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Nurse vacancies converted into associate posts at acute trust


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”

Liz Lees

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”

Liz Lees

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.

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.

liz lees

liz lees

Liz Lees

“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.”


What do you think of this story? Join the debate

At 3pm on Friday 10 March 2017, we’ll be hosting a debate on Twitter. Join in using #NTtwitchat to have your say and hear what your colleagues think.

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Readers' comments (12)

  • And so it begins...nursing on the cheap; I fear for the future of nursing and the safety of patients. They say they're not substituting nurses with associates...if they are no longer advertising the band 5 posts then that is exactly what they are doing...!

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  • This infuriates me. How can they pay them as Band 3 whilst training, but some seconded student nurses are only being paid as a band 2. And they wonder why there's a shortage of nurses.

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  • That's disgusting! All those hard working nurse students paying now huge tuitions fees will find themselves jobless at the end of their degree because all the vacancies will be filled bu nursing associates!

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  • I have no problems with nurse associates because there are some very good HCA that would make excellent nurse associates. However, I see the future establishment on a shift 6 nursing associate and one RN. If anything goes wrong the NMC punish the RN whilst the trust hides everything else under the carpet. I do hope that those who are becoming nursing associate are aware of what they are in for.

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  • I recently applied for a post having been a registered nurse for 22 years with experience on itu and a burns unit and 16 of them as a practice nurse I was told they didn't need nurses like me anymore as the HCA's were doing everything that I could do and because I do not hold a diploma in diabetes they didn't want me. I went away wondering why on Earth I bothered to revalidate in April and what was the point in applying for further posts I'm top band 5 and have been on the same wage for 4 years. Quite honestly I'm considering giving up nursing if I cannot get a job!
    I am really hoping that these HCA's are not taking on cytology and children's immunisations! Then I was told oh actually we could just use you for a couple of months to clear the backlog of imms then dump me afterwards I guess! Sorry but we band 5 nurses are definately being pushed to the kerb!

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  • Revalidation: "Nurses come back to the service you love" ... unfortunately no Trust can really afford to employ/pay you.

    Qualified nurses: "Thank you for your continued dedication" ... unfortunately you will still not get more than 1% pay rise for the foreseeable future (Only if you are one of the lucky ones).

    Student nurses: "No more bursaries, but more training places" ... unfortunately you will have increasing student loans that you will need to start to paying as soon as you qualify because you'll be earning just enough to have to.

    HCAs: Improve your knowledge, prospects and skills" ... unfortunately you will still be doing the job you are doing now, plus you'll be expected to study and take on more responsibilities for the same pay.

    .... have I missed anything that consecutive governments have introduced to encourage people to work for the NHS as a nurse???

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  • I've said this would happen in previous comments. Governments over the past twenty years or more are obsessed with pushing wages down for quite a number of reasons. Why do you think a character like Hunt has been left in charge, he starts confrontations with staff groups one by one, and picks them of. Unfortunately with the RCN being the main staff organisation/union for nurses I think he must already be feeling confident of getting his quart (if not more) out of a pint pot. I'm so glad I'm finished with the whole lousy set up later this year.

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  • So exactly what we predicted is happening - we were told we were being pessimistic, not embracing the opportunities etc. when raising justifiable concerns about this 'new role'.

    Our HCAs do a wonderful job and are a key part of the team - i have no problem with the progression from Band 2 to 3 to 4 Associate Practitioner) - great education & pay progression.

    What I object to is being lied to yet again - the NA is not going to be a substitute nurse.

    No pleasure take in I told you so but ....

    O by the way, I was an enrolled nurse! now complete with an MSc .....

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  • Nurses have no political power hence the indifference to our declining numbers despite every trust being rewarded with the "Caring" accolade and the front line staff being praised as heroes under the onslaught of non-clinical 'managers' obsessed with imposing their corporate business targets on overworked nurses and have been deemed "inadequate and weak leaders" who remain unpunished and instead are promoted to various expensive health quangoes.

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  • I am very shocked. I have just spotted this advert for a Band 3 A & E Technician.

    Nursing is not in the title but looking at the JD/Summary JOB SUMMARY it includes :
    To work under the direct/indirect supervision of and in support of the registered nurse, carrying out delegated nursing and non-nursing duties to promote patient centred care.
    To assist the registered nurse in the delivery of direct and indirect patient care within all areas of the emergency department.

    This job sits in admin and clerical but it seems we can now have anybody dragged off the streets doing bits of nursing and being given privileged access to our bodies when we are ill and vulnerable. I cant think of anything worse than finding a technician doing observations in a busy, short staffed and often frantic emergency dept. What better recipe for disaster.Is this the governments idea of an apprenticeship?

    Type:Permanent Working pattern:Full Time 37.5 hours per week Pay Scheme:Agenda for changePay Band:3Staff Group:Administrative & ClericalSpecialty/Function:Accident & Emergency

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