A number of NHS hospitals are planning to replace an increasing number of trained nurses with cheaper, unregistered ‘nurses’ paid at a lower rate.
Leeds Teaching Hospital and East Kent Hospitals University Foundation are among those trusts known to be making or planning such changes.
The chief executive of another hospital trust, who did not want to be named because staff have not yet been informed, said the nurse “swap” was in response to financial pressures and a shortage of experienced band five nurses.
The increased use of electronic monitoring of patients meant it was now possible to replace registered nurses with healthcare assistants, the source added.
A spokesman for Sheffield Teaching Hospitals Foundation Trust told Nursing Times it uses “band four nurses who have reached a higher level of competence and experience who at times fulfil some of the roles previously carried out by band five registered nurses”.
He said: “In these areas we developed the roles primarily as a response to specific recruitment difficulties and the roles are supported by very specific training programmes.”
Foundation chief nurse Hilary Scholefield added: “We have not used band four posts to replace band five registered nurses in order to make financial savings; in fact it is the absolute contrary.
“Band four posts were introduced in our hospitals more than six years ago and this is now a well embedded formal programme of education and training which has enhanced, not detracted from the 70/30 skill mix of our nursing workforce. It has not impacted on the number of registered nurses we have.”
Unison head of nursing Gail Adams said: “This is not like for like work. You can’t swap band four for band five staff. We have seen the effects of these cuts in Mid Staffordshire and Maidstone and Tunbridge Wells. There has been no discussion of this at a national level.”
A spokesman for Leeds Teaching Hospitals said “a major trust-wide organisational development programme with workforce modernisation at its heart” would include “exploring the potential of new roles to support our registered workforce”.
The trust’s Unison branch secretary Sharon Hamilton – herself a band five nurse – said staff had not been informed of any plans to increase the numbers of band four staff. Asked if she agreed electronic patient monitoring meant there was more scope to use lower qualified staff Ms Hamilton said: “It’s OK having a machine that bleeps but if the patient starts changing colour then it’s only a person who can see that.”
Earlier this month a Nursing Times survey revealed many nurses felt the increased use of patient observation technology made it less likely staff would spot signs of patient deterioration (news, page 1, 13 October).
A review of ward staffing levels and skill mix at East Kent, seen by Nursing Times, states nursing’s transition to being an all graduate entry profession by 2012 could mean fewer nurses, but a greater proportion of leadership roles.
It anticipates a “major expansion in the number of people required to work at assistant and associate practitioner role”, which is paid at band four. It describes this role as delivering “protocol-based clinical care that had previously been within the remit of registered professionals”. Meanwhile, a number of band five nurses at the foundation trust will be moved into band six positions, to take on ward management tasks.
Director of NHS Employers Sian Thomas said such changes were “exactly what Agenda for Change” was for and the knowledge and skills framework could be used to measure the skills appropriate for any new role. “The tools are already there to change the career ladder,” she said. “It’s right where we have qualified registered practitioners to have them doing jobs they are qualified to do”
Ms Thomas said responses to the NHS staff survey indicated that up to one in three nurses felt they were doing jobs that were below their knowledge and skill level, suggesting scope for substitution with lower skilled staff.
Royal College of Nursing head of employment relations Josie Irwin said she feared such changes were “financially driven” but she would not object if they were on the basis of a proper evaluation of clinical needs and staff engagement.
Ultimately, the “test” was whether changes to the nursing profession and skill mix made a positive different to patient care, she added.