Nursing professors and leaders have warned of the potential “confusion” and “danger” arising from the varied training nursing associates are being given on pilot programmes.
Nursing associates, being introduced in England, are in some places being taught the same medicines administration as student nurses, including the use of controlled drugs, while others are not being trained to this level, as revealed earlier this week by Nursing Times.
We also reported that a group set up by Health Education England to scrutinise the new role has recently concluded associates should not be able to carry out intravenous, intramuscular or rectal drugs administration, or give controlled drugs, upon qualification – but should be able to do so with further training.
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An early draft version of proposed proficiency standards for nursing associates was released by the Nursing and Midwifery Council at the end of last year.
It stated that associates must also be able to demonstrate the ability to safely administer specified medications by “a variety of different routes, for example inhalation, topical, oral, subcutaneous, per rectum”, which is partly in contrast to the scrutiny group’s findings.
The NMC, which will regulate associates from January 2019 when the first set of trainees qualify, is still developing the final version of the draft standards for the role and is due to launch a consultation this spring.
“This level of confusion and lack of consistency around the practice of nursing associates is not going to help safety”
Around 2,000 trainees are already half way through two-year pilot programmes, which began in January 2017.
At the University of Central Lancashire, trainees are being taught about controlled drugs “but whether or not they will be involved in the administration of controlled drugs is a service decision,” according Karen Wright, head of the school of nursing.
Likewise, Denise Baker, head of pre-qualification healthcare at the University of Derby, said trainees would be taught about different routes of administration, which would include controlled drugs as part of the ethical and legal considerations.
But in in some places, such as Coventry University, trainees are being told they will not be able to give controlled drugs or carry out more invasive techniques unless they complete further training after qualifying.
“Expecting unregistered staff to do tasks which have previously been carried out by nurses risks placing an unfair burden on them”
Nursing experts have warned that the different approaches to training across England could lead to a lack of standardised care for patients and that associates may be exploited in the way a similar role – state-enrolled nurses – had been in the past.
They also questioned whether trainees were being taught to fully understand the level of clinical risk associated with controlled drugs administration.
Professor Alison Leary, chair of healthcare and workforce modelling at London South Bank University, said: “Being able to administer controlled drugs takes quite a lot of judgement. They are higher risk.
“It’s possible to teach anyone the technical task – but the question is will people have the education to fully understand the risk and to make the judgement,” said Professor Leary.
“This level of confusion and lack of consistency around the practice of nursing associates is not going to help patient safety,” she told Nursing Times.
“We’ve also got a huge body of historical evidence that shows enrolled nurses were exploited and the more complex practice you ask nursing associates to take on, the closer you come to exploiting them for the salary they are on,” she said.
Anne Marie Rafferty, professor of nursing policy at King’s College London, also told Nursing Times that anecdotal evidence suggested there was “variation in how the role is being interpreted as well as implemented in practice”.
“The danger is that this becomes the default mode before HEE guidance and NMC regulation has been issued and is able to regularise practice,” she said.
“The danger is that this becomes the default mode before HEE guidance and NMC regulation has been issued”
Anne Marie Rafferty
“There needs to be clarity and consistency in guidance on what nursing associates can and cannot do between HEE’s scrutiny group and the NMC. The NMC as the regulator is sovereign in these matters and I do not think that nursing associates should be able to administer controlled drugs post training,” she added.
Donna Kinnair, director of nursing, policy and practice at the Royal College of Nursing, also stressed that drug administration was not a mechanistic task and required professional judgement.
“If ongoing assessment of a patient is required it should be the responsibility of a registered nurse,” she said. “It’s concerning that some courses appear to be encouraging exactly the sort of ambiguity between support roles and registered nurses we have warned about.
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“There is no room for equivocation – if unregistered staff are expected to do tasks which have previously been carried out by registered graduate nurses, this risks placing an unfair burden on them and reducing patient confidence in the health service,” said Ms Kinnair.
“The new regulatory guidelines covering nursing associates should seek to end this ambiguity, and clearly define the responsibilities of this new support role, as well as offering explicit guidance on accountability and delegation,” she said.
An NMC spokesman said that while, training programmes for associates may differ, the most important requirement would be for associates to meet the regulator’s standards before being able to join its register.
“Only those trainees that meet our standards will be able to join our register”
“Last year, we released an early working draft of the nursing associate standards so that test sites and trainees can familiarise themselves with the likely standards that nursing associates will need to meet to join our register,” he said.
“Only those trainees that meet our standards will be able to join our register and there will be a robust quality assurance process in place to ensure this is the case,” he added.
As per recent comments made by Professor David Sines, chair of HEE’s nursing associate scrutiny group, an HEE spokeswoman said it would be issuing guidance for employers and universities within the next three months about the scope of practice for nursing associates.