The Nursing and Midwifery Council’s decision to regulate nursing associates will benefit nurses, because it will give them “a great deal more assurance” in their practice when they delegate tasks, the head of the regulator has said.
At an NMC council meeting yesterday – following a lengthy debate – the body’s council agreed to a request from the Department of Health to regulate nursing associates.
“The fact we have said ‘yes’ provides the profession with a great deal more assurance than they had”
NMC chief executive and registrar Jackie Smith said the regulator was not able to control how employers deployed the new role in England, but she told Nursing Times the body would now be able to set the standards for training associates.
She said it would benefit nurses because when they delegated tasks to associates in the future they would be clear to what level they should have been trained. This area had been a “major concern” in the past for nurses who delegated tasks to healthcare assistants, she said.
“We can go on forever and a day debating about whether this is the role that should have been created, but that’s not for us, and all we’ve been asked to do is regulate,” she said.
“The fact we have said ‘yes’ provides the profession with a great deal more assurance than they had,” she said. “Because there are some things that we can control – such as setting the right standards and giving registered nurses clarity around who it is they are delegating to, which has been a major concern.
“I know there is some opposition [to nursing associates] but equally there is a lot of concern about ‘am I just accountable for some unregulated person’,” she told Nursing Times, adding that there were other benefits as well. “[Today’s decision] also allows for some career progression,” she said.
”Regulation means full regulation, not a bit of regulation”
The NMC’s decision on Wednesday was made on the basis that the government in England pays the £4m the NMC expects it to cost to set up regulation for nursing associates, and also on the basis that the DH approves the legislation needed to bring in the new system.
A spokeswoman for the DH said it was aware that the NMC wanted financial support from the government and that it would consider this in due course.
Prior to the decision being taken, Ms Smith told the council that “regulation means full regulation, not a bit of regulation”, and that this “comes at a cost”.
She said the council would, in future, need to consider how far the NMC’s code of conduct could be used with nursing associates, and the extent to which fitness to practise and revalidation requirements could be applied to the role.
Ms Smith later told Nursing Times that she “expected this new professional group to revalidate in the same way that registered nurses and midwives have to”, but noted that all three issues would be formally decided upon by the NMC council in future.
During the meeting, Ms Smith laid out to the council the benefits of regulating nursing associates, as well as some of the challenges.
She stressed that the NMC was the best body to take on regulating the new role because it would allow it to control standards of training and practice – and provide clarity about how those overlapped or were different to nurses.
“There is a suggestion the government are looking for easy options and they’re going to create a cut price nurse”
“If we become the regulator [for nursing associates]…I would suggest we are providing clarity for patients and the profession,” she said.
Ms Smith said if another body were to regulate the role, the NMC would have no control over the clarity provided, and that the two years it would take to bring in required legislation changes would provide the time needed to decide the standard of practice for associates.
“We can protect the graduate workforce by setting the right standards,” she said. However, she acknowledged there would be difficulties in bringing in regulation, after other council members questioned whether the body would be able to make a success of it without affecting its other programmes.
She said that the NMC’s most recent major programme of work – revalidation – would seem like a “walk in the park”, compared with bringing associates onto the register.
Ms Smith later told Nursing Times that, while the NMC had the resources and systems to set regulation up for a new group, the challenge would be introducing a role that not all parts of the profession had supported.
“Getting people to accept the role is a philosophical debate, because there is still so much about it that people are fearful of,” she said.
Council members also described some of the “huge funding pressures” the NHS was currently under and acknowledged the possibility that nurses would be replaced by associates.
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“I think there is an elephant in the room,” said council member Stephen Thornton. “We all know the NHS is under huge funding pressure. Right now out there A&E departments are bulging at the seams.
“And there is a suggestion that the government are looking for easy options to this and they’re going to create a cut price nurse,” he said. “Therefore, directors of nursing are going to be under pressure to change the balance of staffing on the walls and replace registered nurses with nursing associates.
“That may or may not happen. In a sense that is none of our business, but there is a bit of that elephant we are responsible for,” he said.
“That bit of the elephant we can deal with is around setting the scope of practice – if we set that in such way that those [associates] who join the register realise their professional responsibility is to only work within that scope,” he told the meeting.
Speaking to Nursing Times after the decision, Ms Smith said: “We can’t dictate to employers. We can only say these are the standards and this is the code you must adhere to.”
She added that there would be a full public consultation on the standards in the future.