Empowering RNLDs to articulate their unique contribution to addressing health inequalities
Inequality, workforce and outcome: articulating the Learning Disability Nurse’s contribution when working alongside people with learning disabilities.
In 2024, Martin Bollard at the University of Wolverhampton, was awarded funding from the RCN Foundation to undertake a project exploring the potential contribution a new framework has for Registered Nurses for Learning Disability (RNLDs) to improve health outcomes, reduce health inequalities and more confidently articulating their work for people with learning disabilities.
The project examined the extent in which RNLDs are able to address health inequalities through the scope of their primary/acute care practice. The research also captured role perceptions/expectations of RNLDs as well as the capacity for overcoming health inequalities via nurse-led interventions.
The study involved people with lived experience as a key expert citizen reference group, providing commentary on how they would like the LD Nurses to respond to the complexity of their needs and how impact may be evidenced.
Martin’s research was also featured in Nursing Standard which you can read here.
Demystify the role of Registered Learning Disability Nurses
There are 16,840 Registered Learning Disability Nurses (RNLDS) on the NMC register (NHS Benchmarking Data, 2021). Whilst this constitutes a small part of the overall nursing workforce, RNLDs hold an unparalleled qualification with unique skills and competencies. RNLDs work in a multitude of settings across health and social care in a variety of organisations, in and outside of the NHS.
The dispersed nature of the RNLD workforce makes it challenging to scope, track and evidence the contribution they make. However, there is evidence to highlighting the difference and contributions RNLDs make to individuals with a learning disability.
The output of Martin’s 12-month research was a Myth-Busting Tool that aims to help articulate the role of the RNLD and the scope of care they provide. You can read the document in full here.
Myth-busting
Myth 1: Learning Disability Nurses don’t carry out clinical skills
No. RNLDs are trained in the same basic physical care competencies as all fields of Nursing. RNLDs may not work specifically in specialised wards but do carry out clinical skills. RNLDs are also regarded as having enhanced communication skills, a core clinical skill when working with People with a Learning Disability.
Myth 2: Learning Disability Nurses just facilitate social activities
No. Whilst RNLDs can support, signpost or oversee a package of care that may include social activities, RNLDs have a range of skills to promote the optimum health and care for People with a Learning Disability. RNLDs are trained in and can make a variety of different health assessments depending on need and specific associated health condition. These assessments range from, but are not exclusive to, dementia checklists, pain assessments and are often grounded in nursing frameworks that RNLDs have developed themselves.
Myth 3: Learning Disability Nurses only take people to health appointments and administer medication
No. RNLDs work with a range of associated health support and key workers, as well as other health professionals. They are skilled health professionals and over time have acquired specialist skills in areas such as epilepsy and behavioural.
Myth 4: Learning Disability nurses don’t work in advanced roles or carry out functions like prescribing different medicines
No. Many RNLDs work at an advanced level of practice across the four UK nations. Advanced practice is a higher level of practice which can involve, for example, RNLDs both prescribing medications and actively working to reduce the amount of medication people with a learning disability are on.
Myth 5: Learning Disability Nurses do everything related to the person with a learning disability to help mainstream health services
Not strictly true, but in some localities where there are not the resources to support mainstream services, Community Teams, or an acute liaison RNLD, may facilitate mainstream health services and help individual People with a Learning Disability. Localities which have invested in RNLDs working in acute and primary care, or where mainstream services have employed RNLDs directly, RNLDs make a difference to reducing inequalities and improving the health outcomes of People with a Learning Disability.
Myth 6: Learning Disability Nurses only arrange discharges and social care related activities
No. There is more complexity to the role of the RNLDs outside of these two activities. RNLDs will be involved in facilitating discharges from a variety of settings including mainstream hospitals. Within these hospitals, RNLDs can be involved in the case management of individuals from admission through to discharge. This can involve preparing People with a Learning Disability for an or surgery, specific work on aspiration pathways, or ensuring acute care staff are making the necessary reasonable adjustments for People with a Learning Disability.
Myth 7: Learning Disability Nurses work with People with autism who don’t have a learning disability
Yes and No. This very much depends on the different eligibility criteria local service providers have and if there is an Autism pathway on offer. 54% of People with a Learning Disability also have Autism. RNLDs have built up transferrable skills to work with People with a Learning Disability who also have an autism diagnosis. Some RNLDs work within only autism services too.
Myth 8: Only Learning Disability Nurses complete mental capacity assessments for People with a Learning Disability
No. It is the responsibility of every clinician to ensure they adhere to the rights of People with a Learning Disability under the Mental Capacity Act (2005). However, RNLDs working in acute hospitals, for example, have a key role educating and supporting mainstream staff to make the necessary reasonable adjustments under the Equality Act (2010) before treatment decisions are made.
Myth 9: Learning Disability Nurses only work in the NHS and social care organisations
No. RNLDs are a dispersed workforce where their skills are valued by many different organisations. RNLDs make a strong contribution in and across NHS and social care settings but also work in prisons, private forensic environments and run their own social enterprises involving People with a Learning Disability. A key part of the RNLDs role is the co-ordination of care across multi-professional teams.
Myth 10: Learning Disability Nurses work with people who have dyslexia
No. Dyslexia is a special educational need and sits outside of the diagnostic categories associated with Learning Disability. RNLDs do not work in education settings but can work alongside other children and young people’s services such a CAMHS. RNLDs also play a critical role in working with parents and children and young people with a Learning Disability at the point of transition into adult services.