A hospital trust is to remove more than 20 nurse vacancies in order to introduce the same number of nursing associates, but its chief nurse has insisted to Nursing Times that the move is not substitution because the posts are empty.
East and North Hertfordshire NHS Trust said that because the band 5 nurse posts were vacant, the introduction of nursing associates in their place would in fact enhance the team.
“We have got vacant roles. So it’s not role substitution, its enhancing the team”
The organisation is part of a pilot site for testing nursing associates – the new role designed to act as a bridge between healthcare assistants and registered nurses – and converting the posts is expected to save the organisation £130,359 per year, compared to if it had filled them with nurses.
Associates will be paid band 3 wages while they are training, before moving to band 4 upon completing the two-year programme.
The trust reviewed its nurse establishment in April 2016 and, in anticipation of being selected to test nursing associates, put forward proposals to its board to convert 24 band 5 nurse posts into the equivalent number of nursing associates.
It planned to convert one nurse vacancy across 24 inpatient wards, excluding its maternity and intensive care units.
“We’ve done a lot of work over the years on our ward-based establishments and our nurse-to-patient ratios are good”
The trust’s acting chief nurse confirmed to Nursing Times this week that it will go ahead with the plans to convert 21 posts when trainee associates begin at the trust in April.
The organisation was still looking at whether to remove nurse vacancies to cover the four nursing associate trainees that had already begun at the trust across children’s services, as part of the first wave of pilots in January, she said.
Since the government announced its plans for associates at the end of 2015, unions, academics and leading figures have warned the new role must not be used to replace registered nurses.
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The move by East and North Hertfordshire, revealed in board papers, represents the first time that Nursing Times has found concrete plans by an organisation to replace nurse posts with nursing associates – either vacant or filled.
But its interim director of nursing, Liz Lees, insisted that nurses were not being replaced at her trust.
“We have got vacant roles. So it’s not role substitution, its enhancing the team,” she said. “We can’t recruit to all of these band 5 posts. So it’s really using what we’ve got as effectively as possible.
“Plus, we’ve done a lot of work over the years on our ward-based establishments and our nurse-to-patient ratios are good,” she added.
“We could have introduced the band 4s on top [of the nurse vacancies], but we are struggling to recruit our band 5 cohort, which isn’t unusual,” said Ms Lees.
She told Nursing Times she believed the introduction of nursing associates would help to retain staff, especially those support workers who wanted to progress but did not want to be a nurse.
“We are hoping it will attract people, so we can say ’join our organisation as a band 2 and we can give you opportunities’,” she said.
Existing band 2 support workers were selected for the pilots and the empty posts the associates leave behind will be backfilled, said the acting chief nurse.
She said she had no further plans to convert more nurse vacancies into nursing associate posts.
East and North Hertfordshire is part of two pilot sites being led by Great Ormond Street Hospital in London and Hertfordshire Partnership University NHS Foundation Trust.
Royal College of Nursing chief executive and general secretary Janet Davies said: “This is a worrying move and another reminder of the need for more nurses to deliver safe care.
“The RCN repeatedly warned the government that its failure to recruit and retain registered nurses would lead to nursing associates replacing them,” she said.
“It is just not fair on nursing associates to expect them to deliver the same standard of care as a highly trained registered nurse,” she said. “Support staff must supplement their work, rather than replace them.
“Patients are being short changed too. Health outcomes are improved when greater numbers of registered nurses with the right skills mix are on duty,” said Ms Davies.
She added: “The government cannot keep getting away with its failure to ensure the right number of staff with the correct skills mix. It must give urgent priority to increasing the supply of registered nurses.”
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