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RCN reaffirms danger of new role substituting nurses


The Royal College of Nursing has warned that the proposed new nursing associate role must not be used as a substitute for registered nurses.

Plans to create the role, which have divided opinion, were revealed by Nursing Times last year and subsequently confirmed in a government announcement in December.

The move is intended to bridge the gap between healthcare assistants and nurses, and create potential a new route into registered nursing. A consultation on it, spear-headed by Health Education England, has now closed and the body is in the process of analysing the results.

In its response to HEE’s consultation on proposals for the role, the RCN noted that the move would “provide a structure for those who wish to start their journeys to become registered nurses”.

However, the college noted that extended roles for support workers, such as assistant practitioners (Aps), already existed and the RCN believed these “should also be explored further”.

The RCN’s submission (see attached PDF below) stated: “One of the most strongly articulated points throughout our membership and stakeholder engagement has been that a more senior support worker, such as the AP, already exists.”

The college also called on the profession to “learn the lessons from the past” and that the initiative “must not lead to a reintroduction of a second level registered nurse”.

“The RCN believes that differentiation between a role that assists the registered nurse and the registered nurse needs to be explicit and clearly articulated,” it stated.

“What must be stressed is that this role supports, but must not be used to substitute for, the registered nurse,” it added.

“Ultimately, the best interests of patients will be served by developing support staff”

Janet Davies

As part of its submission to the consultation, the RCN carried out a survey of its members.

The survey, completed by 5,230 RCN members, found 67% believed the new role would provide a work-based route into registered nursing for healthcare assistants.

However, 78% thought the introduction of the new role would lead to further reductions in the registered workforce, with nursing associates increasingly used as substitutes.

RCN members also raised concerns around the ability of nurses to support and mentor junior colleagues, with 60% saying they felt registered staff would be hardly or not at all able to provide the necessary support for nursing associates.

In addition, 81% were concerned that the new role could cause confusion for patients.

Meanwhile, 89% also believing that the new roles should be mandatorily regulated, with 65% saying that this should be done by the nursing regulator, the Nursing and Midwifery Council.

Royal College of Nursing

Royal College of Nursing appoints new leader

Janet Davies

The NMC has previously indicated that it would be willing to regulate nursing associates, if asked to be the government.

Janet Davies, RCN chief executive and general secretary, said: “These new roles must not be used as a method of substituting support workers for the regulated, knowledgeable workforce of registered nurses.

She added: “Ultimately, the best interests of patients will be served by developing support staff, either through this new role or extending existing ones, and by ensuring that there are enough registered nurses.”


Readers' comments (11)

  • The idea of an associate nurse in theory sounds good, however I fear that this will be a substitute for registered nurses as there is a massive shortage of nurses ideal for the goverment to save money and plug the gap. What about the public?

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  • This role sounds like the Enrolled Nurse who were the perfect assistant to the Registered Nurse and they were able to convert but for some unknown reason the powers that be decided that N/A's could carry out tasks, normally only carried out by Registered nurses, WHO is responsible if they make a mistake? What happened to holistic care? Why take the retrograde step of going backwards to tasks? Are HCA's registered and paying to be on the register?

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  • From a greedy capitalistic view A less educated workforce is also easier to manipulate and costs less. It will actually drive nurses out not bridge a gap. In my view and in discussions the majority of good fully paid RCN reps were previously disempowered by Peter Carter (honour only Dr) and that has obviously continued. It is obvious this is a nurse replacement what we need to now ask is how union leaders have stopped reps from speaking out on these issues including revalidation. It seems things are heating up and truth is seeping out. In my view and in suggestion of evidence Associate nurses weakens care. The workforce feel betrayed by the unions - and unions stop blaming the workforce it's time you led by example or fall.

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  • The RCN! The workforce or manager union? In my view the managers & regulator union. The only thing one can do in that regard is change unions so as to disempower hostile management but there are no guarantees even with that. Or a new union is started - it can be done. These are difficult times for nursing and the powers that be are making it worse to ensure privatisation.

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  • I work as a support worker and where I work in a nursing home the nurses seem to hide from their responsibilities to protect their pin number.Most of the support workers would make excellent nurses,what we witness is an overpaid and overstretched RN's,who only have contact with clients to give medications.Where has the nursing gone from some nurses?

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  • Tonima a counterview can also be offered to that but I'm not going to go there. All I'm going to tell you is I was one of those who went the full way of supporting all and got burnt for it. But I was also a HCA and so know some of your annoyances. The real answer is we need a greater role for frontline administrators to free nurses up and take responsibility for recording and dealing with legal documentation of very poorly written care legislation. You might make a great nurse, but Tonima don't settle for second best, I would welcome you opened armed as a nurse don't take this false approach - don't listen to those above us all who have betrayed us.

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  • The Enrolled Nurse was a qualified nurse and on the NMC Register and were accountable for their actions

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  • Study the history and back-ground of Enrolled Nursing. And career prospects and pay levels!

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  • I agree with Tonima. I had been working as HCA for the past 5 years and I could say the only difference between the nurse and HCA were knowledge on pharmacology and human anatomy. HCA's were the front liner in the delivery of patient care. It is physically and emotionally demanding. We ensure that patients' utmost needs were taken cared for; from personal hygiene, nutritional intake and comfort. We also do venepuncture and cannulation. While most nurses now a days were just there to give medications and do administrative roles (writing care plans and answer queries). You seldom see nurses who will go out of their comfort zone to provide personalise care to patients, ensuring that patients were cared for in a dignified manner. This kind of nurse is just 5% of the nursing population in the countryside area. The question now is what happened to the nursing code of ethics?

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  • This kind of response previous, which presents as hostile, highly subjective and without known evidence or value base highlights the whole issue of concerns to deskilling and competitive combative nature towards nurses that must be prevented. How do we prove associate nurses are not a cheaper option?

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