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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

Pay rise above 1% ‘needed to ease nurse crisis’

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)

  • michael stone


    '“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.'

    It might lead to confusion over 'ultimate accountability' but there isn't confusion over who does a thing: the person who takes a blood sample, took the blood sample; the person who calculated a drug dosage, performed the calculation. But there could be significant confusion over who is 'ultimately responsible for mistakes' - that is clear.

    It is also clear, that there will be little point in having these NAs unless they can do useful things without a registered nurse 'standing at their shoulder all of the time'.

    It is still all 'very messy' !

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  • Michael Stone you are right!
    The main question here is who is overall accountable when something goes wrong well I personally this its the Trust that employs the Nurse associate and not the "NURSE IN CHARGE" as so often happens.

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  • Sounds to me that they are bringing back Enrolled Nurses. Why would employers pay for a band 5 or 6 when they can employ a band 4? This is the end of professional nursing

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  • sounds like the return of the Enrolled nurse, not such a new role after all thank goodness I am at the end of my nursing career and won't be around to see the demise of nursing

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  • I so agree about the 'Enrolled Nurse', it has been so clear it was heading this way, however, I was surprised at the being able to give controlled drugs as an associate given the situation for registrants currently. Or am I missing something?

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  • I was an enrolled nurse we checked control drugs and did everything a staff nurse did and overall enrolled nurses were better bedside nurses bring them back but not to be used like before , it will happen ,enrolled nurses started same way.enrolled nurses that are left now get same pay, yes, there are some left but you would not know they were enrolled nurses

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  • If this 'leak' is indeed true I would be interested in the definition that separates Nursing Associates and Nurse. Especially in terms of how a patient or other member of staff will have expectations. To quote 'the curriculum framework had been developed as a guide for education providers “to ensure they provide what the NHS needs within their offer”'. Then one can assume without doubt the role will be administering. Cue the NMC for regulation?

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  • Continually in practice since 1974 , SRN SRN topped up with BSc Hons (1st class ) & SPQ 2009. Counting the months until I retire from a profession being devalued beyond recognition

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  • Borrowing a leaf from Helen Wells' comment, this truly could become the downfall of professional nursing services in the UK! There might be no more regards for Professional Nurses (PN) since these NA's will more or less fulfil all the professional responsibilities of a PN. Definitely, unemployment may rock PN's as employers would prefer the NA's for nursing jobs---to save cost. But, can the quality of patient outcome still be the same? The Government should have a rethink on this!

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  • I give it 2 years before the minimum requirement will be one registered graduate nurse on duty supported by a couple of associate nurses no non graduate RNs at Band 4 and Bands 1 &2. And the RCN will do what about it? Get off the fence before your membership is out of a job

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