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Nursing associate role will ‘supplement, not replace’ RNs, says top HEE nurse


The new “nursing associate” role will not remove overall responsibility of care from nurses, though it will take on some of their functions, Health Education England has told Nursing Times.

The role will be fully tested and developed before being rolled out nationally, despite earlier plans to pilot the role at 30 sites having been cancelled, confirmed HEE’s director of nursing Lisa Bayliss-Pratt.

“We must never forget that the person ultimately responsible will be the registered graduate nurses”

Lisa Bayliss-Pratt

Last year, Nursing Times revealed that plans were being developed for a bridging role intended to sit between nurses and senior healthcare assistants, which would also offer a fast-track route onto the register via degree-level apprenticeships.

The creation of what are provisionally being called “nursing associates” – previously often referred to as associate nurses – was confirmed by ministers in December and a consultation on the role was launched yesterday.

In an interview with Nursing Times, Professor Bayliss-Pratt said the consultation exercise would look at what competencies would be required by those in the new role to free up nurses’ time and at the skill mix required in certain clinical areas.

It would allow more registered nurses to move into leadership and management positions and take increasing control of the quality of care provided by their teams, she said.

“There’s something around who’s doing what tasks and whether they are the best people to do them, but we must never forget that the person ultimately responsible will be the registered graduate nurses,” she said.

The consultation document states that nursing associates would not be able to independently review patient treatment plans, measure or evaluate progress to make decisions on patient care, or lead or design the care planning process.

“We absolutely have to test this and see where the role adds the most value”

Lisa Bayliss-Pratt

They would also be unable to manage or oversee care interventions, or provide clinical expertise.

The role would be “firmly grounded” in direct care provision, working across a range of settings and conditions, with greater emphasis on community and public health perspectives, it said.

However, the consultation does not put forward a proposal on the regulation of nursing associates and ask for views instead.

It notes there has been “strong support” for regulation, but asks respondents to “take into account the other measures in place to shape and specify practice”, such as enhanced qualifications and clinical governance.

Meanwhile, it reiterates training for the role will take place via an apprenticeship that leads to a foundation degree.

A “key mechanism”, said the consultation, to deliver this will be the government’s proposed apprenticeship levy on large employers from 2017.

The levy is part of a wider raft of measures the government is planning to boost apprenticeships across all industries. It includes targets for NHS organisations on their numbers of apprentices, which were outlined in a separate consultation earlier this week.

Under the nursing associate proposals, practitioners in the role would also be able to go on to become registered nurses through an apprenticeship.

“Whether we like it or not, we are in a new era”

Lisa Bayliss-Pratt

Concerns have been raised this idea would not provide the same standard of training as the university route, but Professor Bayliss-Pratt stressed it would be a degree-level apprenticeship, which already existed through places such as the Open University.

She said entry routes into nursing needed to be thought about more “creatively”, considering the future needs of the healthcare system in England.

“Whether we like it or not, we are in a new era, we’ve got the Five-Year Forward View, we’ve got financial challenges, quality gaps and increasing patient demand,” she said.

“We need to say, ‘isn’t it great there is more than one way you’ve got to become a registered nurse and that we’ve got to take advantage of that, so we get the diverse nursing workforce our patients need’,” she added.

Last year, Nursing Times revealed that HEE planned to pilot a new senior HCA role at 30 sites across England in 2016, after its creation was recommended in the Shape of Caring report – the review of nursing education and training published by Lord Willis.

However, following the subsequent Department of Health announcement about the intention to formally introduce the position, the initial pilots were called off.

But Professor Bayliss-Pratt told Nursing Times that testing would take place as part of the roll-out of the role.

HEE would be sending out “imminently” a call for expressions of interest from providers across all setting including social care to test the role, she said.

“We absolutely have to test this and see where the role adds the most value, least value and if it adds value in some places,” she added.



Readers' comments (17)

  • More nebulous jargon from them up top! Clueless.

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  • As I see the future it will be a ward run by associate nurses and health care assistants with one registered nurse sitting doing paperwork in an office somewhere. Is this really what nurses who are undertaking the registration route want? Will this improve care for patients or just make care much cheaper? What limitations will there be on associate nurses? I do not know the answers but they are the questions (along with many others I am sure) that we need to ask. Whatever the answers are I suspect things may not turn out as expected anyway, they rarely do.

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  • Nursing is not a series of tasks. The work of nursing is increasingly complex and requires judgement. We know from the evidence that RNs delivering (and not just managing) care offer patients better outcomes. A non graduate route to nursing will make England the exception to nurse training which will possibly make career progression for ANs very difficult This role may also create an underclass of nurses, paid less for a lot of responsibility. A better option would be to develop the assistant practitioner role fully upto foundation degree and have that role as a clearly defined & valued one.
    The proposal of this role is underpinned by false assumptions. Bringing back ENs might look like good financial solution but not necessarily one without a lot of risk to both the workforce and the patients. That risk need to be managed.

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  • here we go again! Reinventing the wheel... we had SEN's doing this kind of essential nursing and having,... (if they chose to do) a conversion course!
    Why do people who know nothing about the NHS and Nursing have to interfere with what was a good system?
    SENs were the life blood of clinical care but some idiot who throught they knew better wanted to replace SEN's with RN's.... and now were going back to the very system we alsready had in place! This is echoed all over nursing and the NHS. ''If it aint broke don't fix it'' ...or interfere with anything else in nursing which works well NHS England!

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  • The problem with trying to make savings is that you eventually run out of ways to do so, thus creating another problem along the way. We are told the NHS would not exist without imigrant labour - but what an odd thing to say, that a former colonial power cannot run its own health system without recruiting from, uh, formerly colonised countries. Meanwhile, the NHS struggles to find placements for UK-trainees and makes the experiences of the student and the employed more problematic.

    This is not a problem? Making a UK persons life harder whilst simultaneously recruiting from formerly colonised countries who cannot afford to pay and then lose their educated and manual-worker class? All fine, then?

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  • This sounds similar to the LPN (Licensed Practical Nurse) roles in Canada. However the LPN's are actually full scope so can pretty much do most things that RN's can do with some exceptions such as; initiating blood transfusions, initiating IV antibiotics. The LPN's have assignments which they are professionally accountable for. They have their own regulatory body.

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  • Ridiculous. So associates are allowed an apprenticeship training whilst nurses are denied it. And our only reassurance is that we still have "responsibilty". Of course we do. But less authority to carry it out.

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  • Full circle. That's all.

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  • what abour rgns who mare not graduates ? will they be made reduvdent as they di=ont have a degree ? the associate nurse will replace the graduate nurse as it is cheap

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  • Lisa Bayliss-Pratt I'm now going to give you the answer - you may not like but some of us are ahead of your curve moving towards a better modern age. Your approach does nothing for why there are many leaving in fact counterintuitive to your thinking you are propelling the leaving rate even faster. The solution isn't adding to hierarchy as you propose, nor in fact leading the nurse to be increasingly off the floor. Your answer is in fact creating a pushing movement of a never ending move upwards and away from floor. Nurses manage already don't be patronising and also the age of the manager is almost dead as you can see in the present general state of affairs. The answer is a special breed of administrators who can deal with documentation, high speed dictation, risk analysis and likely but guided care plan formulation with specific medical knowledge within their domain, thus promoting a direction of underestimates greater time for direct care. That wasn't hard was it....

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