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Clarity over associates needed ‘to avoid disguising workforce shortages’

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“Absolute clarity” about what nursing associates are trained to do and the level of supervision they require will be key to ensuring those in the new role are not used to conceal workforce shortfalls, the chair of the inquiry into the former Mid Staffordshire NHS Foundation Trust has said.

Speaking as part of a Commons health select committee evidence session about nursing shortages on Tuesday, Sir Robert Francis QC said he believed the workforce was in “crisis” and was unsure there were short-term fixes.

“I would suggest we need clarity on all sides as to who these people [nursing associates] are, what they do, how they are trained”

Sir Robert Francis

He said action was needed to tackle the challenging working conditions nursing staff and others were working under. He also suggested the NHS had travelled “in a circle” to returning to a focus on financial concerns rather than patient outcomes – as had been the case with Mid Staffs.

When asked about the introduction of nursing associates and what safeguards should be put in place for those in the role and for patients, he warned of associates being used to disguise staff shortfalls.

Details about what associates are trained to do, what they require supervision for, how they are trained and to whom they are accountable would be crucial for laying out the boundaries of the role, he said.

“I think it is very important we don’t disguise shortages in the workforce by having lots of people dressed rather similarly walking around wards and everyone thinks they are nurses – when they are not,” said Sir Robert.

“I would suggest we need clarity on all sides as to who these people [nursing associates] are, what they do, how they are trained, who they are accountable to and how they are going to be supervised,” he added.

“When roles of this nature are looked at as a solution to a workforce problem… the registered nurse is likely to have to continue supervising such people”

 

In the past, when there were state-enrolled nurses – a role phased out during the 1990s – as well as assistants known as nursing auxiliaries, and registered nurses, both staff and patients were aware of the responsibilities they each held, he said.

Sir Robert said that while he welcomed the introduction of nursing associates as a route into nursing, it was important the role was regulated so that training was standardised.

Robert Francis

Robert Francis

Sir Robert Francis

He noted this was different to the current situation for healthcare support workers who often receive very little training, which is not standardised, and had led to a “huge” variation in the way they worked across different organisations.

“When roles of this nature are looked at as a solution to a workforce problem, we have to bear in mind the registered nurse is likely to have to continue supervising such people and therefore we need to know what they need supervision for,” he added.

The Mid Staffs inquiry looked at care failings following a number of deaths at the trust. It resulted in 290 recommendations for the NHS and wider health and care services when Sir Francis published his final report in 2013.

One of the recommendations made by Sir Francis was for healthcare assistants to be regulated.

In January the NMC agreed to the government’s request to regulate nursing associates, a role designed to sit between HCAs and registered nurses in England.

The NMC has released an early draft version of the standards associates will need to meet, but a full public consultation will not take place until spring 2018.

A total of 2,000 nursing associates began training on two-year programmes from January this year with employers and universities involved in piloting the role.

Last month the health secretary announced 5,000 nursing associates will train in 2018, followed by 7,500 in 2019.

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