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'Criticisms over the nursing associate role are misplaced'


I was taken aback last week when a furore erupted over the possibility of nursing associates being able to administer medication.

peter carter

peter carter

Peter Carter

The concern expressed by both the media and several leaders in the nursing profession suggested that this was a departure from current practice. The implication was that only registered nurses could administer medication safely and nursing associates would be incapable of doing so.

I have some sympathy for the media commentators who may be unaware of contemporary practice with respect to administration of medication. I would hope for better from some nursing leaders who expressed such severe misgivings.

Let’s examine current practice. Right across the UK, healthcare assistants already administer medication in care and nursing homes, in domiciliary care and in some parts of the NHS. Many of these HCAs have not had any training or merely cursory training. Although, I hasten to add there are some employers that provide comprehensive training in the administration of drugs for their HCAs.

However, just last week there was extensive media coverage of the death of a patient who had been given diazepam by a healthcare assistant, against regulations.

It seems to me that people conflate the administration of medication with highly complex regimes such as the care of babies in neo-natal units. The reality is that every day people self administer medication and carers ensure their loved ones receive their medication in a timely and safe manner.

“We are being invited to believe that people who have been through an accredited two year programme would not be capable of ensuring that people receive their prescribed medication”

So why the criticism? Think about it, we are being invited to believe that people who have been through an accredited two year programme would not be capable of ensuring that people receive their prescribed medication.

I know that there is far more to medication management over and above the administration, such as recognising side effects, having the confidence to withold medication if there are concerns etc, I could go on.

”HCAs do carry out nursing care and many without a comprehensive education programme covering the fundamentals”

However, it seems to me that the eruption of criticism over the Health Education England pilot was more about tribalism associated with nursing than concerns over patients receiving timely, appropriate and safe treatment. I have not heard any of the critics expressing concern that HCAs are already carrying out tasks and procedures that are the province of registered nurses. Although HCAs do not have ’nursing’ or ’nurse’ in their job title, we cannot escape the fact that HCAs do carry out nursing care and many without a comprehensive education programme covering the fundamentals of nursing care.

I believe that we need well educated registered nurses and, as the healthcare needs of the growing population continues, we need to increase the number of registered nurses. However the reality is that there is a role for the nursing associate. Providing they have a programme that ensures they are competent we should support the development of this role.

”As a result of poor workforce planning over many decades we now have a major shortfall in the nursing workforce”

As a result of poor workforce planning over many decades we now have a major shortfall in the nursing workforce and it will take years to educate the number of registered nurses that will be needed. Overseas recruitment will be with us for years to come and the role of nursing associate will be essential in helping to bridge the gap in personnel in terms of numbers. I predict many nursing associates will go on to eventually qualify as registered nurses.

I call on the leaders of nurses to support this role in the interest of patient care.

Peter Carter is former chief executive and general secretary of the Royal College of Nursing


Readers' comments (6)

  • Poor 'workforce planning' is but part of a lot of 'poor' NHS management at ALL levels, over the last few decades.

    The chasm between the level of direct patient contact and all levels above is beyond reach by even the most innovative of chasm breaching machines.

    The King has no clothes is long since inadequate in coming close to drawing an accurate analogy. The King, his Queen, their lords, ladies, courtiers, footmen and gardeners have been stark b#####k naked and thinking all is hunky dory for far too long, is so much more relevant and accurate.

    The NHS does need a proper reorganisation but we have the problem that the decision makers are the ones who need reorganising, which sadly wont happen while they're blissfully oblivious to their own nakedness.

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  • It's all very well saying that people can be taught to administer medications. Of course they can. Anyone can. What concerns me is whether the associates will have the clinical expertise to decide NOT to administer a prescribed medication; to be able to justify clinically why the medication has been omitted and to take the appropriate action. Will they have the clinical expertise and knowledge to decide when to administer PRN medications? Will that be their decision or the nurse's? This article skirts around the main issues in an attempt to tow the party line. Will medication errors be the responsibility of the nurse in charge or the trust? Because people are human and there will be errors.

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  • I ended up in front of the NMC because of a SHCA. She had all the training but was not accountable so muggings was referred. It took a high court judge to overturn it.
    having seen SHCAs do medicine audits, they shouldnt be allowed anywhere near. Short in one box - just fill up out of another. If a resident dies just keep the meds in a cupboard to top up when short in a meds audit.
    No one bothers to check so nothing is done.
    I would never trust a HCA either as an RN or as a patient

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  • Peter Carter, you are WRONG.
    And what is worse is that you clearly refuse to accept that this idea is not only deeply unpopular, but divisive and harmful. You are attempting to reduce what we do to a series of orders and tasks but our job is far beyond what you think it is.

    Firstly, healthcare/nursing assistants have not taken over anything. They are tool for registered Nurses to spread their practice across. They are our inferiors ad they do not do any job whatsoever better than any actual nurse could. So whatever rose tinted glasses you have spent the past decade looking through need to come off.
    Large numbers of assistants actually means that your trust is cheating its nurses and patients of someone with actual training and knowledge.

    It also means that your hospital hasn't invested in its organization or provision.

    What you fail to grasp is that whateer an assistant does is meaningless. They don't know why. and bed making and bathing whilst not much of a skill is not nursing. Our job is a scientific job that involve multiple aspects of anatomy, physiology, pharmacology, disease patterns and progession, clinical decision making, research, acute management, iatrogenic causes and outcomes, people management, therapy, coaching, referrals, information gathering, documentation, follow up care, case management, wound care, nutrition, chronic disease management (and bypassing) and health promotion.

    We ALONE do this. The assistants are responsible for none of it. Seeing that our course (in comparison to almost every other country in the world) is woefully inadequate, only the richest fool in christendom would believe that what we will get in theses 'associates' is someone willing to do the job, which is going to the scut work. they aren't going to be doling out drugs. Why? Because what sane trust would allow them to No, it will be bedpans and back-rounds for them - with the exception that we will see a lot less work from them as is proven by any DGH which has the odd band 3/4 and a plethora of bad 2's. The band 3/4 is not the best of the bunch, i can assure you.

    Peter Carter, please, remove yourself from this any debate. You are too inculcated into the fold now. You cannot speak for us any more than Sooty can speak for bears in the wild. You've drank the kool-aid and you aren't even remotely suspicious.

    The outrage is appropriate and you have revealed yourself to be no friend to our profession.

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  • Wow well done "anony on11/11/16@08:06am

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  • I could not disagree more with Peter Carter. I have respect for all members of the healthcare team. That respect does not translate into confidence in anyone being able to administer medications. There is a big difference between lay people nursing their family member and an employee doing so in a nursing home.
    I think Mr Carter has been away from the frontline for rather too long for me to feel he has any expertise in or awareness of the reality of clinical practice, staffing levels, supervision and acuity to make these pronouncements.

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