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”
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.”
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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”.
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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.