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RCN concerned nursing associate role ‘remains ill-defined’

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Concerns remain over how new nursing associates will be trained and whether they will be used as substitutes for registered nurses, according to the Royal College of Nursing.

However, the regulation of the new role is a welcome “early step” towards standardised education, registration and regulation for all support workers, said the college.

“A lack of clarity over the scope and nature of the job could jeopardise patient care”

Janet Davies

Overall, the role could prove a valuable addition to the healthcare workforce, despite the remaining concerns over substitution and training, highlighted the RCN.

The college today published its response to the Nursing and Midwifery Council’s consultation on nursing associates and the planned regulation of the role by the NMC.

The RCN response is based on four workshops held across England, plus a UK-wide survey with 2,500 responses and interviews with stakeholders in the NHS, independent sector and education.

Positively, it noted that the nursing associate position could act as a bridge to becoming a registered nurse, which could offer a much-needed boost to nurse numbers in the longer term. But it stressed that it was “not a new profession” and the RCN remained concerned that the role remained “ill-defined”.

This, it warned, could lead to nursing associates being asked to perform duties outside the remit of a support role, putting undue pressure on individuals and affecting patient care.

While the RCN said it supported the need for associates to be able to work across a range of settings, the proposed standards do not provide sufficient guidance on what is expected of the generic role.

Preceptorships would be required to ensure new nursing associates can work effectively in specific healthcare settings, that may require particular skills, according to the college.

It has called for trainee nursing associates to have supernumerary status, allowing them the space and time to learn.

But it warned that cuts to NHS training budgets could mean existing staff struggled to understand the role, and how it would fit into the current workforce.

The RCN has also repeated its earlier concerns about employers replacing registered nurses with nursing associates.

The college said it was already aware of a number of employers planning to reduce costs in this way, which it warned could have a serious detrimental impact on the quality of patient care.

Overall, the RCN said it believed that nursing associates must be viewed as being in a support role that worked under the delegation of a registered nurse.

They must also be adaptable to work in a variety of settings, with a range of service users, and developed in recognition of the important role employers play in supporting work-based learning.

In addition, the RCN said role must be a “viable platform” for progression to become a graduate registered nurse and, most importantly, a contributor to high quality safe and effective patient care.

Janet davies

Janet davies

Janet Davies

Janet Davies, RCN chief executive and general secretary, said: “We are determined to see the successful integration of nursing associates into our current workforce and we will play our part in the getting this right.

“Nursing associates must be a clearly designed role to complement the existing healthcare workforce and supporting our registered nurses,” said Ms Davies.

She added: “To ensure safe and effective patient care, nursing associate training must be consistent across England, and nursing associates must have supernumerary status while they train.

“The ambiguity around the role must be removed, with nursing associates working under delegation from a registered nurse,” she said. “A lack of clarity over the scope and nature of the job could jeopardise patient care, and place unfair pressure on support staff asked to act beyond their training.”

The controversial new role, which sits between a healthcare assistant and registered nurse, was announced in December 2015 as part of government plans to tackle NHS staff shortages.

In January 2017, the first group of 1,000 trainee nursing associates began two-year programmes, followed by a further 1,000 in April that year at pilot sites across England.

Meanwhile, in April this year, the NMC said just under 500 further trainee nursing associates had also started programmes in England, with more than 4,000 expected to begin later in 2018.

A draft workforce strategy, published in January by Health Education England, estimated that out of the 45,000 associates expected to have qualified by 2027, around 17,000 will have become nurses.

Last month, a key milestone was passed in parliament that brought closer the regulation of the nursing associate role by the NMC.

In January 2017, the NMC agreed to a government request to regulate nursing associates. However, legislative changes were required before the nursing regulator could take on the additional task.

The move subsequently gained “broad support” in a government consultation, paving the way for the required legal process to begin.

On 27 June, the Section 60 Order to amend NMC legislation allowing the body to regulate nursing associates was cleared in a House of Lords debate.

As a result, amendments can be made to the Nursing and Midwifery Order to provide the NMC with the necessary legal powers to regulate the nursing associate profession in England.

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Readers' comments (2)

  • I am a first year adult nursing student currently on my second placement. I have 15 years HCA experience but am aware that I am to practice within my limitations of a student nurse. The week I started placement was the first week nursing associates started. I have witnessed them canulating and taking blood. I do not understand why student nurses are not to learn these skills but nursing associates can. I find it hard to understand when apparently they have the exact same skills log as nursing student do. Also find it difficult to cope with the fact they are paid to train and have no student loans and in just over 3 years they could be the same band. It is so stressful and blurred.

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  • With the fall in nursing numbers on the register nursing associates will enable the NMC to gain more fees to "top up"! At the recent NMC council meeting where the nursing associates plans were launched, it was made clear by the council that they held no responsibility over how the roles would be implement and that fell completely onto individual trusts. This is wholly irresponsible and shows once again that the NMC is not fit for purpose, how can they implement such a monumental change in roles and not carefully plan how the roles will be working. They should be leading the process - they will be quick to punish RN's for not supervising NA's properly or NA's for making mistakes when they are working without the correct level of support and in the meantime the patient suffers once again.

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