Viewing nursing as a task-based role will put patient safety at risk, the chief executive of the Royal College of Nursing has warned after leaked documents last week revealed training requirements for the forthcoming nursing associate position in England.
Janet Davies said proposals that nursing associates could be allowed to independently draw up and administer controlled drugs were “ridiculous”. This was suggested in Health Education England internal papers, seen by Nursing Times’ sister title Health Service Journal, showing the proposed curriculum for nursing associates.
Ms Davies also said there was a lack of transparency about how the new role was being developed.
The HEE documents, reported on last week, said the new group of workers would be expected to have medication knowledge and be capable of handling drugs, as well as carry out invasive procedures on patients. They will also be able to work independently of registered nurses.
Ms Davies told HSJ: “Nursing is far more than just a series of tasks and what is beginning to happen is that nursing is being seen as a series of tasks which can be divvied up among a number of people and that is not what nursing is.
“If you divide work into tasks it creates problems in terms of continuity of care, communication and experience of the patient. This is starting to revert to the old way of working, which actually gives really fragmented care to the patient.
“People are not fully appreciating the skills and the knowledge of nursing. When you’re dealing with a patient you’re not just doing one task, you’re doing multiple things. Let’s not dumb down nursing by seeing it as a series of tasks.”
”When you’re dealing with a patient you’re not just doing one task, you’re doing multiple things. Let’s not dumb down nursing by seeing it as a series of tasks”
The RCN has supported the development of a support worker role, but Ms Davies said she found the new details about nursing associates “a big problem” and criticised the lack of details that were known about the role, which will begin training from January.
She said: “There is a lack of transparency and things seem to be happening that people are not aware of.”
On the proposal to allow nursing associates to administer controlled drugs, she said: “It is ridiculous. That is not a role for an unregulated worker or a person who is not a registered professional. That is seeing something as a task without appreciating what is behind it.
“The role of the [registered nurse] before they allocate any sort of role or task to do, as a registrant they are accountable to ensure the person is competent and able to do it. Health Education England or anyone else cannot take that responsibility away from a registered nurse.”
”There is a lack of transparency and things seem to be happening that people are not aware of”
She said she did not believe administering controlled drugs was something that should be delegated to a support worker. “This is not about being protective of the registered nurse it’s about patient safety and quality of care,” Ms Davies added.
Critics of the new role fear it will lead to trusts employing them instead of registered nurses. The RCN chief executive said: “We know that’s the absolute danger of this role. We know the numbers of registered nurses has an effect on mortality, that work has been done and we shouldn’t be diluting that skill mix.”
She said there were still problems with the training of healthcare assistants more generally, an issue highlighted by the 2013 Francis report. “Before we have sorted that problem we are bringing in another one,” she said.
Ms Davies’ comments follow concerns raised by other nursing leaders, who claimed the development of the role had been rushed with too little time for full consultation with the profession.
They also renewed previous calls for nursing associates to be regulated, claiming that without regulation nurses could be held accountable for drug errors made by associates.
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