Introductory Guide For Someone Considering A Career In Learning Disability Nursing

The Health Needs Of People With Learning Disabilities

In order to provide a context to learning disability nursing, it is first helpful to understand the health needs of the population being served.

Research tells us that people with a learning disability have poorer physical and mental health than the general population, and as a result often die prematurely (Mencap, 2012; CiPOLD, 2013; Blair, 2018; LeDer, 2019).

There are a number of factors that influence health outcomes for this population; for example, there are a range of chronic and acute health conditions that are noted to be more prevalent in the LD population.

And physical conditions such as obesity, coronary heart disease, constipation and respiratory conditions can have fatal consequences if not identified or managed appropriately (LeDer, 2019).

Evidence also suggests that mental health conditions are more common in the LD population, with some research estimating prevalence rates of 15-52% greater than the general population, depending on the diagnostic assessment tools and criteria used (Hatton et al 2017).

People with learning disabilities can be more vulnerable to developing mental health conditions, some reasons may include biological factors, exposure to negative life events, discrimination and having access to fewer coping or support networks (Mencap, 2018). CiPOLD (2013) identified that physical and mental health conditions such as these, can often be missed because of diagnostic overshadowing.

Diagnostic overshadowing occurs when health professionals make assumptions about an individuals’ behaviour, often attributing their presentation to their learning disability rather than investigating underlying physical or mental health cause (Blair, 2018).

Leading to conditions being missed or misdiagnosed, resulting in poorer health outcomes and preventable causes of deaths for people with learning disabilities.

Preventable deaths contribute to the high mortality rates in this population, with CiPOLD (2013) reporting that 38% of people with a learning disability die from an avoidable cause, compared to 9% of people without a learning disability.

The most recent LeDeR (2019) report also concluded that on average men with a LD die 23 years younger than the general population and 27 years younger for women with a LD.

When we compare life expectancy for the general population, the ONS, 2018) report that life expectancy at birth in the UK remains at 79.2 years for men and 82.9 years for women, based on this data we can estimate that the current life expectancy at birth for people with LD is 56.2 years for men and 55.9 year for women.

Furthermore CiPOLD (2013) reports that those individuals with more severe learning disabilities are more likely to encounter multiple co-morbidities and are therefore more likely to die even earlier.

There are other complex socio-economic and political factors responsible for contributing the health inequalities that people with LD experience; the negative perception of learning disability has been perpetuated during the COVID-19 pandemic which has further contributed to the health inequality rhetoric.

The inappropriate use of ‘Do Not Resuscitate’ (DNR) for people with a learning disability during the first wave of the pandemic highlighted the value that society places on people with LD.

This unacceptable practice has called for greater protections to be put in place to prevent further stigmatising of this vulnerable population.

Furthermore PHE (2020) have reported that people with a learning disability were up to 6 times more likely to die from Covid-19 and, in the 18-34 age group, their risk was 30 times higher.

Despite these findings, until very recently, people with LD were not prioritised to receive the COVID vaccine.

What Is Learning Disability Nursing?

The role of the LD nurse is paramount in addressing the multiple complex health needs of people with a LD.

This cohort of nurses provide specialist healthcare and social care support to people with a learning disability, their families and the people who support them.

The support provided can be delivered in a range of settings, for example, the family home, schools, colleges, workplaces, hospitals, clinics, GP surgeries, mental health services and prisons (NDTi, 2020).

Learning Disability Nurses possess all the fundamental clinical skills of a registered nurse, together with a range of additional specialist learning disability skills and knowledge.

The role is multi-faceted, drawing together many essential components of health facilitation, education, advocacy, health leadership and communication.

These broad specialist qualities are embedded within the clinical role and form the basis of the specialist nurse.

LD nurses play a vital role in care delivery as they are holistic practitioners who bridge the gap between the medical model and social model of care.

In drawing the two worlds together learning disability nurses strive to improve the lives of the people they support by mitigating the effects of health inequalities.

The Learning Disability Nurse aims to mitigate the effects of disability, by tackling social barriers that prevent people living independently (NDTi, 2020).

Person-centred and holistic care approaches are used to help address health inequalities and reduce the incidence of diagnostic overshadowing and premature deaths (NDTi, 2020).

These approaches support the delivery of safe and effective assessment and care planning; proving invaluable to improve and maintain physical and mental health (DHSC, 2012).

Why Do Students Want To Become A Learning Disability Nurse?

Learning disability nursing is often viewed as a hidden field of nursing.

From our experience of offering LD Nursing within our portfolio of nursing programmes at Northumbria University, we know many applicants coming to interview say that they stumbled across the course when they made their UCAS application.

Hidden it may be, but applicants often come inspired by their own first-hand experiences for example having a family member with a LD, have work experience or having worked in a formal care setting.

While it is widely acknowledged that nursing is vocational the desire to be a LD nurse is unique.

Applicants often recount the same story; in that they were looking for a position in care, went to work with people with a LD and just “loved it.”

What is apparent is the connection within the individual, whether that be a strong feeling, vocation or altruism, there is a psychological connection.

This is echoed in NDTi, (2020) “As a career choice, learning disability nursing is extremely rewarding and presents an attractive offer for individuals who may want to diversify in their career.

As many examples attest, the range of roles which learning disability nurses fulfil, goes someway to illustrate the adaptability and the transferability of their skills and knowledge.”

The Student Demographic

Learning disability nursing programmes attract students from a range of backgrounds.

Typically, applicants come directly from sixth form or further education institutes, some of whom bring with them personal experience of supporting people with LD.

In the same way, the course also attracts mature students or graduates looking for a career change, with applicants having had some professional experience in LD care.

What Are The Personal Characteristics And Skills Required For Learning Disability Nursing?

Learning Disability Nurses provide a specialist role in providing support to people with a learning disability, their families, and the wider support team (NMC, 2018).

Therefore, is essential that you are a good communicator and enjoy working with people in helping to make a difference.

In your career will work with a wide range of service users, family members and professionals.

You will also be responsible for managing and supporting people with a range of complex needs; therefore, it is important that you are organised and flexible to respond to changing need.

In order to effectively assess and support patients, nursing incorporates the art of noticing (Watson and Rebair, 2014).

Consequently, it will be a significant help if you are observant and take care in noticing the small things that result in making an enormous difference in people’s lives.

In addition, there are several other personal characteristics that will help you consider whether LD nursing is for you.

For example:

● if you believe in fairness and social justice?

● if you enjoy working in a person-centred and holistic way?

● do you consider yourself to be compassionate and creative?

● do you like to use your creativity to problem solve and reach the best outcomes?

If you possess these characteristics, then LD nursing may be the right career pathway for you.

Previous Care Experience Is Not Essential

Previous care experience can be helpful for students, but it is not essential, as the programme of study will help you develop and learn new skills during your nurse education.

It is important to remember that your experiences of working with and alongside people come in many different forms and are all equally important.

On account of this, it is helpful to consider the skills and qualities gained from such experiences.

It may be useful to think about situations where you have demonstrated motivation, commitment and worked hard.

Also consider any leadership experiences or situations of conflict or where you had to assert yourself.

All these skills can be especially useful for student nurses.

What Qualifications Are Essential To Study Learning Disability Nursing And What Routes Of Entry Are Available?

There are several routes available in applying to study learning disability nursing.

Each university will have its own provision and admissions requirements, so we would encourage you to contact your university of choice to find out their specific programmes and entry routes.

The detail here outlines our provision at Northumbria University to give you an indication of what we expect and what others will likely be looking for.

Northumbria University offers a 3-year full time programme, which leads to a graduate registered nurse and BSc qualification.

Standard Entry for Northumbria’s undergraduate BSc nursing course is 120 UCAS tariff points.

Qualifications can be made up from a combination of acceptable Level 3 qualifications which may include: A-level, BTEC Diplomas, Access to HE Diplomas etc.

A minimum GCSE grade 4/C or equivalent in Maths and English Language is also usual requirement.

Further information about studying undergraduate learning disability nursing can be found at UCAS. UCAS also manage applications for undergraduate nursing programmes.

For those students who already have an undergraduate degree there may be an opportunity to study at master’s level.

Northumbria University offers a 2-year full time course, leading to MSc qualification and graduate registered nurse status.

The standard entry requirements are a minimum 2:2 honours degree and GCSEs at Grade 4/C or above in English Language and Mathematics.

Candidates also need to demonstrate evidence of prior learning and experience in a related field.

MSc applications are made directly to the institution.

The nursing degree apprenticeship is another route into LD nurse education.

This is an employer led option, where the apprentice is employed by the organisation and released by their employer to study in a higher education institution.

The entry requirements are usually the same as set out for the BSc programme and this route will lead to a BSc qualification and registered nurse status upon graduation. (DHSC, 2016)

For more information, please refer to the Nursing degree apprenticeship factsheet.

Tips To Consider When Applying For A Learning Disability Nursing Course

Before you apply for a course, you may wish to consider the benefits of attending an open day.

An open day visit can help in your preparation, as this will help you find out more the programme of study, as well as giving you the opportunity to find out more about the institution and its facilities.

When you are applying for a place on a LD nursing programme make sure to include the reasons why you are interested in this specific field of nursing.

At Northumbria we offer a range of nursing courses including Mental Health, Child, and Adult branches, so it is important that you tailor your personal statement to your area of interest.

As you are looking to continue your education, make sure to report on your current or previous studies, and consider how they link to your nursing application.

It is also important to highlight the experience you have gained from your current studies.

Ensure to include any transferable skills you have gained from school, work, or your personal life.

Also consider any projects where you have been required to demonstrate organisation or leadership skills.

Remember the information provided on your personal statement does not necessarily need to be connected to your studies; an example might be to include any extra-curricular activities or hobbies or any voluntary or community work you have undertaken during Covid-19.

The Learning Disability Nurse Interview - Top Tips

In order to secure a place on a LD nursing programme you will be required to attend an interview, therefore suitable interview preparation is recommended.

In readiness make sure you have studied the course profile, and ensure you understand what is involved in being a nurse.

People with learning disabilities can be vulnerable to a range of physical and mental health conditions and are more likely to experience co-morbid conditions, yet despite this, they still experience challenges in accessing appropriate health care services.

So, make sure you do your research, find out what it is like to be a nurse, and consider what skills are required for LD nursing.

Be prepared to talk about your skills and qualities and how they can help you in becoming a nursing student.

Also ensure to read about current nursing and health care issues so that you can contribute to the interview discussions.

The essence of nursing is built on a solid foundation of values (DHSC, 2012; DH, 2012; NMC, 2018); therefore, you can anticipate a value-based recruitment approach during your interview.

Values based recruitment helps to attract students whose individual values and behaviours align with the profession and with the wider NHS values.

Therefore, make sure you are familiar with the NHS values, the 6Cs of nursing, NHS Constitution and the Nursing & Midwifery Council Standards.

Also, think about what you are going to wear, as it is important to consider how you present yourself to the interview panel.

During the current covid disruption, you may be invited to attend an online interview.

While online platforms provide you with the convenience of being interviewed in the comfort of your own home, it is important to remember that you are attending a formal appointment, so make an effort with your attire.

Choose something you feel comfortable wearing, providing it is not your pyjamas!

Make sure you prepare questions to ask your interview panel, remember the interview is a two-way process and you need to find out if the course is suitable for you.

Here’s an article with some specific nursing degree course interview tips by a student nurse.

What Should Students Expect When Studying To Be A LD Nurse?

Regardless of which route you take into nursing; you can expect a combination of both clinical placement and academic requirements.

The Nursing & Midwifery Council (NMC) requires that nursing programmes provide students with essential academic and clinical experiences during their learning journey.

Consequently, students will gain exposure to a range of clinical placements during their programme and will also be required to address a range of academic projects and assessments.

The emphasis on higher education is to promote independent learning and independent thinking.

Therefore, a prominent level of motivation, commitment and time management skills are required to address the essential elements of the programme.

During placement, students will gain access to a variety of clinical areas, such as specialist community teams, children services, forensic inpatient services, prison services and specialist school environments.

During this time students will be guided by a range of clinical staff to help achieve clinical standards and proficiencies.

Depending on the placement area, students may be expected to work shift patterns and need to be prepared to travel.

In the academic setting students will have access to a range of academic and pastoral support to help facilitate learning and achieve academic excellence.

Students, however, are encouraged and supported to develop their study and time-management skills to help them address the requirements of the programme.

Engagement with learning leadership programmes and peer study groups are also a helpful means of facilitating good study habits.

To foster our ongoing commitment, feedback is actively sought from our student group to support the quality assurance of the programme.

During the covid-19 disruption students have continued to be fully supported and this is reflected in our most recent National Student Survey feedback (2020) with students offering an overall satisfaction rating of 93% for LD nursing.

Our commitment to students is also noted in the Guardian University League Tables (2021) with Northumbria University being ranked 12th for Nursing & Midwifery in the UK.

What Are The Challenges For The Learning Disability Nurse?

The current learning disability workforce in England is noted to be under-resourced in meeting the needs of people with a LD.

There are many factors that contribute to the current position, foremost the LD nurse workforce are one of the oldest workforces, which has resulted in many experienced nurses taking advantage of retirement.

In recent years we have also seen a reduction of people joining the profession; associated with misconception and stigma surrounding the role.

Research carried out by NDTi (2020) highlights the ongoing perception that LD nurses are often regarded as not being “proper nurses”.

The temporary loss of the nursing bursary has also impacted on admission to the profession.

Research indicates that these factors have contributed to a 40% decline in the workforce causing a national shortage of learning disability nurses (NDTi, 2020).

We need more nurses to strengthen the workforce and promote the excellent work LD nurses do; this is echoed by NDTi (2020) who recommend education to health and social care staff to highlight the valuable contribution LD nurses make across health and social care.

Stigma is also an issue that needs to be tackled, and we need to move away from the label of not being “proper nurses”.

Theories of marginalisation and stigma have been associated with learning disability nursing since the role began.

In the article parallel stigma, Mitchel (2000) explores the relationship between nurses and the people they care for, purporting the parallel stigma developed over the last century.

Moving forward, we need advocates to raise the profile of this branch of nursing and help dispel those misconceptions commonly associated with people with learning disabilities and the specialist LD nurse.

Despite these challenges, there has never been a better time to join the profession and it is reassuring to know that there are strong plans in place to redress the balance.

Primarily, there is an established commitment to increase undergraduate places to welcome new nurses into the profession (NHS, 2020).

The plan recognises that we need to recruit and train more learning disability nurses and there are now a flexible range of options available to encourage people to become a LD nurses, this, together with the return of the nursing bursary, can make studying to become a LD nursing a flexible and realistic option. (Strengthening the Commitment, 2012; NHS, 2019; NHS, 2020; NDTi, 2020).

Reassuringly, we are already starting to see a significant uplift in applications for nursing programmes across the UK, partly inspired by the work of nurses during the covid-19 pandemic (Ford, 2021).

Furthermore, the Department of Health and Social Care (DHSC, 2019) have announced their commitment for mandatory learning disability and autism training for health and care staff in the UK, supporting the commitment to reduce health inequalities.

What Are The Prospects Of Finding A LD Nurse Job?

In view of the of the current climate, graduates are in an extremely optimistic position in gaining employment.

Over the past 8 years, at least 99% of Northumbria University LD graduates have been successful in gaining NHS employment directly after completing their programme of study.

The remaining 1% have opted to travel or take a year out before moving into the workforce.

While no university course can guarantee future employment, these are excellent statistics in supporting the onward career pathway.

What Are The Career Opportunities For Learning Disability Nurses?

The challenge is often choosing which area to specialise.

Many students start the programme with a specific onward career path in mind, however, change their mind as they progress through the course.

Students find it helpful to experience a range of clinical learning opportunities and placements help to stimulate their decision-making.

The role of the LD nurse is wide and diverse, and so too are the career opportunities.

The fundamental skills and experiences developed throughout the LD nursing programme will prepare graduates to shape their onward career.

Many NHS organisations, education institutes, independent and voluntary organisations welcome applications from LD nurses.

Authors

Written by Carol Morgan and Janice MacKnight The authors are both Senior Lecturers and Admissions Tutors at Northumbria University.

References

Blair (2018) Diagnostic Overshadowing: See Beyond the Diagnosis. University Press. Available at: www.intellectualdisability.info/changing-values/diagnostic-overshadowing-see-beyond-the-diagnosis

Department of Health (2012) Compassion in Practice. Available at: https://www.england.nhs.uk/wp-content/uploads/2012/12/compassion-in-practice.pdf [Accessed on 01.04.2021]

Department of Health & Social Care (2016) Nursing degree apprenticeship: factsheet. Available at: https://www.gov.uk/government/publications/nursing-degree-apprenticeships-factsheet/nursing-degree-apprenticeship-factsheet [Accessed on 01.05.2021] Dept of Health & Social Care (2012)

The NHS constitution for England. Available at: https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england. [Accessed on 30.04.2021]

Department of Health & Social Care (2019) ‘Right to be heard’: The Government’s response to the consultation on learning disability and autism training for health and care staff. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/844356/autism-and-learning-disability-training-for-staff-consultation-response.pdf [Accessed on 06.05.2021]

Ford, M. (2021) Nursing courses see 32% rise in applications during Covid-19. Nursing Times. Available at: https://www.nursingtimes.net/news/education/nursing-courses-see-32-rise-in-applications-during-covid-19-18-02-2021/ [Accessed on: 13.05.2021]

Hatton, C., Emerson, E., Robertson, J., & Baines, S. (2017). The mental health of British adults with intellectual impairments living in general households. Journal of Applied Research in Intellectual Disabilities, 30(1), pp.188-197.

Mencap, (2012) Death by indifference: 74 deaths and counting. A progress report 5 years on. Available at: https://www.mencap.org.uk/sites/default/files/2016-08/Death%20by%20Indifference%20-%2074%20deaths%20and%20counting.pdf [Accessed on 30.04.2021]

Mencap (2018) Mental health: People with a learning disability can be more likely to experience poor mental health. Available at: https://www.mencap.org.uk/learning-disability-explained/research-and-statistics/health/mental-health [Accessed on 19.04.2021]

NDTi (2020) This is Us –This is What We Do. A report to inform the future of Learning Disability Nursing. Available at: https://www.ndti.org.uk/assets/files/Learning-Disability-Nursing-Report-FINAL.pdf [Accessed on –1.04.2021]

NHS (2019a) The NHS Long Term Plan. Available at: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf [Accessed on 19.04.2021]

NHS (2019b) Learning Disability Mortality Review (LeDeR) Programme: Action from Learning. Available at: https://www.england.nhs.uk/wp-content/uploads/2019/05/action-from-learning.pdf [Accessed on 30.04.2021]

NHS (2020) We are the NHS: People Plan 2020/21 - action for us all. Available at: https://www.england.nhs.uk/wp-content/uploads/2020/07/We-Are-The-NHS-Action-For-All-Of-Us-FINAL-March-21.pdf [Accessed on: 06.05.2021]

NMC (2018) The Code: Professional standards of practice and behaviour for nurses, midwives, and nursing associates. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf. [Accessed on 30.04.2021]

Mitchell, D. (2000) Parallel stigma? Nurses and people with learning disabilities. British Journal of Learning Disabilities, Vol. 28, pp.78-81

PHE (2020) Deaths of people identified as having learning disabilities with COVID-19 in England in the spring of 2020. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/933612/COVID-19__learning_disabilities_mortality_report.pdf [Accessed on 06.05.2021]

The Guardian (2021) Best UK universities for nursing & midwifery – league table. Available at: https://www.theguardian.com/education/ng-interactive/2020/sep/05/best-uk-universities-for-nursing-midwifery-league-table [Accessed on: 13.05.2021]

The Scottish Government (2012) Strengthening the commitment: The report of the UK Modernising Learning Disability Nursing Review. Available at: file:///C:/Users/wnhf9/Downloads/00391946.pdf. [Accessed on 20.04.2021]

University of Bristol Norah Fry Research Centre (2013) Confidential Inquiry into premature deaths of people with learning disabilities (CIPOLD). Available at https://www.bristol.ac.uk/media-library/sites/cipold/migrated/documents/fullfinalreport.pdf [Accessed on 30.04.2021]

Watson F., and Rebair A. (2014) The art of noticing: essential to nursing practice. British Journal of Nursing. 11;23(10), pp.514-7. doi: 10.12968/bjon.2014.23.10.514. PMID: 24851914

3 years ago

Carol Morgan
Carol Morgan
3 years ago
Hi Sarah, I would recommend a Return to Practice course. Many Universities offer short courses of this nature. The course ... read more

Hi Sarah, I would recommend a Return to Practice course. Many Universities offer short courses of this nature. The course is suitable for Nurses wishing to return to the professional register and re-register with the NMC. You may wish to check out the course offered at Northumbria University. I hope that helps? Kindest regards, Carol
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3 years ago

Sarah Oxenbury
Sarah Oxenbury
3 years ago
I am RNMH trained since 1988. I haven’t got my PIN right now, and am working in a nursing home ... read more

I am RNMH trained since 1988. I haven’t got my PIN right now, and am working in a nursing home but want to return to the register. What’s the most straightforward way to do it??
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Introductory Guide For Someone Considering A Career In Learning Disability Nursing

This article provides guidance to those considering a career in LD nursing by providing an overview of the student nurse pathway, application process, common questions and life beyond student nursing.

Topics Covered In This Article

Introduction

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