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Trust to cut nurse numbers to make way for nursing associates

  • 19 Comments

The board of a hospital trust in the West Midlands has agreed to reduce the numbers of registered nurses on its wards and replace them with the new nursing associate role.

Royal Wolverhampton Hospital NHS Trust’s board agreed on Monday to change its nursing establishment after a skill mix report by its chief nurse Cheryl Etches.

“The trust needs to build an adaptable contemporary workforce”

Board report

It is one of the clearest examples which have come to light so far of nursing associates being used instead of registered nursing staff, according to Health Service Journal. However, the trust maintains that the move has the support of nurse managers, will enhance care and that safety remained a “priority”. 

At its meeting on 30 October, the trust’s board approved a reduction in the number of full-time equivalent band 5 registered nurses by 23.58 to a total of 507.85. At the same time, the number of band 4 roles will be increased from their current six to 30.52 to reflect the addition of 24 nursing associates.

The decision appears to contradict assertions from the government and NHS leaders that the controversial new role should be used to complement but not substitute registered nurses.

The trust carries out a twice yearly adult inpatient skill mix review and in its latest report Ms Etches told the board it needed an “adaptable contemporary workforce to respond to the changing world”.

The chief nurse described both the nursing associate and also the assistant practitioner role as “opportunities”. She noted that the nursing associate was not a registered nurse but would “undertake some of the duties that a registered nurse currently undertakes”.

As a result, it would enable the registered nurse to “spend more time on the assessment and care associated with both complex needs and advances in treatments”, she said in her report (see PDF attached below).

Ms Etches, who is due to retire in March, highlighted that nursing associates would have the training and skills to “bridge the gap” between healthcare assistant and registered nurses.

“The role is designed to enhance the quality of personalised care, strengthening the support available to registered nursing staff and reducing the reliance and dependency on registered nurses to undertake elements of care that others can be trained to understand and do,” she said.

She added: “As a trust, it offers a much welcomed further option of how to safely align the right staff with the right skills to match patient need, dependency and the environment of care.”

The Royal Wolverhampton NHS Trust

Wolverhampton trust’s ‘outstanding’ chief nurse set to retire

Cheryl Etches

In a further statement from the trust, Ms Etches said: “We are always looking at ways to modernise our workforce and respond to the changing world of the NHS.

“Following discussions within the organisation and taking professional opinions into account, which have been supported by the sisters and senior nursing team, we have decided to increase the number of band 4 positions to make way for the nursing associate and trainee nursing associate roles,” she said.

“By introducing these roles, we aim to enhance the quality of personalised care given to our patients however patient safety remains our priority,” she added.

During the development of the nursing associate role it was stated that it was not designed for substituting nurses.

Lord Phil Willis, who first proposed the role, previously said there needed to be a “clear understanding that this is a post to support the nursing workforce” and that it was “not a replacement”.

Research published by the British Medical Journal earlier this year found that for every 25 patients, substituting one nurse with a non-nurse increased mortality by 21% on an average ward.

Janet Davies, chief executive and general secretary of the Royal College of Nursing, criticised the Wolverhampton trust’s decision.

She said: “This is substitution. Our position is really clear that there may be a role for these staff but not as a substitute for nurses. The evidence is really clear about the risks to patients.

“This doesn’t make sense. They have got the skill mix the wrong way round and I think the trust is taking a big risk,” she told Health Service Journal.

She said the college was concerned at increasing numbers of trusts replacing registered nurse posts with nursing associates.

As reported by Nursing Times, another hospital trust said in March that it wanted to remove more than 20 nurse vacancies in order to introduce the same number of nursing associates.

East and North Hertfordshire NHS Trust said that because the band 5 nurse posts were vacant, the introduction of nursing associates in their place would in fact enhance the team. The trust’s chief nurse insisted that the move is not substitution because the posts are empty.

Meanwhile, health secretary Jeremy Hunt announced last month that more than 12,000 nursing associates are to begin training through apprenticeships in England by 2019.

In addition to the 2,000 associates already in training this year at pilot sites, 5,000 more will begin in 2018 and 7,500 every year from 2019 onwards, he told the Conservative conference in Manchester.

The Nursing and Midwifery Council is not due to begin regulating nursing associates until 2019 and has yet to approve training programmes for the role, though it has published interim standards.

  • 19 Comments

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Readers' comments (19)

  • Ms Etches ‘ modernisation ‘ is taking Nursing back to the 1940’s and the introduction of the SEN! It was at the introduction of P2K that the SEN was not fit for purpose and treated like a second class nurse

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  • This will open floodgates for the substitution of nurses as they retire with cheaper workers. In 20 years time people will remember nursing ...and its organisation the RCN.

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  • This is heading for disaster.

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  • P Rogers

    It’s good to see NT still sitting on the fence. There’s no ‘appears to’ about it, the decision at the Royal Wolverhampton Hospital (RWH) clearly contradicts the DH and NHS England position that Nursing Associates (NA’s) are a support to, not a replacement for Registered Nurses (RN).

    The RWH wouldn’t be alone in considering the use of Nursing Associates to plug gaps in its RN workforce. A body, especially one with some training is better than no body at all, but why reduce the RN establishment to create NA posts? Perhaps they know they have no hope of filling the RN vacancies they are carrying; reducing the RN establishments makes the vacancy rate look a little better, something the DH would appreciate. Just as likely is that this is part of a cost improvement plan – the changes reported amount to an increase of just 0.98wte Nursing Associates over the number of band 5 posts to be axed, so a significant net saving. It seems clear that what Ms Etches actually means when she says the Trust needs an “adaptable contemporary workforce to respond to the changing world” is that it needs a less skilled and cheaper one.

    Given the as good as ‘like for like’ replacement of RNs with NA’s the trusts reported assertion that it ‘will enhance care and that safety remained a priority’ is what you might call fake news and somewhat insulting the Registered Nurses who work for the Trust.

    Finally why now? Nursing Associates won’t be actually available to employ in band 4 positions until Dec/Jan. Perhaps RWH are rushing it through before Ms Etches retires, so the next incumbent can honestly say ‘it wasn’t me’.

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  • P ROGERS 3 NOVEMBER, 2017 2:10 PM

    "Finally why now? Nursing Associates won’t be actually available to employ in band 4 positions until Dec/Jan. Perhaps RWH are rushing it through before Ms Etches retires, so the next incumbent can honestly say ‘it wasn’t me’. "

    Exactly and that is why nursing is in a mess. Hierarchy are more concerned about their positions and what looks good on paper with the right boxes ticked. They don't really care about patients. That is left to the rapidly decreasing number of band 5 nurses who are treated with little respect.

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  • Well, I never saw that coming and as per usual the nursing NMC and RCN and government brown noses supported it, utterly useless.

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  • Anyone who has tried to work in this system would realise that this leaves trained nurses doing all of their own work already at breaking point, and then plugging all the tasks that associates cannot do as well. Palliative patients wait longer for their rescue doses as rgns are so thin on the ground. It is utterly disgusting and I have after 25 years moved away from clinical work and taken all the skills and experience with me. Fabulous way to improve care. NOT!!

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  • "East and North Hertfordshire NHS Trust said that because the band 5 nurse posts were vacant, the introduction of nursing associates in their place would in fact enhance the team. The trust’s chief nurse insisted that the move is not substitution because the posts are empty." If they stop advertising the Band 5 jobs, we'll draw our own conclusions as to whether substitution is occurring.

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  • Guys I wouldn't worry too much because nursing associates will also soon start to feel the pinch when they are expected to take on more than they can handle. They too will get fed up of the shortages and lack of senior support its only a matter of time. Nurses or in this case nursing associates will vote with their feet!

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  • Expect an avalanche of Registered Nurses leaving as they will be burnt out with the responsibilities of managing wards and departments, of giving regular nursing care, of checking the work of the newly qualified associates, teaching the associates and above all facing every shift with the possibility of being responsible to the NMC for associate errors.
    Shame on Ms Etches - what a legacy she will be leaving.
    Finally where are our nursing leaders who should be standing up for the maintenance of nursing standards and promoting the values of good bedside nursing? Too busy trying to make nursing ever more academic and forgetting the necessary tenets of good nursing care. I
    Still our Chief Nursing Officer, RCN leaders and Professors of nursing are all in their safe jobs and very financially secure.
    I despair.

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