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Hospitals to replace nursing posts with lower paid assistants

  • 70 Comments

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.

  • 70 Comments

Readers' comments (70)

  • nurses are nurses and should all being doing the same job - that is looking after patients. They should all be trained and skilled in carrying out the same tasks to meet patients' needs and ensure high quality care. What are all these different bands and hierarchies - hospitals in other countries manage their health services with out all this hassle, competiveness, sense of superiority etc. All nurses should have a good, comprehensive, basic training and gain experience, with the help of additional training to suit their needs, throughout their career. All these bands lead to a sense of superiority in those at higher level and threat to those at lower levels. All is needed is nurses of equal status doing the same job and one more experienced and competent person in charge who has received management training at Master's level or equivalent. Other nurses should all be responsible for a case load of patients, work in a collegiate interdisciplinary and nursing team where information is exchanged and support given, apprenticeships for students, etc. Nurses should be renumerated by salary bands according to years of experience working in any nursing-related field or where their experience may be relevant to their post and with additional renumeration for any extra courses of study and qualifications which are relevant to their current job. Qualified healthcare assistants are also able to help with basic nursing care so that nurses can concentrate on more technical work and the skills which are exclusive to qualified nurses who have received a different and longer training. This works in other European countries where nurses and healthcare assistants are regarded as professionals in their own right, are highly esteemed by the public, receive adequate renumeration and have excellent working condions, why is it so much more complicated and insonsistent in and in NHS
    and private hospitals in the UK where standards are always fluctuation in a large part because of all the uncertainties of employment, employment conditions, an adequate social security structure, supervision, team collegiality and support, with the offer of further support both within and independent of the team and coaching and adequate and appropriate further training for staff and appropriate and adequate renumeration. Lack of human and financial resources is not an excuse. The issue is with redistribution of these resources to the areas where most needed - i.e. holistic patient care.

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  • I agree with much of the response content here, especially the under-valued nature of nursing & of the problems with genuine professional accountability this could create.

    The issue of referring to these post-holders as 'nurses' is an even bigger worry & the NMC should defend that title with greater vigour ( we pay them enough annually to expect some return from them now & again!). Equally it is up to nurses themsleves to defend their professional realm - improving performance (still too many stories of poor practice), maximising the place of academic education (still hear manuy saying 'why do we need to study at this level to be a nurse' attitudes) & finally we need to stop taking on, unquestioningly, unwanted medical roles (& being paid on the cheap for them in relation to the medics) in the guise of extending practice, leaving nurses no option but to give much of their own job away to the unqualifed staff as a result.

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  • I'm afraid while we have Sisters replaced by Ward Managers and Nurses doubling up for Doctors.. and our most specialised clinical practitioners at 'desk jobs'. someone somewhere has to provide the backfill. This may be a contriversial statement but to my thinking it is a fact of experience.. that becuse our academically qualified Nurses look down on 'task orientated nursing as inferior' they will be replaced by task-trained staff who may not have the depth of clinical knowledge that a trained Nurse has, but who can perform nursing functions to a higher standard, because they have time to talk with patients and understand and deliver the patient's basic needs. This can only get worse with BSc only Nurses! Lets face it colleagues "What do we do as Nurses that no on else can do better? Care?" In an underfuded ever depleating Health Service for our Exective Managers this is the only way forward. Management is not measured by performance in terms of Standard of service delivery really that is a smoke screen... good Management in healthcare now is measured by HOW MUCH YOU CAN SAVE/CUT in service provision without it being noticed! What are bodies like the RCN and NMC doing? Nothing!! Welcome to the real fiscal world.

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  • I'm afraid while we have Sisters replaced by Ward Managers and Nurses doubling up for Doctors.. and our most specialised clinical practitioners at 'desk jobs'. someone somewhere has to provide the backfill. This may be a contriversial statement but to my thinking it is a fact of experience.. that becuse our academically qualified Nurses look down on 'task orientated nursing as inferior' they will be replaced by task-trained staff who may not have the depth of clinical knowledge that a trained Nurse has, but who can perform nursing functions to a higher standard, because they have time to talk with patients and understand and deliver the patient's basic needs. This can only get worse with BSc only Nurses! Lets face it colleagues "What do we do as Nurses that no on else can do better? Care?" In an underfuded ever depleating Health Service for our Exective Managers this is the only way forward. Management is not measured by performance in terms of Standard of service delivery really that is a smoke screen... good Management in healthcare now is measured by HOW MUCH YOU CAN SAVE/CUT in service provision without it being noticed! What are bodies like the RCN and NMC doing? Nothing!! Welcome to the real fiscal world.

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  • I am so fed up with the constant messing around with the nursing workforce. In the relentless drive to make us a 'profession' those in the seats of decision making have actually desomated what was a good and satisfying 'job' with various roles and levels of responsibiliy. I qualified in 1980 - a lifetime ago it seems, and have practiced in various positions throughout that time. I have bore witness to the changes that have occurred and conclude that most have not brought about many effective improvements, in fact many have contibuted to a gradual decline in standards, too many to detail here. I have felt the desire for a while to leave nursing, but probably will hang in for another few years and then go for early retirement - I may still work but not in nursing! I can envisage others in my age group doing the same....what will happen to nursing in the future, goodness knows, but probably there will be HCA's running the wards by then and RN's performing major surgery!!

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  • I work in primary care as a senior practice nurse with BSc Hons in health related subjects as well as IT. I do not wish to be contrary for the sake of it but I have worked with two HCAs who have both been more efficient than SOME trained nurses as well as management staff!
    This doesn't mean I condone replacing registered nurses with untrained nurses per se, but that I do find nursing is often a very judgemental and poorly assessed profession where letters after ones name does not always reflect application of the skills.

    During my return to nursing in the 90's as a mature SEN with a degree I found many 'real' nurses very patronizing, only seeing being by the bedside ALL the time as being a 'good' nurse. Because I dared to show an interest and had an awareness of IT as well as looking after the patient at the bedside I was often put down as 'not having the interest of the patient at heart', when in fact I had a vision of how important documentation and transfer of information from one HP to another, and the continuity of that, was of great help to the patient.

    In nursing we should welcome diversity and realise that good spelling for example, or good grammar, is not a sign of intelligence or ability to perform or think at a high level and that many people for example with certain kinds of dyslexia or even Aspergers Syndrome may in the past have not passed to get into nursing by the usual route.

    Thankfully, it is now being recognised that team work involves lots of varying and compounding ability not always reflected in academic acheivement and that it can happen where a HCA with no qualifications can see something that someone with a degree can not.

    What I do disagree with are so-called managers or NHS employers, often GPs condoning for example, practice nurse posts at Level 4/5 when an experienced practice nurse has not only done RGN, but has often worked in a highly specialised role at Level 6/7. Many 'trained' HCAs can attract the Level 4 rate.

    I think some non-clinical or even non nurse employers should be compelled to understand the roles of those they employ rather than the other way round as this bad employment practice detracts from nursing professional accountability by restricting those who do have the skills to perform to their ability.

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  • I would like to comment on a statement made earlier in this thread:
    "I have to point out that by it's very nature i.e. below standard spelling, punctuation and grammar, that it illustrates the difference in levels of intelligence and education needed to fulfill the role of a nurse. Nurses are educated to a very high standard, and for very good reason."
    The nurse that made that comment needs to get into the real world. Nursing documentation is renowned for being dreadful. The spelling is appalling and the grammar usually worse than a ten year olds.If nurses were as highly educated as claimed then we would not have the problems of failure to recognise deterioration that we are now experiencing.
    Nurses have a duty to keep themselves up to date and competent to work in their area, so lets start making them truly accountable and stop using the excuse that they are understaffed, over worked and being used as cheap doctors.

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  • *sigh*

    Im a Band 2 HCA in a community hospital and just to reinforce what was said earlier in this discussion, we are not all brainless and useless etc. Before I came into my current job I passed three A-Levels and studied for a degree in Disability Studies and Health and Social Care, and indeed began the first year of training as an RNMH.
    My hospital is run purely by nurses and HCA's form the backbone of it - it is all to common for there to be only one trained nurse per shift who has to deal with all the paperwork, meds etc so its left to us HCA's to do all the practical stuff. And as for being Band 4 - dont make me laugh! No such thing as progression where I work - I work with people who have been there since the hospital opened and have never been moved from Band 2 - there are some DOMESTICS who are on a higher band than us!
    All Im saying is dont write us off - there are plenty of us who are more than capable of being nurses. I agree with the fact that qualifieds shouldnt be being replaced with HCA's but all Im saying is please give us a break. I didnt finish my training due to illness and Im waiting for secondment to go back, but just because Im working as an HCA doesnt mean Im an idiot thank you!!!

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  • Yikes! don't think I can handle any more stress..... Many Band 5's already feel extremely overstretched on a daily basis. It is so true that being accountable for the incompetence of Band 2's adds to our burden of work, not to mention poor attitudes too. Add this to the many times agency workers are brought in who dont care enough about what they are doing, or have never worked on a ward before!!! but are used to 'beef up' the ward staffing numbers - puts still more pressure on the Band 5's. How much more do we have to take???????

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  • So far this year I have had the specialist enhancements cut then a pay freeze and now I see the job that I trained hard to do can now be done by anyone ! It seems that everyone loves Nurses until they have to pay for us. I'm afraid this is the straw that may have broken the Camel's back.

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