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‘Robust safeguards’ needed over use of nursing associates to counter substitution

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The “real risk” that nursing associates are used as a cheap alternative to nurses has been underlined at a major health conference, where delegates called for any attempts by employers to substitute roles to be resisted.

Speakers at Unison’s annual health conference stressed that, without clear safeguards, employers would inevitably fill nurse vacancies with associates “in desperation”, due to long-standing staffing gaps.

“There must be robust safeguards against substitution of nursing associates”

Unison Nursing and Midwifery Occupational Group

Some claimed the introduction of the new role was also a “cynical attempt” to plug the gap left by migrant workers who may leave the country in the future following Brexit.

It was also suggested that the removal of bursaries for student nurses from this autumn would drive older applicants – deterred by debts from loans – into the lower-paid associate role instead.

“There must be robust safeguards against substitution of nursing associates for fully qualified nurses,” said union members from Unison’s Nursing and Midwifery Occupational Group which presented the debate to the conference yesterday.

“Safe staffing ratios need to be clear, as outcomes for patients are worsened when qualified nurse posts are replaced by less qualified staff,” they said.

Despite the risks, delegates said they welcomed the opportunities for career progression for healthcare support workers that the introduction of nursing associates was expected to bring.

They also supported the Nursing and Midwifery Council’s decision to regulate nursing associates, which are intended to “bridge” the gap between healthcare assistants and registered nurses.

But they said it was important for all parts of the support workforce to be regulated as well – though calls to introduce regulation for HCAs have long been ignored by ministers.

In addition, delegates at the event in Liverpool called for all support roles to have national scopes of practice defined, so that staff and patients were clear on their responsibilities.

A band 4 assistant practitioner told the conference “every day is a battle” for them, because their role was not regulated and registered staff were worried about accountability for any tasks they delegated.

“It is important to define education, training and competency standards for the whole support workforce, and this must be set nationally,” she said.

A motion calling on the union to campaign for a series of changes surrounding the introduction of nursing associates was carried.

These included an independent evaluation of the nursing associate pilots, a consistent approach to the associate qualification – so it counted towards a nursing degree – and nationally defined competency standards for all parts of the healthcare support workforce.

Motion: Healthcare support workers and the nursing associate pilots (Nursing and Midwifery Occupational Group)

Conference notes that the NHS is in the midst of a nursing shortage, which has led to healthcare assistants (HCAs) working in the NHS performing roles previously done by nurses without the equivalent pay or education. Instead of investing in the whole HCA workforce, the government has chosen to focus on creating a new ‘nursing associate’ role in England, a move that conference does not believe will solve the NHS staffing crisis.

Whilst it is recognised that the new nursing associate role could help improve the career prospects of existing healthcare assistants who already provide vital support to the NHS, they should not be seen simply as another cheap alternative to registered nurses.

In October last year, Health Education England (HEE) announced a pilot scheme that will train 2,000 people as nursing associates over the coming months. It is vital that these new roles are recruited into UNISON membership to ensure that they are not exploited by their employers who may use the uncertainty around the purpose of the nursing associate to plug gaps in NHS care because of nursing shortages.

Conference is worried that the nursing associate is a role that is only being developed in England, leading to more divergence with Scotland, Wales and Northern Ireland in the shape of the nursing workforce.

Conference is also concerned that it is unclear how the nursing associate will be distinct from, and fit with, existing assistant practitioners working in the nursing sector. Many assistant practitioners, who already work directly to support nurses, feel their role has been marginalised and devalued by the introduction of this new role.

Conference calls on the Health Service Group Executive to campaign for:

1) Nationally defined scope of practice and role titles for each level of HCA and the nursing associate so that role boundaries and responsibilities are clear for staff and patients.

2) Standardised education, training and competency standards for the whole support workforce set nationally.

3) A review of pay banding and career structures for all healthcare support workers.

4) More investment and support for those who wish to progress on-the-job into registered nursing or other health professions.

5) Appropriate and proportionate regulation for healthcare support workers including nursing associates.

Conference further calls on the Health Service Group Executive to:

a) Ensure UNISON continues to be involved nationally in overseeing the nursing associate pilots and developing job descriptions and joint guidance on employment issues.

b) Work with branches and regions to monitor the nursing associate pilots and ensure that nationally agreed job descriptions and Agenda for Change bandings are used consistently, with all nursing associates receiving their normal salary including unsocial hours throughout their training.

c) Work with branches and regions to recruit and organise nursing associates to ensure they are properly supported.

d) Resist attempts by employers to use these new roles for purposes of role substitution and dilution of skill mix in nursing teams and seek clarity on expectations for different roles and how they might fit into care teams to maintain public safety and confidence without creating divisions.

e) Campaign for appropriate learning opportunities and career development to be available to all members of care teams. This must avoid reinventing further discrepancies across and between different roles.

f) Insist that future developments are subject to equality impact risk assessments and principles of equal pay for work of equal value.

g) Campaign for guaranteed jobs at the end of nursing associate training or apprenticeships.

h) Ensure that nurses involved in training nursing associates are given mentorship training, sufficient time and appropriate banding.

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