Hospital leaders must carefully weigh up the risks and benefits of bringing nursing associates into their workforce before deploying them, according to new national guidelines.
The resource has been developed by England’s chief nursing officer Dr Ruth May with support from an expert steering group made up of some of the most senior nurses from the health sector.
“Filling a registered nurse post with a less skilled worker entails risk”
It urged hospital bosses to use the skills of nursing associates to their “fullest degree”.
“There are considerable opportunities and benefits in deploying the nursing associate,” it said. “Some of the opportunities and benefits will come unexpectedly, others will be intentional and planned.”
The first qualified nursing associates entered the workforce this month. The government has commissioned research to be carried out to evaluate how the roll-out goes which will, in time, provide an evidence base for the deployment of the role.
In the meantime, the National Quality Board has published the new guidelines (see PDF attached below) to help NHS ward managers and trust executives deploy nursing associates.
The formal launch of the role followed a trial by Health Education England, in which trainee nursing associates were employed across 35 test sites.
The role was created to bridge the skills gap between healthcare support workers and registered nurses and to help meet some of the challenges facing the NHS around demand and staff shortages.
“Local leaders will require educating about the role and how it can best be used”
The new deployment guidelines recognised that there had been some unease about the new role and how it would fit into the workforce.
“As with all new roles, there has been substantial debate and discussion about the NA’s place in the multidisciplinary team and the aligned scope of professional practice and accountability,” the report said.
The resource highlighted the importance of getting the right skill mix and ensuring every ward had the appropriate balance of registered nurses, nursing associates and healthcare assistants in place.
“The skills and capabilities of the nursing family must be carefully considered to ensure that the right person is delivering the right care to the right patient at the right place and time,” it added.
Using an “evidence-based tool” such as the safer nursing care tool when making staffing decision was recommended.
Trusts were expected to complete a “quality impact assessment” before introducing nursing associates to consider the potential impact on patients, service users and staff, and also finances.
“This involves anticipating, monitoring and measuring the consequences of activities and making sure that, as far as possible, any negative consequences are eliminated or mitigated, and any positive impacts are identified and maximised,” the report said.
Data should also be collected after introducing nursing associates to see what difference they made to key areas of performance and patient and staff experience.
The resource outlined that there must be a “clear process” in place for raising concerns or highlighting positive outcomes related to the deployment of nursing associates to the director of nursing.
In addition, the report recommended that trusts compared their deployment decisions with those of similar organisations. “While you need to exercise caution, comparing staffing with peers can act as a ‘sense check’, particularly of assumptions and professional judgements,” it added.
“We want to ensure that their clinical teams have the resources to deploy nursing associates safely and effectively”
The importance of empowering senior nurse leaders with the knowledge and understanding of what nursing associates can do and how they should be utilised was highlighted.
“The ward sister/charge nurse/team leader role is critical in ensuring the delivery of safe and effective care in care areas; they are responsible for ensuring staffing meets locally agreed levels,” the report said. “This post-holder is also responsible for setting the culture of compassionate care and teamworking.”
“The successful deployment of the nursing associate will depend (at least in part) on the commitment and understanding of the local leaders,” the report said.
“Local leaders will require educating about the role and how it can best be used and have an opportunity to discuss any concerns about implementation,” it added.
“As leaders are key to promoting understanding of the role and myth busting, organisations should ensure they are adequately prepared before deployment,” the resource said.
Until solid evidence was compiled, leaders were advised to apply their professional judgement when making staffing decisions drawing on relevant information from sources such as the Nursing and Midwifery Council, Health Education England and the Care Quality Commission.
The guidance stated that trusts should “consider staff capacity and capability” when investigating patient safety issues. It added that where nursing associates were deployed, reports of incidents in which a patient was or could have been harmed should be dealt with separately.
However, Alison Leary, professor of healthcare and workforce modelling at London South Bank University, said she was concerned that nursing associates would be used in the place of registered nurses and that the document did not fully mitigate the risks.
She told Nursing Times: “It’s tricky one as the gap they are trying to fill is not clear. The assumption that the role is designed to bridge the skills gap between the healthcare support worker when we don’t understand that gap is not a good one.
“We do know there is a very large gap in the registered nurse workforce and this is the gap they will potentially fill,” Professor Leary said.
“Filling a registered nurse post with a less skilled worker entails risk and there does not appear to be anything in this document which mitigates risk,” she said.
Professor Leary said she would have liked to have seen more guidance based on evidence included in the document.
However, she added: “It is good to see the guidance affirm the need for appropriately qualified staff and that employers should give thought to their implementation.”
Dr May, who began in her role as CNO last week, said the new document would ensure trusts had the right mix of staff.
She said: “As nursing associates are deployed into the NHS workforce this month, we want to ensure that their clinical teams have the resources they need to do this safely and effectively.
“The National Quality Board’s new resource recommends procedures on governance, leadership and reporting, so that all care settings have the tools they need to achieve the correct skill mix,” she added.
Nursing associates are regulated by the NMC and will be expected to uphold its code of practice. Like registered nurses, they will need to renew their registration via the same revalidation process.
The NMC has also developed standards of proficiency setting what all nursing associates must know and be able to do at the point of registration.