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NMC regulation of nursing associates 'will benefit nurses', says regulator's chief exec


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”

Jackie Smith

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”

Jackie Smith

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”

Stephen Thornton

“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.

Nt editorial jackie smith

Nt editorial jackie smith

Jackie Smith

“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.


Readers' comments (6)

  • It appears even the NMC don't know what the role will entail other than involving a few elephants.

    How can they regulate a role they don't understand?

    £4 million is a huge amount of money, now effectively to be spent on paperwork/administration, would this not have been better used for bursaries?

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  • Why not regulate assistant practitioners as it's clear the nursing associates are the same!

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  • Many years ago there were registered nurses (RN) and enrolled nurses (EN), each with legally defined and accountable roles. Then, enrolled nurses were removed as it was felt by some that they were "second class nurses" - quick fix, often low-grade 'conversions' were offered and miraculously, enrolled nurses were suddenly 'proper' nurses. Strangely (or not), the well-trained HCA is exactly the same role as the old EN. The well-trained HCA will become a 'nursing associate' and in around 10-15 years time I imagine there will be a move to merge these to the register proper, as they will feel that they are 'second-class nurses' and that will have to be remedied. The old system worked well: registration for more academically/managerially minded nurses; enrollment for the more practically-minded nurse. All this money being constantly wasted on politically motivated agendas simply sickens me and is one of the many reasons why the NHS is in such a parlous state..

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  • Of course they have agreed to regulate them. Money talks.

    I agree with the previous comments regarding the NMC agreeing to regulate something they don't even know what it is going to entail!

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  • In relation to one of the comments above, and which I have heard in various forms before, I have never been able to understand why many people feel only academic or career minded nurses should be registered and enrolment be for the more practically minded. I assume academic or career minded nurses are those who have studied to degree level to acquire registration and enrolled nurses have not. It seems to me that this implies that 'on the floor' nurses do not require to be educated to a degree level and that those who are are only interested in management or academia. This seems to me to be the polar opposite of what we need and what patients deserve: intelligent nurses educated to degree level able to assess patient needs accurately and respond appropriately (if staffing allows of course!). Good nursing does require intelligence and not just a caring nature and studying for a degree should not condemn a nurse to management or academia or imply s/he is unsuited to hands on patient care. Yes, there are some excellent nursing assistants and some awful registered nurses, but the 'old system' is not the answer. Neither are the new nursing associates.

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  • I am one of the new trainee nursing associates. As a senior HCA of 15 years experience I welcomed the chance to gain more knowledge and be a better carer for my service users. However the negative comments and the fears displayed in these letters is soul destroying. I feel like no one will properly mentor me and leave me out in the cold if I start my training somewhere other than my current place of work. Please trust that I and my co workers who jumped at the chance for this training will be responsible enough to care enough to do our tasks properly. Give us a chance to prove ourselves.

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