Nursing associates may not require direct supervision when they carry out tasks, which could include administration of medicines such as insulin and enteral feeding, according to the national body developing the new role.
Health Education England gave the go-ahead for the role yesterday, as it published findings from a six-week consultation that found there was support for nursing associates.
“Does someone have to look over [nursing associates]… or can they be trained and proved to be competent to undertake activities under indirect supervision?”
The national training body told Nursing Times it will now develop a scope of practice for the new role at five sites during workshops this summer before testing it in early 2017.
HEE’s director of nursing Lisa Bayliss-Pratt said one of the key issues that would be looked at was whether nursing associates should be directly supervised by a nurse who is present as they carry out tasks.
“We will be discussing and debating in July the issue of direct and indirect supervision,” she told Nursing Times.
“So what does that mean – does it mean someone has to look over them to do these things or can they be trained and proved to be competent to undertake activities under indirect supervision, and how would that work?,” she said.
“We want to ensure people understand what [nursing associates] can and can’t do and then can delegate with confidence”
Ms Bayliss-Pratt said it was important to establish how the role would be supervised, because nursing associates would be used not only in hospitals but in the community and social care settings as well.
In HEE’s report on the consultation findings, it said the role’s indicative scope of practice would allow nursing associates to “deliver care under the direction of a registered nurse but will not require direct supervision, delivering care at times independently in line with a prescribed or defined plan of care”.
It said nursing associates “might also potentially contribute to care assistant supervision”. The report also included a list of suggested tasks for the role that were put forward by respondents.
It said the most frequently named task was administration of medicines including B12, insulin, enteral feeds and oxygen, phlebotomy, venepuncture and cannulation. Other tasks were catheterisation, ear irrigation, flu injections, leg ulcer bandaging and Doppler assessment.
“If you do something not within your scope of practice or job description that’s an employment issue and we must never lose sight of that”
Ms Bayliss-Pratt said if there was consensus – following the testing carried out in the summer – then medicine administration would be included in the role’s job description.
She reiterated that once this and other elements of the scope of practice had been defined, HEE would then decide whether nursing associates should be regulated.
Nursing Times asked Ms Bayliss-Pratt who would be accountable for patient safety if nursing associates were supervised by registered nurses.
In response, she said: “As an employee you are accountable to your employer. So if you do something not within your scope of practice or job description, that’s an employment issue and we must never lose sight of that.
“But what we want to do with this role is ensure people understand what it can and can’t do, and then can delegate with confidence the activities this role is trained to do safely and effectively, to make sure we don’t compromise patient safety.”
The consultation results found some respondents had concerns the nursing associate would substitute nurses.
“We know numbers of bodies doesn’t equate to the right skill set you need within a team”
Nursing Times asked how HEE would be testing the new role and if it would be modelling different combinations of numbers of nursing associates alongside registered nurses needed for safe care, but Ms Bayliss-Pratt said they would not be testing the role in this way.
She stated: “We know numbers of bodies doesn’t equate to the right skill set you need within a team because it’s very dependent on the individual, their length of experience, the type of postgraduate training they have had and the client or patient group they are looking after.
“So there is no robust methodology to say, if you’ve got two registered nurses and four nursing associates you will be fine, because it will depend on the dependency of the people you are looking after and the types of people you have got within that workforce,” she said.
When asked how HEE planned to address concerns raised by consultation respondents about paying for training the new role, Ms Bayliss-Pratt said it was “still working through” the financial implications and more details would be available following testing.