The new nursing associate role has been developed very much with England in mind but how and if it will fit into the healthcare systems of the rest of the UK remains undecided, Nursing Times can reveal.
In fact, it has recently emerged that a “degree of hostility” exists towards the new role has developed among Scotland, Wales and Northern Ireland.
“There is a degree of hostility towards the role”
At the end of January, the UK’s Nursing and Midwifery Council agreed to the English government’s request to regulate the new role, which is designed to sit between healthcare assistants and registered nurses.
However, it has been claimed that Scotland, Wales and Northern Ireland do not want to see associates used in their own countries and that they are “weary” of fitting in with England’s workforce plans.
The devolved nations said they already have similar roles to associates – such as assistant practitioners and support workers – that are governed by codes of practice and training standards.
At the NMC’s latest council meeting last month, it also emerged that ministers in England were in ongoing discussions with the devolved countries about whether regulation should be applied to all UK countries or just England.
Differential use of nursing associates across the UK would create a lack of clarity, according to NMC council papers discussed at the meeting.
“There is clear evidence of improved outcomes from graduate level professionals”
During the meeting council member Maura Devlin, former head of the Northern Ireland Clinical Education Centre, said it would be important for the NMC to mitigate the risks caused by the UK countries having divergent nursing workforce structures.
NMC chief executive Jackie Smith told the council there had been a “clear indication” that the other UK countries did not want to use the role, but that she believed there was “strength of feeling that they want UK-wide regulation”.
“There is a degree of hostility towards the role and a clear indication that they don’t wish to deploy it in those countries,” she said, adding that she was in continued discussions with the chief nursing officers from all the UK countries.
Ms Smith later told Nursing Times that, while the NMC wanted to bring in UK-wide regulation, it would not be imposing the role upon any country.
She referred to comments made by NMC chair Dame Janet Finch during the meeting, in which she highlighted that regulation of nursing associates effectively meant the body was approving a qualification, which it was then down to other countries to decide how to use.
“I will continue to work with my CNO colleagues across the UK”
It is widely understood that associates have been brought in to deal with nursing shortages in England.
When asked what was causing hostility towards associates, Ms Smith said: “This is an England problem and the other countries are perhaps a bit weary of trying to find solutions to an England problem.
“But there are hundreds of thousands of registrants in England – it’s a big workforce. That’s not to diminish the size of the other countries at all. But these are factors we need to take into account,” she said.
“As a regulator, we are not there to represent the interests of any professional group in any particular country. We are there to understand the issues and say is this something we should do that would improve public protection,” she added.
She also noted other countries believed they did not need associates because they would overlap with existing assistant roles that were already governed by their own practice standards.
Ms Smith said one of the CNOs had already suggested the body needed to learn from the former state-enrolled nurse, an assistant position that was phased out during the 1990s.
Professor Fiona McQueen appointed CNO for Scotland
She acknowledged the UK split would make it “challenging” for the NMC to bring in associate regulation.
CNO for Scotland Fiona McQueen told Nursing Times her country was “committed to four country working on the regulation of healthcare professionals, which is sensitive to genuinely unique needs of each area”.
She said the Scottish government was aware of concerns about nursing associates but that until final details of the position, including a scope of practice, were available it was not able to make an evidence-based decision on the use of the role.
“There is clear evidence of improved outcomes from graduate level professionals and the Scottish government considers that there is a considerable risk to patient safety in moving clinical nursing practice away from such a level,” she said.
“NHS Scotland already has skilled assistant practitioners who work under the direction of our graduate professionals, and our mandatory induction standards and codes of practice introduced in December 2010 are a proportionate response to the risks this group presents,” added Ms McQueen.
Meanwhile, a spokeswoman for the government in Wales said it was working with the NMC, Health Education England and other UK health departments to more fully understand associates.
“In Wales we have, for some years, been investing in the role of healthcare support workers. This has included developing governance and career development pathways, with the ability to progress to nurse education,” she told Nursing Times.
“As the work in England progresses, it will be important to see how this new role compares with existing roles in Wales. This analysis will help inform the future direction in Wales and the ongoing discussions about the appropriate model of regulation for this role,” she added.
Nursing Times also contacted the devolved government in Northern Ireland, but it was unable to provide a comment due to purdah rules ahead of its forthcoming leadership election.
In a statement, CNO for England Professor Jane Cummings: “We need to ensure that our workforce is equipped to meet the varied and ever-changing needs of our population and the new nursing associate role in England is one way we can support this.
“I will continue to work with my CNO colleagues across the UK to see how this and other models of staffing can deliver the appropriate workforce for the future,” she said.