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CNO sets out safe deployment of new nursing associate role


The chief nursing officer for England has said she “would not be against” regulation of the new nursing associate role if its introduction caused concerns around patient safety.

Jane Cummings told conference delegates yesterday that she had an “open mind” about regulation of the new post, which the government wants to introduce as a bridge between healthcare support workers and registered nurses.

“They are supporting the care of patients under the supervision of registered nurses”

Jane Cummings

“If people are trained and educated and are working potentially at a band 4 level, and are caring for people even under the supervision of a registered nurse, if there are issues around patient safety or needing to maintain safety for the public, then I would not be against regulating them,” she said at Nursing Times’ Deputies Congress.

The Nursing and Midwifery Council has previously told Nursing Times that it would be able to regulate the role is asked to do so.

NMC chief executive and registrar Jackie Smith, who also addressed the event for deputy nursing directors in London on Tuesday, said it was for the profession to decide if it wanted the role introduced first and that the regulator was “neutral” on the issue.

“Our role in this is to influence discussion and be clear if we are asked to regulate we are ready to do it,” said Ms Smith.

Meanwhile, the CNO also stressed that she was “absolutely clear” that those in the future nursing associate role would not be nurses.

“These are nursing associates, people that are educated at a higher level than we’ve currently got with our healthcare assistants, and they are supporting the care of patients under the supervision of registered nurses,” she said.

When asked whether registered nurses might be substituted with nursing associates in the future, she said it should not be done on the grounds of affordability.

McGill University Health Centre

CNO ‘not against’ regulation of new nursing associates

Source: Andy Paraskos

NT editor Jenni Middleton with Jackie Smith and Jane Cummings at NT Deputies 2016

However, Ms Cummings suggested there could be instances where it occurred appropriately due to skill mix, for example where a situation did not necessarily require a qualified nurse to be present but did need a staff member with more training than an ordinary HCA.

“You might have a ward where you need an extra nurse and at the moment all you have is an RN,” she said. ”But actually when you look at the needs of the patient and you use proper patient dependency [tools] and you link that to the skills available, in some cases you might have a nursing associate who is there because they can do more than an HCA but because the patients don’t need another RN.

“In some cases, it may be entirely appropriate to have somebody that is trained and educated and able to deliver care at a band 4 level but it’s got to be for the right reason – not because we can’t afford a registered nurse,” she told delegates.


Readers' comments (15)

  • I've been reading a lot regarding this role recently and as a current Assistant Practitioner I'm left wondering where I will fit into this new role as a band 4 already?? I am however completely in favour of being regulated as RGNs are and firmly believe it's the way forward.

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  • Anthony Johnson

    If it's the profession’s decision to decide if it wants the role then I don't want it. It's dangerous to be putting a lower band in that is eventually going to become redefined as a nurse the moment the NHS Bursary changes, Brexit and lower numbers of international non-EEA nurses kicks in.

    We always 'progress' towards America's healthcare system. Even though they now see LPNs as a mistake that they shouldn't have introduced, our current government plods on with the introduction of Nurse Associates. If your a Band 5 and you don't want to be doing the job of a Band 6 for a Band 5 pay you need to not support Nurse Associates.

    That's the point of these changes. Deband, Deskill, Demoralise and then? Privatise. That's what they've been doing for the past 30 years in our NHS. We, as a profession, should speak out against it.


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  • Its already started at North Tyneside Hospital and Northumbria Uni
    Cheaper for privatisation

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  • Cheaper for privatisation and creates an unco-operative competitive market between nurses and associates. Also means infighting means not directed at the causation by government approved leaders and bad management at local levels. This is a bad idea and it is the patient that suffers.

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  • For me the introduction of the Band 4 role is certainly not to de skill or demoralise nurses, it's about supporting nurses to provide appropriately skilled care at point of contact and allowing other bands to alleviate tasks that can be carried out by qualified AP's or NA's and diversify the general skill mix. Surely having more qualified people working in the NHS is a good thing??

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  • The issue is a complex one. We, as a profession are always willing to embrace new ways of working and, of course want to alleviate some of the short staffing and poor skill mix that we are currently experiencing. The shortage of about 22,000 RN's nationally appears to be the driver for this new role.
    However, diluting our level of study, academic rigour, experience and skill levels is not the answer to a shortage of nurses. Treating nurses better, honouring the NHS pay review body recommendations and not "trashing" pensions would all help with recruitment and retention.
    As a registered nurse of 34 years I do not trust this government or NHS managers as so much of what they propose is driven by cost and not quality. How many senior nurses at band 8a, 7 and 6 have been down banded in the supposed name of service improvement when we all know that it is fuelled by each employers Cost Improvement (CiP) programme. We get lied to on a daily basis by managers who don't even believe it themselves.
    Of course, it is not as though we have not been here before with "Enrolled Nurses" whose role when I first started included taking charge of the wards. When we realized that experience alone was not enough and that further clinical skill development and academic study were essential for better patient outcomes we introduced conversion courses to move enrolled nurses up to RN competency levels.
    Why does Govt not learn the lessons of the past or is this a deliberately cynical move to further dilute the nursing profession which, in turn undermines the NHS and makes it even more vulnerable to private sector vultures?

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  • To Jennifer Hartley:
    Your comment is only is theoretical. Think it through: We had SENs before, how were they used? Were staff patient ratios any different? Did staff ratios change after all the SENs were converted? In the very ideal case that you, as a staff nurse, find you are working with a nursing associate who has trained up from being the HCA that you usually work with, what will you be doing while they are doing the drug round for you, or hosting the MDT meeting? or changing dressings?. And while they are doing all that for you, who will be doing their old job?
    Do you think there is going to be more money spent to improve nurse patient ratios under this administration? I think not. So at the very best, a band 2 becomes a band 4, which actually does cost more money and will have to be paid for. Maybe with the extra training they will be more motivated about the detail of the work they do, but you can't get something for nothing. The more time spent on one task means less on another.
    The fundamental problem with nursing is that hands on nursing has no effective professional representation, so we have one new idea after another, productive wards, medical early warning charts, inadequate computerised documentation, systems which are never reviewed for effectiveness once implemented, and sometimes simply are ignored and fall out of use, with serious to dangerous results.
    My other question is: Who dreamed up this idea in the first place, and why, why introduce another tier, when we have only just got rid of one?

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  • "For me the introduction of the Band 4 role is certainly not to de skill or demoralise nurses, it's about supporting nurses to provide appropriately skilled care at point of contact and allowing other bands to alleviate tasks that can be carried out by qualified AP's or NA's and diversify the general skill mix. Surely having more qualified people working in the NHS is a good thing??"

    This is very naive.

    As the next comment rightly points out we have since 2010 seen the down-banding of many senior posts, with a consequent dilution of skills, experience and knowledge (there is not a Band 5, and precious few 6s, on the planet who could do what I did as a 7 and yet my 7 post was replaced by a 5). This new level of "associate" is just another means to do this: think why the EN role no longer exists.

    The cost cutting pressures have been around as long as I can remember: my first "nursing" job as a nursing assistant in the mid-'80s was essentially filling a substantive staff nurse post...

    The fight to make nursing a more highly qualified profession has been a long one and it is not time to step back now.

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  • "Its already started at North Tyneside Hospital and Northumbria Uni
    Cheaper for privatisation"

    And just look where Jim Mackie, the chief exec of Northumbria Healthcare, is now.

    Is this a coincidence?

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  • michael stone

    I tend to agree with the point made by Jennifer Hartley - provided you do NOT DISTRUST the 'powers that be', then closing 'the ability gap' between HCAs and RGNs seems entirely sane.

    However, I am not at all sure that I do trust 'the powers that be' - so 'in a political sense' I share the same types of concern expressed by some posters after Jennifer.

    If this new level of HCAs is introduced, it will be interesting to see to what level it becomes 'a career grade' (do people 'just sit there') or a route for progression to RGN: clearly, the greater the proportion of people whose moved on to RGN, the lower the 'political risk', but if a lot of people 'just sit in the grade' the 'political risk' is much greater.

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