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Leak reveals nursing associates will be allowed to give patients drugs unsupervised


Nursing associates will be expected to calculate drug doses and independently administer controlled medications, leaked documents have revealed.

Health Education England internal papers show the proposed curriculum for nursing associates, and describes how the new nursing role will also be allowed to carry out invasive procedures on patients without the direct supervision of a qualified nurse.

The HEE document sets out specific skills nursing associates should be capable of after their two year training course, which will begin for the first cohort of 2,000 in January.

The document said: “By the end of the programme, the trainee nursing associate will be able to deliver planned nursing interventions… in a range of health and/or care settings under the direction of a registered nurse without direct supervision, delivering care at times independently in line with an agreed/defined plan of care.”

They will also be able to assess, plan, deliver and evaluate care, as well as recognise deteriorating patients, according to the document leaked to Nursing Times’ sister title Health Service Journal.

The HEE document said nursing associates will “correctly and safely undertake medicine calculations; administer medicines safely and in a timely manner, including controlled drugs”.

Anne-Marie Rafferty

Anne-Marie Rafferty

Anne-Marie Rafferty

Additionally, the document said this will only happen where deemed appropriate and set out in organisational medicine management policies. Associates will also be expected to be able to “correctly and safely receive, store and dispose of medications”.

Last week a job advert for trainee nursing associates at an NHS trust in Manchester revealed some of the competencies the role is likely to be trained in, including knowledge of medications and their administration, as well as monitoring patients’ vital signs.

Meanwhile, an official decision has yet to been made by the Department of Health on whether nursing associates should be regulated, and by which organisation.

Anne Marie Rafferty, professor of nursing policy at King’s College London, said she was concerned about the proposals in the leaked document.

“It does not appear to be well thought through and is a recipe for confusion within the nursing profession, the public and other professions such as doctors about who is doing what in clinical practice,” she said.

“What are these people not able to do? What would be the sole preserve and prerogative in terms of scope of practice for the qualified registered nurse? It also raises questions over accountability because of the confusion it will create,” she added.

Lisa Bayliss-Pratt

Lisa Bayliss-Pratt

Lisa Bayliss-Pratt

Professor Rafferty said it was vital the role was based on the best available evidence, properly piloted and evaluated before being rolled out across the NHS.

But Lisa Bayliss-Pratt, director of nursing at HEE, said the curriculum framework had been developed as a guide for education providers “to ensure they provide what the NHS needs within their offer”.

She added: “We have developed this framework as a result of wide consultation across the health and education systems, listening and responding to their needs to ensure this role plays a key part in a multidisciplinary team that focuses on quality of care.

“HEE’s response to the consultation makes clear that this new role will support registered nurses and employers are expecting to deploy them as such,” she said.

The Royal College of Nurses has previously warned that the role should not be a substitute for registered nurses but the chief nursing officer for England Jane Cummings recently stated in a blog that the new role would not be used in this way.

Previous studies have shown the dangers for patients in substituting non-qualified staff for qualified nurses.

In February, research into staffing levels at 137 acute NHS trusts between 2009 and 2011 found trusts that employed more healthcare assistants relative to the number of beds had an increased risk of mortality. The risk of death decreased by 7% for every additional bed per HCA.

Last year global safe staffing expert Linda Aiken, director of the Centre for Health Outcomes and Policy Research at Pennsylvania University, said the plan to create a nursing assistant role was “crazy”.

She said evidence in the US showed employing licensed practical nurses – the US equivalent of nursing associates – increased mortality and poorer outcomes.

Commenting today, RCN chief executive and general secretary Janet Davies said: “The nursing associate role must not be a substitute for registered nurses, who are required to make clinical judgements using a high level of experience and knowledge to assess complex situations.

“Nurses are responsible for the wellbeing of their patients and this includes delegating some tasks to other members of staff. Part of their professional accountability involves making a judgement over when it is safe to delegate responsibilities to colleagues,” she said. “To continue to do this properly they will need much more clarity over the roles and responsibilities of nursing associates.

Royal College of Nursing

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Janet Davies

“Safe administration of medicines is a key patient safety issue,” she said. “Drug administration is not a mechanistic task – it requires professional judgement, and if ongoing assessment of a patient is required it should be the responsibility of a registered nurse.

“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 Davies.

“The introduction of nursing associates can be an opportunity to provide support to registered nurses and improve care for patients. However, there must be no ambiguity about how the roles overlap, and all staff should be given responsibilities that are appropriate to their skills and experience,” she added.


Readers' comments (52)

  • I work in a unit that has slowly introduced the band 3 and then the band 4 role. Prior to that all staff were registered nurses. We now have the same number of 3s and 4s as we do band 5s. Without doubt the unregistered staff do a grand job, but they have limited knowledge and are (rightly ) not allowed to check or administer medication. The result of this is more and more pressure and responsibility on the already burdened shoulders of the band 5s and 6's. I have no doubt as time goes on the number of unregistered staff will rise as the number of registered staff fall, as we all know it is nursing on the cheap. Yes I remember the enrolled nurses and the great job they did, but nursing has changed completely since those days. We do not need a lot of staff all vying for a 'piece of the action'. We need some to carry out good basic care and basic observations and then high calibre registered nurses to do what they are trained for - high quality clinical care.

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  • Pussy

    Thin edge of the wedge but then didn't we know? Inevitably roles will merge into one and there will be disasters and "lessons will be learnt" when it's too late. What a mess.

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  • Nurses are paying the NMC yearly only to be penalised as a result of unregulated staff's mistakes. Qualified Nurses are getting undervalued and disrespected by the employers and NMC.
    Qualified UK Nurses should work abroad.

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  • Groundhog day for definite.

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  • Hello I have been a HCA for over 10 years and I really want to become a nurse... and I am struggling getting in, due to my lack of qualifications. What is the name of this course training and how do I go about doing this training?

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  • Anthony Johnson

    Definitely feel that we should be training people to become RNs instead of introducing a cheaper substitute. It shows that we don't value the people who are becoming Band 4s or the Band 5s who will be replaced by their introduction.

    As someone else rightly stated, I am training to become a Nurse, not a manager or an associate practitioner. Devaluing the profession risks patient safety and if it is not stopped proves how inept we as nurses are at advocating for ourselves. I will refuse to place my pin in the hands of another person.

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  • I'm 6 weeks out from qualifying and the more I read about what the NA's will be able to do the more I'm wondering what the point of my training is. I agree with others in that it seems like nursing is a dying profession, there will be an increased decline in the number of people who are wanting to train as a band 5, which considering recent changes to funding, is already in full effect.

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  • Totally agree with Michael Stone. Who will be accountable? another underlying policy to bring down professional nursing as its cheaper! Will it end up being anyone who has done an NVQ or a six week course be able to carry out a professional nurse job to save money? I would not advocate this profession to any young person today, if they had potential I would advise them to pursue a career with regular pay rises and respect for the job that they do.

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  • All very interesting and important but; it's November. Shouldn't we have started rowing about the flu jab by now?!

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  • As a student nurse currently in second year of a Bsc Hons, this makes for a distressing read. It devalues all of the hard work that we are currently putting in, and concerns me greatly as to the career that I am getting into. Will the role of a registered nurse exist in the future of nursing? I am not sure anymore.

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