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Band four assistants 'no substitute' for nurses


Advanced healthcare assistants are ‘no substitute’ for registered nurses, according to the organisation charged with ensuring the NHS workforce has a suitable skill mix.

Skills for Health director of workforce strategy Andrew Butcher’s comments will be welcomed by those concerned that nurses are being replaced with cheaper assistant practitioners placed at band four in the Agenda for Changepay framework.

Mr Butcher was speaking to Nursing Times after Skills for Health launched new core standards for assistant practitioners, the generic term for band four staff.

He said: “They [assistant practitioners] aren’t a substitute for nurses. They can’t do everything that a nurse does. What a staff nurse used to do can’t be done by one of the APs.”

Assistant practitioners work in a variety of areas such as stroke, district nursing, podiatry, radiography and mental health.

The six standards cover areas such as recruitment, education and training and the level of supervision they are required to work under.

Mr Butcher said supervision of these roles would not be “onerous”.

The Skills for Health document says assistant practitioners may work under distant guidance or work as lone workers.

Where appropriate, they should supervise others, take some responsibility for training and in some cases carry out training themselves.

Mr Butcher said they would carry out tasks such as taking blood pressure and carrying out observations, freeing up other professionals to take on more advanced roles.

He said: “Nurses need to know how to do all these things but don’t need to be doing it all.”

The roles could be seen as a “stepping stone” to a nursing career, he said. Training should take two years and result in a foundation degree or diploma.


Readers' comments (11)

  • I disagree with band 4 taking on a higher role. Nursing is a 3 year course covering indepth skills and training, enabling the evidence based knowledge and skills for understanding the role of a staff nurse which involves taking on the responsibility and accountability for other co-workers. Not all staff nurse want to be assigned to paper work we want the hands on care and practical work which we have been trained to do. APs are trained to assist with activities of living, monitoring observations and to report any defecits to a nurse. Thes tasks carried out by the APs are a massive help and much appreciated by nurses; as it relieves the presure and allows nurses time to carry out and prioritise patients care dependent upon their individual needs.

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  • 1943 Nurses Act - State Enrolled Assistant Nurse? is the wheel just being reinvented?

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  • ANPs are just the new State Enrolled Nurse and look how good many of those (we) were. In fact highly respected nurses often delegated difficult tasks because of their 'can do' abilities. When my daughter was in A&E some years ago both the junior doctor and the staff nurse passed the task they had not the skills to do to the SEN!!!
    I have seen this on more than a couple of occasions, and it is about time the powers that be recognise that it is not the basic qualification that matters but the individuals characters, enthusiasm, dexderity, communication skills of which no single component can be measured either from a degree or from not having one single GCSE.

    In my view the ANP is the ideal way to enter into the nursing pathway and the practical experience, along with nursing modules could qualify that person to become a Staff Nurse. I have known SENs with MSc in Nursing who were not considered suitable level to do a drug round and I also was an SEN with a BSc Hons before nursing decided I would need one and had more nursing qualifications that the Level 1 Registered nurses. I breath a sigh of despair that nursing is not only going backwards, but has not learned from it's experience.

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  • I am in total agreement with the above writer and would like to add, what do we expect when the decision to have all nurses trained to degree level is so heavily supported by those in the profession holding positions of authority. Many other commentators are less than sure that all degree RN is the way to go. The decision will lead to RN expecting to be paid more because of the higher level of educational completion. The pay pot is not bottomless.

    Many RN's were horrified at the introduction of NVQ's and believed that this would lead to job losses which of course did not occur. We have NVQ qualified staff doing jobs very competently now that were considered only a short time ago to be the exclusive province of the doctor or registered nurse so why is this such a bad idea. May be it is just the age old fear of change. I am afraid that change is here to stay.

    I am the wrong side of middle age and know that I will probably need care sooner rather than later, so lets use change to benefit the current and future patients not rail against the ideas of forward thinkers. Not all good ideas are thought up to save money. If you want good care then train staff to the best of your ability rather than dismissing the staff as being a threat.

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  • Band 1 or A grade HCA's already carry out task such as observations and Blood pressures. A HCA who has worked to get to band 3 or 4 should expect to do so much more.
    As a Band three HCA I carry out clinical skills that the trained nurses and doctors just do not have time for. These include cannulation and phlebotomy. Where has Mr Butcher been living.

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  • In Greater Glasgow and Clyde HB, if you work in a psychiatric ward you automatically get a band 3. I know assistants who have walked in from the street with no experience or training and automatically got a band 3.

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  • The SEN rides again - come back the bedside nurse!! As with most things in health we constantly go around in circles!! Perhaps we will once again attract 'caring' people to the nursing profession rather than those that only want to climb the academic and managerial ladder. It would in hind sight, have been prudent to continue the EN training. I was originally an EN and was pressurised into completing a registered course or leave the profession as at the time I was working in paeds.

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  • As a band 3 nursing assistant, I would like to point out that I expect to be asked to help registered nurses not only with training band 1 and 2's to become competant in basic skills such as helping feeding, bathing and helping patients to retain their independance and encourage their independance, but to also mentor these very junior staff. The qualified nurses have so much to do with mentoring their students and running their teams, and sometimes the wards and departments that with the best will in the world they cannot do everything necessary to help nursing assistants. Are the qualified staff generally aware the band 3 nursing assistants can become NVQ assessors which helps qualified staff to trust band 3 nursing assistants with their patient's care? That NVQ assessors are an invaluable source for teaching patient care to the standard which the SEN'S used to give. The standard of knowledge might not be the same, but the responsibility is still to the qualified staff. The qualified staff who think that band 3 nursing assistants cannot be trusted to give the patient care required are obviously not aware the level of required knowledge or able to delegate where necessary.

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  • As a Trainee Assistant Practitioner about to qualify to practice as a fully fleged Assistant Practitioner, i would like to make it known, that we have learnt theory behind our practice (indepth) and all those within my cohort have far more responsibilities within their roles than taking blood pressures and carrying out observations. Maybe Mr Butcher and those " Trained " nurses should take the oppotunity to shadow a Assistant Practitioner to observe the wider skills developed through training and foundation degree study.

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  • I know one example where the candidate is completing this module just by doing the things she has always been doing prior to this and by staying in the same unit.Whereas, the enrolled nurses had a very defined medical,surgical,elderly,operating theatres,accidents and emergengies and other specialities pathways.These placements required theoritical and practical display of experience gained and feedback from the ward sister was upmost.

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