Everybody should know their rights and entitlements in the workplace but unfortunately, many of us don't. In order to feel confident, secure and happy at work, we really need to know all the information, whether it is uncertainty about what to do about a dispute or a maternity issue. Below is some information that is key to know in the workplace.

Discrimination, bullying or harassment/

All employers are responsible for ensuring that all staff know that this kind of behaviour is not tolerated and policies should be in place to protect employees from discrimination. Sexual discrimination, sexual orientation, gender identity, age and race discrimination, religion or belief and disability all fall under this category.

Steps to take if you are a victim of any of the above:

• Get advice from the Acas helpline, Citizens Advice Bureau or a bullying helpline
• Talk to colleagues to find out if anyone else is suffering or has witnessed what's happened to you
• See someone who you feel comfortable with to discuss the problem, perhaps a senior nurse or practice manager
• Keep a diary of all incidents: record dates, times, witnesses, your feelings, etc, keep copies of anything relevant, e.g. letters, memos, emails, notes of meetings
• Inform your employer of any medical help you seek
• If you are able, tell the person to stop whatever it is they are doing that causes you distress, as they might be unaware of its effects – you might want to ask someone else to act on your behalf
• Consider writing a letter or email if you can't confront the person
• If you make a formal complaint, follow your employer's procedures
• If you have a union representative or other adviser, ask them to help you state your grievance clearly

Maternity and Paternity rights/

If you become pregnant, you automatically have the right to ordinary maternity leave and additional maternity leave. At the end of ordinary maternity leave, you are entitled to return to your original job. At the end of additional leave, you should still be able to return to your original job, but if this is not reasonably practicable, a suitable alternative job will be made available for you. During maternity leave, you may work and be paid as usual for up to 10 'Keeping in Touch days'.

All pregnant employees are entitled to time off with pay to keep appointments for antenatal care made on the advice of a registered medical practitioner, midwife or health visitor. Antenatal care may include relaxation classes and parent-craft classes. Except for the first appointment, you must show your employer, if requested, a certificate from a registered medical practitioner, midwife or health visitor, confirming the pregnancy together with an appointment card or some other document showing that an appointment has been made.

What pay am I entitled to during maternity leave?

You are entitled to Statutory Maternity Pay (SMP) if you have been employed by your employer for a continuous period of at least 26 weeks ending with the 15th week before the expected week of childbirth, and have average weekly earnings at least equal to the lower earnings limit for National Insurance contributions. SMP can be paid for up to 39 weeks; it is payable by the employer but partly (or, for small firms, wholly) reimbursed by the state.

From April 2010 the standard rate of SMP is £124.88 a week (or 90 per cent of your average weekly earnings if this is less than £124.88 a week). For the first six weeks the rate is 90 per cent of average weekly earnings with no maximum limit. The standard rate of SMP is reviewed every April.

If you have not been working for my employer long enough to qualify for SMP, don't panic! You may be entitled to Maternity Allowance (MA), paid by the Benefits Agency, for up to 39 weeks. To qualify, you must have been employed or self-employed for 26 weeks out of the 66 weeks before the expected week of childbirth and have average weekly earnings of at least £30.

To qualify for maternity leave, you must tell your employer by the end of the 15th week before the expected week of childbirth:

• That you are pregnant
• The expected week of childbirth, by means of a medical certificate if requested
• The date you intend to start maternity leave. This can normally be any date which is no earlier than the beginning of the 11th week before the expected week of childbirth up to the birth.

Your employer must then write to you within 28 days of her notification, setting out your return date. You can change this date if you give your employer 'eight weeks' notice.

During the 26 weeks' ordinary maternity leave (plus optional 26 weeks additional maternity leave), you are entitled to benefit from all your normal terms and conditions of employment, except for remuneration (monetary wages or salary). You can also do up to 10 days' work during your maternity leave without losing any Statutory Maternity Pay. Your employer should agree payment with you for the time worked.

If you are a father to be or will share the responsibility with a partner for bringing up a child, you may have the right to Statutory Paternity Leave and Pay. This includes adoptive fathers-to-be.

To qualify, you will have worked continuously for your employer for 26 weeks ending with the 15th week before the baby is due, or the end of the week in which the child's adopter is notified of being matched with the child.

Paternity leave is available to employees who:

• Have or expect to have responsibility for the child's upbringing
• Are the biological father of the child or the mother's husband or partner
• Have worked continuously for their employer for 26 weeks ending with the 15th week before the baby is due or the end of the week in which the child's adopter is notified of being matched with the child.

Those who are eligible can choose to take either one week or two consecutive weeks' paid paternity leave (not odd days).

Parental leave/

If you have completed one year's service with an employer, you are entitled to 13 weeks unpaid parental leave for each child born or adopted. The leave can start once the child is born or placed for adoption, or as soon as you have completed a year's service, whichever is later. You can take it at any time up to your child's fifth birthday (or until five years after placement in the case of adoption). If your child is disabled, you can take 18 weeks up to his or her's 18th birthday.

A request should be made your employer giving 21 days notice of the start date of the parental leave- the employer may ask for this to be in writing. As long as you qualify for parental leave and give your employer the correct notice, you should be able to take parental leave at any time.

To take parental leave straight after the birth or adoption of a child, you should give notice 21 days before the beginning of the expected week of childbirth or placement. In cases where this may not be possible you should give notice to your employer as soon as possible. For example, if a child is born prematurely or where less than 21 days notice is given that a child is to be placed with you for adoption.

You will remain employed while on parental leave and some terms of your contract, such as contractual notice and redundancy terms, still apply. At the end of parental leave you will have the right to return to the same job as before or, if that is not practicable, a similar job with the same or better status and terms and conditions. If leave is taken for a period of four weeks or less, you will be entitled to go back to the same job.

Parental leave should only be taken to care for the welfare of a child, for example you may wish to take leave to:

• Stay with your child who is in hospital
• Spend more time with your child
• Make school/childcare arrangements and to help them settle in.

An employer can only postpone parental leave if they have a good business reason for doing so, for example: seasonal production, another member of staff is off or the staff absence would harm the business. Parental leave can be postponed for up to 6 months but cannot be postponed so that the leave ends after the child's fifth birthday (or 18 in the case of adopted or disabled children).

Redundancy and Notice/

Both the employer and employee are normally entitled to a minimum period of notice of termination of employment. These are regarded as being amongst the main terms of an employment contract, and should therefore be included on an employee's written statement, which he should receive within two months of starting work. In the event of a dispute over notice requirements, the parties should try to resolve the matter by following the company's internal procedures.

Both you and your employer are normally entitled to a minimum period of notice of termination of employment. After one month's employment, you must give your employer at least one week's notice; this minimum is unaffected by longer service. Your employer must give you:

• At least one week's notice after one month's employment
• Two weeks after two years
• Three weeks after three years and so on up to 12 weeks after 12 years or more

However, you and your employer will be entitled to a longer period of notice than the statutory minimum if this is provided for in the contract of employment.

Most employees, subject to certain conditions, are entitled to certain payments during the statutory notice period. You can waive your right to notice or to payment in lieu of notice. Your employer can also waive their right to notice.

Unfair dismissal/

Dismissal is normally fair only if your employer can show that it is for one of the following reasons:

• A reason related to your conduct
• A reason related to your capability or qualifications for the job
• Because you were redundant
• Because a statutory duty or restriction prohibited the employment being continued
• Some other substantial reason of a kind which justifies the dismissal and that they acted reasonably in treating that reason as sufficient for dismissal

Employees have the right not to be unfairly dismissed. In most circumstances you must have at least one year's continuous service before you can make a complaint to an employment tribunal. However, there is no length of service requirement in relation to 'automatically unfair grounds'. Also, the requirement is reduced to one month if you claim to have been dismissed on medical grounds as a consequence of certain health and safety requirements that should have led to suspension with pay rather than to dismissal.

A complaint of unfair dismissal must be received by an employment tribunal within three months of the effective date of termination of the employment (usually the date of leaving the job) unless the tribunal considers this was not reasonably practicable. Time limits may also be extended where statutory procedures apply - subject to certain conditions.

If both you and your employer agree, instead of going to an employment tribunal, the case may be heard by an arbitrator under the Acas Arbitration Scheme. If a tribunal establishes that a dismissal has taken place it is normally for your employer to show that it was for a fair reason and that they have, as a minimum, followed the statutory disciplinary procedures. In such cases the tribunal must then decide whether, in the circumstances, your employer acted reasonably in treating that reason as sufficient for dismissal.

Dismissals are classed as 'automatically unfair', regardless of the reasonableness of your employer's action, if you are exercising specific rights to do with:

• Pregnancy: including all reasons relating to maternity
• Family reasons: including parental leave, paternity leave (birth and adoption), adoption leave or time off for dependants
• Representation: including acting as an employee representative and trade union membership grounds and union recognition
• Part-time and fixed-term employees
• Discrimination: including protection against discrimination on the grounds of age, sex, race, disability, sexual orientation and religion or belief
• Pay and working hours: including the Working Time Regulations, annual leave and the National Minimum Wage

Employees who are dismissed and have completed at least one year's continuous employment are entitled to receive, on request (orally or in writing), a written statement of reasons for dismissal within 14 days. An employee dismissed during:

• Her pregnancy or her ordinary or additional maternity leave
• His or her ordinary or additional adoption leave

is entitled to a written statement of the reasons regardless of length of service and regardless of whether or not the request was made

References: ACAS website

For more information on employment rights, please visit: www.acas.org.uk

A Dental Nurse assists the Dentist in all aspects of patient care and also supports other members of the dental team. A Dental Nurse mainly works in surgery assisting the Dentist but can often work on reception and participate in administrative duties too. It is the duty of the Dental Nurse to:

• Open and close the surgery every day.
• Adhere to cross-infection and health and safety protocols to the highest standard.
• Ensure that all equipment is adequately disinfected after every single patient and dental instruments are decontaminated correctly.
• Set up for each and every patient, providing the Dentist with the correct equipment and instruments.
• Assist the Dentist during treatment by passing relevant instruments and equipment, aspirating and retracting if necessary.
• Prepare and mix materials.
• Write patient notes correctly and efficiently as dictated by the Dentist.
• Monitor the patient from them entering the room, during treatment and as they leave the surgery.
• Offer support and reassurance to patients.
• Carry out stock control.

If and when a Dental Nurse works on reception, duties may involve:

• Greeting patients and checking them in.
• Answering the phone and dealing with patient enquiries.
• Booking appointments.
• Taking payments.
• Liaising with laboratories and referral practices/hospitals.

In order to become a Dental Nurse, you need to embark on a course which is recognized by the General Dental Council (GDC), such as the National Certificate, which is awarded by the National Examining Board for Dental Nurses (NEBDN) or the NVQ Level 3 in Dental Nursing. It is also now compulsory for every Dental Nurse to register with the GDC. Most Dental Nurses start their training in a Dental Practice immediately and have a day release during the week for college study. Training on average lasts about 18 months to 2 years depending on the course.

Once you have qualified as a Dental Nurse, there are additional qualifications that are obtainable such as:

• Dental Radiography.
• Oral Health Education.
• Dental Sedation Nursing.
• Orthodontic Nursing.

All post-graduate courses are awarded by the NEBDN and the British Dental Association provides most of the courses.

The Dental Radiography course enables the Dental Nurse to take radiographs of patients as advised by the Dentist. The course involves online study and theory combined with practical training provided by a qualified member of the dental team such as the Dentist. Throughout the course, the Dental Nurse has to take a series of radiographs including bitewings, periapicals and OPG’s and record the patient details and the reason for the radiograph. There are also case studies that need to be completed. There is an exam at the end of the course and you will be awarded the qualification if you have passed the exam and completed the coursework adequately.

The Oral Health Education course enables the Dental Nurse to offer Oral Health Education to patients, families and even groups of people, e.g. at a school. The course has the same elements as the Dental Radiography course and involves online study combined with practical training. Case studies need to be recorded throughout the course and there is a written and oral exam at the end.

The Dental Sedation course enables the Dental Nurse to assist as the “second appropriate person” present as well as the Dentist providing the sedation.  The course involves theory work and practical work including case studies, which can be obtained by visiting a dental practice or hospital that regularly offers sedation if your practice does not- however the sedation course is only really of use to a Dental Nurse who is regularly working in a sedation-based environment. Similarly to the previous courses, there is a written and oral exam at the end of the course.

The Orthodontic Nursing course enables the Dental Nurse to work efficiently alongside an Orthodontist. The course also has a combination of theory and practical work and an exam at the end.

Where can Dental Nursing lead to?

There are many paths available to Dental Nurses who want to advance into other areas of Dentistry, including:

• Dental Hygiene and Therapy.
• Practice Management.
• Teaching and Assessing.
• Lecturing.
• Representing a Dental Company (Sales)

Dental Nurses can also work in different environments. There is obviously general practice, orthodontic practices, hospitals and even the Army recruit Dental Nurses.

This includes accurately charting all present teeth and past treatment, all treatment needed, correctly labelling and mounting radiographs, maintaining an updated medical history, keeping a record of all correspondence with specialists etc, retaining consent forms and recording accurate clinical notes every time the patient attends.

It is important to maintain correct records firstly so that all information about the patient is available in order to provide them with the treatment and care most suitable for them, and secondly for legal reasons.  If there is any dispute between the patient and dentist it is important that the dentist can provide accurate notes showing any diagnosis, advice or treatment they have given to the patient, and their reasons for doing so.  The dentist therefore can provide written evidence justifying any treatment or advice they have given to the patient.

Patient Details

A record should be kept of the patient’s date of birth, current address and telephone number and/or email address. The patient should be routinely asked if there is any change in contact details.

Attendance

Records should be kept of all appointments patients have failed to attend, have cancelled or attended late.

Medical History

Patients’ medical history should be updated every time the patient attends. This is extremely important as certain drugs the patient may be taking, such as anticoagulants, can cause excessive bleeding after extractions, and other medication can react with drugs administered during dental treatment, such as the adrenaline contained in some local anaesthetic solutions.

If medical history is checked verbally a record should be made in the patient’s notes. Ideally the patient should be given a medical history form to complete prior to the appointment which can then be scanned to the patient’s notes if these are computerised, or kept with the patient’s record card.

The following should be recorded:

• The patient’s GP

• any medical conditions such as epilepsy or diabetes

• any allergies such as Asthma or Penicillin allergy

• any infectious diseases such as Hepatitis B or HIV

• if the patient is pregnant

• any medication  the patient is currently taking

• if the patient is currently undergoing any treatment or has had any recent operations

• oral cancer risk factors including whether the patient smokes and average weekly alcohol consumption

Charting

Dental charting is a diagrammatic representation of teeth and their surfaces providing a visual note of the patient’s teeth and any treatment they have had on them. Charting is not only important in the respect that it shows the dentist an immediate representation of the patient’s mouth so is an important aid in patient diagnosis and treatment, but it is also an aid in forensic identification of bodies. Correct charting can be the only means of identifying bodies in cases such as burn victims, so it is of vital importance that it is recorded accurately.

At the patient’s first visit a full base chart should be recorded showing all teeth present and any treatment that has been carried out on them. The charting should be checked each time the patient attends and updated if there are any changes.

There are two main systems of tooth notation available when referring to specific teeth in the clinical notes. In the United Kingdom Palmer tooth notation is often used. In handwritten notes it involves using a quadrant symbol and the tooth number:

__                                        __

|           lower left                     |      lower right      __|  upper right        |__        upper left

As demonstrated this does not work well on computerised notes (!) so quadrants are referred to as UL - upper left, UR - upper right, LL - lower left and LR - lower right.

The International Dental Federation two-digit system is a globally recognised form of tooth notation where quadrants are recognised as numbers:  1 - upper left, 2 - upper right, 3 - lower left, 4 - lower right, and for deciduous teeth, 5 - upper left,  6 -  upper right, 7 - lower left and 8-  lower right.

Both forms of notation are acceptable and the dental nurse should use the system that the dentist prefers.

Other forms of charting may be required such as charting the findings of a Basic Periodontal Exam - this ideally should be carried out at every examination appointment. Pocket, mobility, plaque or surface wear charting may also be required.

Clinical Notes

At an examination or emergency assessment appointment the first thing that should be recorded in the clinical notes is the patient’s chief complaint, followed by anything else the patient complains of or wishes to report. This should be recorded as closely as possible to the patient’s own description of their symptoms.

Any diagnosis or observations the dentist makes should then be recorded along with any charting updates. All discussions regarding treatment options, including costs or any questionable prognosis of any treatment, changes in treatment plans or post-operative warnings should be recorded.

At appointments where patients are undergoing treatment concise details should be made of the treatment being carried out and correct notation of where it is being carried out, along with records of any drugs administered and materials/equipment used. Records should be made of any post-operative advice given.

Notes should always be recorded during and directly after the patient’s visit as it is required that they are contemporaneous. It must also be taken into consideration that patients’ can request to see their clinical notes; therefore they must be written in a professional manner with no derogatory comments made about the patient. For example, if a patient attended complaining of a broken tooth a note should be made of this, including how and when it was broken, what tooth or area of mouth patient describes and any symptoms:

‘Pt c/o broken tooth UR area this morning whilst eating cereal, causing sensitivity to cold.’

The dentist’s diagnosis, any vitality tests or radiographs, and any discussions about treatment plans should then be recorded:

‘O/e: UR5 fractured mesio-buccal cusp, pt has a heavy bite and not much tooth left so advised patient that a crown is the best option. Explained to patient tooth can have a composite restoration but that it may not last long. Explained differences between gold and porcelain bonded crown, advised patient that PBC was the most aesthetic option, but gold is slightly stronger and helps periodontal condition. Patient concerned about crown blending in with existing crowns and veneers, concerned about metal becoming visible due to gingival recession as this has happened to the patient before. Discussed option of Lava crown (metal free), shown patient some photographs of Lava crowns, patient wishes to go ahead. PA taken of UR5 to check suitability of tooth for crowning, PA shows tooth to be suitable .Pt given verabl and written estimates and consent form to sign.’

Although the dental nurse should record as much information as possible in the patient’s clinical notes and write them as accurately as possible, the dentist is ultimately responsible for their content, so before any notes are saved and the patient’s appointment is marked as complete, the dentist should check that the notes are satisfactory and make any necessary additions or ammendments.

Radiographs

If radiographs are processed and mounted digitally then they should be attached to the correct patient’s notes, orientated correctly and labelled accurately recording the type of radiograph and teeth present on radiograph. Reasons for taking radiograph and findings should be recorded in the patient’s clinical notes. Radiographs that are manually processed should also be correctly mounted and labelled and kept with the patient’s record card.

Correspondence

Any correspondence with specialists or hospitals such as letters or emails should be retained and either scanned to the patient’s digital notes or kept with the patient’s record card. Any paper work regarding confidential information about patients should be shredded after scanning to patient’s notes. This also applies to medical history forms.

A record of any correspondence made regarding the patient, or with the patient, over the telephone should be made in the patient’s clinical notes.

Patients’ notes are a legal document. Dental nurses therefore have a responsibility to make these records as accurate and detailed as possible so that all relevant information is present and correct. This includes accurately charting all present teeth and past treatment, all treatment needed, correctly labelling and mounting radiographs, maintaining an updated medical history, keeping a record of all correspondence with specialists etc, retaining consent forms and recording accurate clinical notes every time the patient attends.

It is important to maintain correct records firstly so that all information about the patient is available in order to provide them with the treatment and care most suitable for them, and secondly for legal reasons.  If there is any dispute between the patient and dentist it is important that the dentist can provide accurate notes showing any diagnosis, advice or treatment they have given to the patient, and their reasons for doing so.  The dentist therefore can provide written evidence justifying any treatment or advice they have given to the patient.

Patient Details

A record should be kept of the patient’s date of birth, current address and telephone number and/or email address. The patient should be routinely asked if there is any change in contact details.

Attendance

Records should be kept of all appointments patients have failed to attend, have cancelled or attended late.

Medical History

Patients’ medical history should be updated every time the patient attends. This is extremely important as certain drugs the patient may be taking, such as anticoagulants, can cause excessive bleeding after extractions, and other medication can react with drugs administered during dental treatment, such as the adrenaline contained in some local anaesthetic solutions.

If medical history is checked verbally a record should be made in the patient’s notes. Ideally the patient should be given a medical history form to complete prior to the appointment which can then be scanned to the patient’s notes if these are computerised, or kept with the patient’s record card.

The following should be recorded:

• The patient’s GP

• any medical conditions such as epilepsy or diabetes

• any allergies such as Asthma or Penicillin allergy

• any infectious diseases such as Hepatitis B or HIV

• if the patient is pregnant

• any medication  the patient is currently taking

• if the patient is currently undergoing any treatment or has had any recent operations

• oral cancer risk factors including whether the patient smokes and average weekly alcohol consumption

Charting

Dental charting is a diagrammatic representation of teeth and their surfaces providing a visual note of the patient’s teeth and any treatment they have had on them. Charting is not only important in the respect that it shows the dentist an immediate representation of the patient’s mouth so is an important aid in patient diagnosis and treatment, but it is also an aid in forensic identification of bodies. Correct charting can be the only means of identifying bodies in cases such as burn victims, so it is of vital importance that it is recorded accurately.

At the patient’s first visit a full base chart should be recorded showing all teeth present and any treatment that has been carried out on them. The charting should be checked each time the patient attends and updated if there are any changes.

There are two main systems of tooth notation available when referring to specific teeth in the clinical notes. In the United Kingdom Palmer tooth notation is often used. In handwritten notes it involves using a quadrant symbol and the tooth number:

__                                        __

|           lower left                     |      lower right      __|  upper right        |__        upper left

As demonstrated this does not work well on computerised notes (!) so quadrants are referred to as UL - upper left, UR - upper right, LL - lower left and LR - lower right.

The International Dental Federation two-digit system is a globally recognised form of tooth notation where quadrants are recognised as numbers:  1 - upper left, 2 - upper right, 3 - lower left, 4 - lower right, and for deciduous teeth, 5 - upper left,  6 -  upper right, 7 - lower left and 8-  lower right.

Both forms of notation are acceptable and the dental nurse should use the system that the dentist prefers.

Other forms of charting may be required such as charting the findings of a Basic Periodontal Exam - this ideally should be carried out at every examination appointment. Pocket, mobility, plaque or surface wear charting may also be required.

Clinical Notes

At an examination or emergency assessment appointment the first thing that should be recorded in the clinical notes is the patient’s chief complaint, followed by anything else the patient complains of or wishes to report. This should be recorded as closely as possible to the patient’s own description of their symptoms.

Any diagnosis or observations the dentist makes should then be recorded along with any charting updates. All discussions regarding treatment options, including costs or any questionable prognosis of any treatment, changes in treatment plans or post-operative warnings should be recorded.

At appointments where patients are undergoing treatment concise details should be made of the treatment being carried out and correct notation of where it is being carried out, along with records of any drugs administered and materials/equipment used. Records should be made of any post-operative advice given.

Notes should always be recorded during and directly after the patient’s visit as it is required that they are contemporaneous. It must also be taken into consideration that patients’ can request to see their clinical notes; therefore they must be written in a professional manner with no derogatory comments made about the patient. For example, if a patient attended complaining of a broken tooth a note should be made of this, including how and when it was broken, what tooth or area of mouth patient describes and any symptoms:

‘Pt c/o broken tooth UR area this morning whilst eating cereal, causing sensitivity to cold.’

The dentist’s diagnosis, any vitality tests or radiographs, and any discussions about treatment plans should then be recorded:

‘O/e: UR5 fractured mesio-buccal cusp, pt has a heavy bite and not much tooth left so advised patient that a crown is the best option. Explained to patient tooth can have a composite restoration but that it may not last long. Explained differences between gold and porcelain bonded crown, advised patient that PBC was the most aesthetic option, but gold is slightly stronger and helps periodontal condition. Patient concerned about crown blending in with existing crowns and veneers, concerned about metal becoming visible due to gingival recession as this has happened to the patient before. Discussed option of Lava crown (metal free), shown patient some photographs of Lava crowns, patient wishes to go ahead. PA taken of UR5 to check suitability of tooth for crowning, PA shows tooth to be suitable .Pt given verabl and written estimates and consent form to sign.’

Although the dental nurse should record as much information as possible in the patient’s clinical notes and write them as accurately as possible, the dentist is ultimately responsible for their content, so before any notes are saved and the patient’s appointment is marked as complete, the dentist should check that the notes are satisfactory and make any necessary additions or ammendments.

Radiographs

If radiographs are processed and mounted digitally then they should be attached to the correct patient’s notes, orientated correctly and labelled accurately recording the type of radiograph and teeth present on radiograph. Reasons for taking radiograph and findings should be recorded in the patient’s clinical notes. Radiographs that are manually processed should also be correctly mounted and labelled and kept with the patient’s record card.

Correspondence

Any correspondence with specialists or hospitals such as letters or emails should be retained and either scanned to the patient’s digital notes or kept with the patient’s record card. Any paper work regarding confidential information about patients should be shredded after scanning to patient’s notes. This also applies to medical history forms.

A record of any correspondence made regarding the patient, or with the patient, over the telephone should be made in the patient’s clinical notes.

Kim RDN

Communicating well with patients is vital in Dentistry and benefits both the patient and the Dental Nurse. The patient because they will feel genuinely cared for and understood and the Dental Nurse because she will feel fulfilled and satisfied with her performance.

Examples in which good communications are absolutely necessary:

• Explaining treatment and gaining consent.

• Pre and post-operative instructions.

• New patient exams.

• Discussing payment.

• Gaining consent for using patient photographs.

In order to care for our patients well and in accordance with the rules and regulations, it is important that patients are fully aware and understand the information we relay to them. It is also important that WE understand what patients say to us also and what patients tell us could be interpreted not only by word but also by body language. That is why we need to be able to communicate on many different levels. As a Dental Nurse, we need to monitor the patient and inform the Dentist if at any time we feel there are any concerns with the patient.

Non-verbal communication.

Patients can alert us subconsciously if there is something wrong by using vocal or physiological communication and also by using expressions and posture. A patient may whimper, cry or even scream while having treatment. We do not need them to tell us that they are unhappy, their vocal communication does that instead. A patient may also pull away from the drill, close their mouth or tense up their legs. Again, this indicates they are not comfortable with what is going on. Other things we must notice are physiological changes such as excess sweating or paleness. Lastly, expressions such as grimacing are also ways of non-verbal communication.

Good rapport is so important when caring for a patient .Rapport is an important feature of sub-conscious communication and is often described as being “in sync” or “on the same wavelength” with the person you are communicating with. There are different methods of building rapport, the most common being;

• Mirroring

Mirroring basically means getting into the rhythm of the person you are communicating with on as many levels as possible. There are three types of mirroring; Emotional, Posture and Tone/Tempo. Emotional mirroring basically involves empathizing with the emotional state of the person you are communicating with and letting them know subconsciously that you are “on their side”. Posture mirroring involves matching the body language of the person you are communicating with subtly by mirroring the same message with your energy and attitude. Tone/Tempo mirroring involves matching the tone, tempo and volume of another’s voice.

• Commonality

Commonality is a technique which involves purposely finding something in common with a person in order to build trust and confidence. This can be done through shared interests, hobbies, dislikes etc.

• Reciprocity

Giving someone a gift or doing them a favour triggers feelings of obligation in the person on the receiving end.

Good communication and care can be achieved by:

• Knowing your patient and having your patient know you.

Introduce yourself to your patient and make eye contact. Find out how they preferred to be addressed, e.g. Mrs Smith or more informally, Janet. Once you know their name, make an effort to remember that person so that at their next appointment you can greet them directly by name. The patient will not believe that you remember them from 6 months ago and no doubt feel secure and happy coming to a dental practice that knows them as an individual and not just “another patient”.

Ask how they are and try to find out a bit about them to make them feel more comfortable. Information is a great tool. Find out if the patient has any up and coming events such as a wedding. When they attend for their next appointment, ask them how it went. Again, they will be very surprised that you remembered that they were attending a wedding and feel flattered. Find out if they have any fears or issues and do your best to help them. Let them know a bit about you and try to relate to the patient, e.g. “I’m not keen on injections either, but it’ll be ok.” Treat each patient as an individual and give them the level of care that they require. Some patients need a little bit extra than others if they are nervous or frightened for example.

• Listening.

When the patient is speaking to you, give them your undivided attention to show them that you are genuinely listening to them. Position yourself so you are facing them and look into their eyes. By listening, you are more likely to pick up on matters that could be missed if communication is poor such as previous bad experiences with a Dentist. As a Dental Nurse, patients are more likely to speak to you about delicate matters as it is often difficult for patients to address the Dentist due to nerves or sometimes intimidation.

• Maintaining confidence and professionalism.

Always keep cool and calm and care for the patient adequately despite your surroundings. Working as a Dental Nurse can often be a fraught, “running round like a headless chicken” type experience, especially when the diary becomes double booked and there is an endless run of emergencies, however this does not mean that patient care and attention can be compromised. The patient should not see the madness behind the scenes. If you have to leave the room or are called out to the desk for example, calmly excuse yourself. It is also important that the Dental Nurse stays in control and acts in confidence.

Maintaining good communication with patients.

There are ways that a Dental Practice can maintain good communication with their patients and also please them as individuals. Some of these ways are:

• Sending routine recall/reminder letters.

Some Dental Practices advise patients to pre-book their 6 monthly appointments in advance to guarantee a preferred time and date, other practices simply advise their patients to contact to make an appointment nearer the time they are due. Depending on whether the patient has made their appointment or not, one of these letters should be sent out every 6 or 3 months depending on when they are due to come back for their routine review. More Practices are now confirming appointments in other ways such as email and text reminders, which are very popular and convenient amongst patients.

• Post-treatment courtesy calls.

Imagine this- you have had to endure an Apicectomy the day before and you are feeling a bit sore and sorry for yourself. The phone rings and it is actually the Dental Nurse who assisted through your appointment asking you how you are feeling and asking you to contact the practice if you need to and that the team are there for you if you have any questions. That is bound to make any patient feel better and the benefit to this very simple but effective task is that WE know that the patient is ok after treatment and THEY feel valued and cared for. It is ideal if the Dental Nurse can make the calls however the Receptionist can do this also.

• Birthday cards.

Sending a patient a birthday card is a lovely touch and reinforces the fact that you do care and value them as a patient.

• Thank You cards.

If a patient refers a friend to your practice or writes a nice testimonial then sending them a “thank you” card is a relatively inexpensive and nice thing to do and could very well encourage them to do more for you. Some Practices take this a step further and have referral systems in place. For example; refer 1 person to the practice and receive 10% off your next course of treatment, refer 5 people to the practice and receive £25 gift voucher and 10 off your next course of treatment etc.