendance at college offer the best access to tutors, assessors, and the experiences and opinions of other students.

The academic approach of the NEBDN course suited Cary as she already has a degree in an arts subject, and the course matter suited her approach to learning. But a lack of support from her practice at the time of her Objective Structured Clinical Examination (OSCE) was a problem.

For Molly, the NVQ worked well as she was given support by her practice team, but also had access to a tutor and assessor at college. The more self-reliant approach fed her curiosity.

Bibles and doorstops

One thing we both agree on is that ‘Levison’s Textbook for Dental Nurses‘ is the Bible. If you’re a student nurse, or if you support the training of a student nurse, READ LEVISON’S.

We’ve both seen and heard of students who claim to have never opened the cover. In our experience, they’d all do better if they had a read – the answer is always in there somewhere.

You have an NVQ Level 3 – you can drive a JCB (ii.)

Did you know that the NVQ qualification for a plant operator (not including Crane Supervisors, Appointed Person and similar roles) is also a Level 3 equivalent?

Dental nursing is a very technical job. And while the safety implications may not be as obvious as for those of operating a back-hoe excavator, they can be just as devastating if overlooked. Think cross-infection, needle-stick injuries and anaesthetic for starters.

We believe that the skills required of a dental nurse are often undervalued – not just in the wage packet, but in the general perception and public recognition of what we do, and that’s a problem for retention.

and Jolly Hockey Sticks (iii.)

Trainees and apprentices often say that they expected their ‘in employment’ training to be more formal and ‘professional’, given it is such a complex role. However, most training is on-the-job.

It is very rare for employers to have designated trainers and training facilities, and surprisingly common for 2nd-year trainees to be left to train new recruits. Also, for trainees to be left to ‘get on with it’ after an alarmingly short period of training and supervised work – two days in Cary’s case.

This contributes to a relatively high number of disillusioned apprentices and trainees failing to complete their courses and qualify, and is something that employers need to pay more attention to.

When you take on a trainee you have a moral obligation to ensure they achieve their qualification in a timely manner. With an apprentice, this is a contractual obligation, and one of the parties is the Government.

New car, caviar, think I’ll buy me a football team (iv.)

This isn’t a platform to campaign for higher wages – no nurse of any speciality goes into the profession to become rich. But in comparison with other Level-3 roles and the level of responsibility that dental nurses carry, most are poorly paid with many qualified nurses on not much better paid than the national minimum wage.

Combined with the lack of support in training and no clear career progression path, is it any wonder that many practices find it difficult to recruit and retain nurses?

This is an important point because many young dental nurses leave their job not to go to another practice, but to a job outside the profession. Particularly in urban areas, you have to consider wages within the overall job market, not just in comparison with other dental practices.

Ooh – that’s interesting!

One way to address retention might be the moves proposed to extend the duties of nurses, giving scope for advancement and greater job satisfaction. However, few practices are organised in such a way to make this practical.

A lead down this route might be expected at some point from the big chains such as {my}dentist and BUPA as they seek efficiencies and address the challenges of recruiting dentists (a whole separate article). But the vast majority of practices are privately owned and relatively small, meaning that it is far easier for the dentist to continue to provide the treatments and services that could be given by a nurse.

Many dentists (yes, we mean YOU) are also personally set in their ways and it will be some time before the proposed changes in the roles of dental nurses come to fruition as some would rather keep those tasks to themselves.

Stick around kid – you ain’t seen nothing yet

What can we practically do to make it easier to recruit, train and retain dental nurses?

First, get involved with local schools and professional bodies such as the NEBDN and Association of Dental Nurses to promote dental nursing as a career. The amount of time and effort can be surprisingly small.

Second, think carefully about your recruitment processes and what you are actually trying to achieve. If you want an apprentice, understand what is required of you to support them. If you choose to take a trainee (usually a more mature candidate), support them properly and make sure they are on the course of study that suits them rather than the one with the cheapest course fees.

Third, treat nurses well once they’re qualified. Make sure they are on a competitive wage, but also give nurses a chance to progress in terms of scope and technical capability. We’ve gone through a lot to become a qualified nurse, which suggests a bit of ambition. If you want to keep your nurse, find a way to feed that ambition.

After all, training is an investment – recruitment is a cost.

About the writers

Molly Sibson

Molly Sibson is a tutor/assessor at Derby College, working with NVQ students attending the college. Molly trained as a dental nurse, qualifying in 2013, and progressed to senior nurse and then practice manager. On the way she also qualified as an assessor and moved to a role with Learn Direct assessing distance-learning students before joining the staff at Derby College.


Cary Cray-Webb

Cary Cray-Webb

Cary Cray-Webb is a dental nurse. She qualified in 2015 and currently works for a ‘big-two’ corporate chain having started at ‘the other one’. In between, she has also worked for a small chain and has gained experience at four very different practices.

Cary is also a director of Precision PR Limited, a specialist marketing company whose clients include the Pearl brand from BHA Software.



i. Roy Castle was the original presenter of BBC’s ‘Record Breakers’ TV show, and closed the programme with a song that claimed ‘Dedication’s what you need.’

ii. JCB is a manufacturer of heavy construction machinery, best known for the manufacture of back-hoe excavators.

iii. Eton Rifles refers to a song by ‘The Jam‘ about the ‘establishment’, typified by former pupils of private schools such as Eton. ‘Jolly Hockey Sticks’ is a colloquialism sometimes used to refer to former pupils of private schools such as Cheltenham Ladies College.

iv. Reference to the song ‘Money‘ by Pink Floyd

Cary Cray-Webb