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”
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”
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.
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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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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.
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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.