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Supervision of nursing associate role to be 'debated' over summer


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?”

Lisa Bayliss-Pratt

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”

Lisa Bayliss-Pratt

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”

Lisa Bayliss-Pratt


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”

Lisa Bayliss-Pratt

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.


Readers' comments (10)

  • This new role is a step backwards and the reintroduction of the enrolled nurse but just using a differnt name.

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  • I don't know why its so hard to admit that getting rid of the SEN role was a huge mistake which has had disastrous consequences for the entire healthcare sector and we should just move on. Bring back the SEN.

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  • What is the difference between this role and the band 4 assistant practitioner?

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  • Anthony Johnson

    Because these nurses aren't SEN's Tony Stein. They won't be trained the same way and won't receive the same funding for their education. If HCAs have the ability to become Nurse Associates they have the competency to become Registered Nurses.

    We should stop attacking the working class and fund their degrees because it leads to better patient outcomes and is safer. We have the money to do it but we lack the political will so it's up to the profession to make the argument rather than saying that 'we'll have to just go with it'. It's nursing's choice if the NAs come in. We should stand up and say no, we want better standards for staff and patients.

    Even in America they admit that having LPNs is a bad idea for patient safety, why are we trying to drive down blooming standards!

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  • Because lean methodology dictates cheaper deskilled options with less rights

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  • Josephine  Dyer

    This role will definitely take pressures of qualified nurses. They should have never got rid of the SEN role. There are thousands of HCSW that be idiot from this role, they are the heart of care prodominally on the wards. Most HCSW don't have the qualification to under take degrees so this role will give them more autonomy and more pay in which they deserve. Looking forward the implementation of this role on my ward .

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  • michael stone

    Shrewdle9327 May, 2016 4:35 pm

    'If HCAs have the ability to become Nurse Associates they have the competency to become Registered Nurses.'

    That isn't 'a necessary logical truth', but I agree with some of your comment: once upon a time degrees for working-class students were funded, but back then relatively few people went to university - the 'send most people to university' objective, made politicians 'recoil at the prospect of funding grants for so many' while previously 'grants for fewer' had been the case. See the (off-topic) PS.

    But ignoring 'the politics' it seems to me unarguable, that the skill gap between most HCAs (I'm not saying all - see 27 May, 2016 1:48 pm) and the least-qualified registered nurses, is currently too big. Whether the gap is narrowed by up-skilling some HCAs, or reducing the numbers of less-senior nurses (clearly a legitimate worry, with a Tory Goverment in particular), is a rather different, and deeply 'political', question.

    PS When I went to university in the early 1970s, only about 10% of people did that - now, more like 50% I gather. When I went, only about 8% of people graduated with a first, and perhaps 15% with a 2:1 (those figures were higher for sciences, and lower for the arts: in chemistry I think about 10% of us got firsts, but I believe it was about 6% in English [however, more scientists got 3rds, 'pass' degrees, and fails - relative to the sciences, arts degrees were more bunched in the 2:1/2:2 awards, with fewer firsts and fewer degrees below 2:2]).

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  • Ms Bayliss Pratt says re accountability " as an employee you are accountable to your employer (re procedures undertaken in your Associate role)"
    Does anyone really believe that in the blame culture of the NHS this accountability would actually not suddenly be foisted on the Registered nurse on duty at that time? As a former RCN Officer I have seen the blame skewed over and over again.
    I know everyone is saying that this is an emergence of the EN role and I fully agree with this, but En's were properly trained and were deemed competent in procedures that would be expected of them when working in different settings as of course the RN's are. This is a cheap Government ploy to save money on salaries and promise some pie in the sky role to HCA's. The RCN and other unions should be fighting much harder for better funding and conditions for RN's and not pathetically falling into political traps.

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  • Nursing should be accessible and actively reach out to the working class, whose communities have been seriously deskilled from professionalization.
    The more nurses living and engaging in these communities would led to better health outcomes.

    I am excited about these new roles, but spektical on its application in the context of a conservative government. Real accountability shouldn't lie with PIN.

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  • Well we can see the back lash from when they stopped the EN/SEN training, this is good news for HCA that want to progress, I disagree with the above comment re HCA going straight on to RN traing unless they want to. Current nhs staff with good experience need funding or partial funding for these courses.

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