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Trainee nursing associates may not have supernumerary status


Concern has been raised about the newly approved training arrangements for nursing associates that allow host organisations to choose whether to include students in their safe staffing quota.

The Nursing and Midwifery Council (NMC) today rubberstamped the standards and guidance that will be used in the education and regulation of nursing associates in the UK.

“It is hard to see how nursing staff, educators and the public can be confident in this approach”

Donna Kinnair

The first cohort of nursing associates – introduced to bridge the gap between healthcare assistants and registered nurses – will qualify in January 2019. Apprenticeships will be the main route into the profession.

Unlike trainee nurses and midwives, nursing associate students will not be entitled to supernumerary status in their place of work during their apprenticeship.

Employers can choose to include apprentice nursing associates in their minimum staffing quota, but they must show how they will protect a certain amount of time for the student to learn.

Under this model, the student will still be supervised while they work towards meeting the NMC standards and will be given time off by their employer for academic study and placements with other organisations.

“We believe this is a very positive step”

Danny Mortimer

The NMC has introduced the new model to support employers taking on nursing associates whose programmes are funded by the apprenticeship levy, which can only cover training expenses.

The new standards for nursing associates were approved by the NMC council during in a meeting in public at its London office today. In papers that went before the council, it said: “There are soundly-based concerns about whether employers will invest in nursing associate apprenticeships if they are perceived as too costly. The apprenticeship levy can only be used to fund training costs, not for wider capacity-building in a setting that hosts students, or for backfill. This matters because, unlike nursing, for nursing associates the apprenticeship route is conceived from the outset as the principle route by which people will train to enter the new profession.”

The regulator will use its quality assurance procedures to ensure students are given sufficient time to learn and will also evaluate the programme to make sure there are no adverse impacts on patients or learners.

Host organisations can also choose to follow the traditional supernumerary route - where students are an addition to the minimum number of staff required for safety.

However, the Royal College of Nursing has today criticised the decision not to enforce compulsory supernumerary status for nursing associates.

Dame Donna Kinnair, the college’s acting chief executive and general secretary, said: “We have significant concerns around the NMC’s decision not to treat trainee nursing associates as supernumerary.

“The alternative protected learning time is ill-defined and without an overarching quality assurance framework, it is hard to see how nursing staff, educators and the public can be confident in this approach,” she said.

“There is a strong rationale that supernumerary status allows nursing staff to learn effectively and safely,” she said. “Any move away from this approach must be supported by robust evidence and planning.”

During the council meeting, Dr Geraldine Walters, the NMC’s director of education and standards, highlighted that the regulator had carried out a consultation over the nursing associates plans. 

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Geraldine Walters

She said 66% of respondents had agreed with supernumerary being a requirement for pre-registration nursing associate programmes. Conversely, 62% also agreed that the NMC should permit a different approach to protecting learning in practice settings.

Responding to NMC council lay member Hugh Bayley on what actions could be taken if students were not being provided adequate learning time, Dr Walters said they could be removed and given a new placement in line with the regulator’s current procedures.

While recognising the benefits of supernumerary, NMC council registrant member Karen Cox said it did not guarantee a quality learning experience for students.

During the meeting, lay council member Stephen Thornton also expressed a “lingering anxiety” that employers facing high demand could allow nursing associates to carry out tasks they were not trained for.

He added: “My fear is we will have a number of nursing associates at fitness to practise who have been under tremendous pressure by their employers to do what they are not able or qualified to do.”

NMC nursing associate programme manager Emma Westcott said the NMC was only a part of the “jigsaw” and other regulatory organisations like the Care Quality Commission and NHS Improvement would play their part to ensure nursing associates were introduced safely.

Meanwhile, Danny Mortimer, chief executive of NHS Employers, welcomed the approval of standards by the NMC.

He added: “We believe this is a very positive step that will enable the service to provide meaningful education for trainee nursing associates, and in turn support the delivery of patient care of the highest standards of quality and safety.

“Many employers are enthusiastic about this new role and we believe the decisions announced today by the NMC will support the service to further scale up the development and deployment of nursing associates,” he said.



Readers' comments (5)

  • Hmm. Didn't see this coming a mile off. And let me guess who is ultimately responsible for any problems caused by staffing wards with untrained staff. Instead of protected learning time, I'd prefer to see a maximum amount of hours allowed to include students in the staff complement.

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  • I'd prefer to see this ridiculous role abandoned now. Put the time effort and money into training health care assistants properly and bring back the bursary. I have asked on numerous occasions how the associate role will be integrated into a busy ward environment and nobody can tell me.

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  • It was encouraging to hear the council members raise concerns over employers not putting sufficient funds to ensure NA's had appropriate protected learning time. I was also encouraged to hear them questioning in regards to employers from organisations with less robust HR structures, not supporting the NA's in their roles appropriately and blurring the lines in regards to their job role. It is important that this is monitored and these new NA's are safeguarded against being put in positions that can lead to risk. They are unlikely to be able to challenge their managers, even though it is their responsibility to do so and I was encouraged by the questions raised by the council on how this could be monitored. However long term it is important to consider how this will be maintained once the spotlight is turned off! I do wonder if some employers may use the role of the NA to replace vital nursing staff and the risk that this may then pose

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  • I understand peoples concerns about the delivery of a "new" role. Reality is this, that whilst in training these TNA's, must have 20% of their clinical time working on placements and a further 1 day a week doing the classroom/academic input they require. Whilst back in their normal work environment these TNA's should be working against their approved job description and in line with what they have been deemed trained and competent in the practice of. The responsibility for this to be managed needs to fall with the TNA who must learn to stand their ground and only work in a safe an appropriate manner and their line manager/support to ensure they are not being pressurised to be involved in unsafe practice. The key in making this successful, is to ensure appropriate support is given to the staff and leaders in these clinical area's to make sure they are able to safely and appropriately plan their establishments and to understand the skills and scope of the new role and in designing an establishment model that allows the patients and staff to be safe and cared for appropriately.
    I see little point in always looking behind us, yes the bursary and secondments were a great model, but we don't have them now and this is what we are going to have for the foreseeable future. The NA role is not a replacement of the RN role, but a diversification of a nursing workforce to help rise the level of care available and reduce stress on the staff that are carrying the burden of what is a grossly understaffed Health system. #embracechange

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  • Let us be clear, diluting the skill mix results in poorer outcomes for patients. Good otcomes are clearly associated with having a high proportion of RNs providing direct care to patients. The research evidence for this is ever increasingly compelling.

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