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'The nursing associate role will belittle the value of bedside care'


So, nursing associates (NAs) – an  inevitable response to evergrowing staffi ng crisis? 

Skill mix opportunity? Or hopeful punt to rein in staffing costs for a perpetually underfunded NHS? Well… yes, those things. And probably some others as well. For example, might they also be the health service acting out a class system? Want to work in healthcare but can’t afford to go to university? Have you considered being an NA? Who knows where it might lead. Varicose veins probably, and perpetually raised eyebrows, but we all get that.

And is it a way of regulating more staff as band 4 training becomes formalised? Yes probably. And that is broadly considered a good thing –not least for whoever gets to bid for the contract to do the regulating.

And, if we are being creative, might it be a way of designing NAs with specialist skills in, say, older people’s care? Mental health care? Children’s services? To eschew the normal “generalise before you specialise” route and instead prepare practitioners for specific clinical areas and needs? I’d like that. But what are the odds of it happening? But it could be quite exciting couldn’t it? There go those eyebrows again. Some of you don’t even know you’re doing it do you?

One thing that won’t be on, however, is saying: “Nursing associates? Oh you mean a bit like the old SEN”. You’ll be sent to the naughty step and accused of being un-modern. For younger readers the State Enrolled Nurse was shorter (two-year) nurse training abandoned in the long run-up to Project 2000. Not registered, requiring fewer academic qualifications and being, well, assistant practitioners (shhh), the role has become symbolic of many things since it was phased out.

A legendary nurse once announced that, given a good wing man and half a dozen solid SENs she could “take” Canada. While that may have been the gin speaking, it is certainly the case that SENs have a reputation for being reliable and patient-focused, for being a nursing infantry of essential skills, differentcoloured uniforms and no nonsense.

Yet, to some extent, when we think of SENs now, their narrative is one of character and quality. They were capable and skilled practitioners but represented something more than what they did – they represented a presence, something solid, something unfashionably satisfied. Please don’t think I am judging or belittling here, I am talking about image not individuals. SENs were not (for a very long time) perceived to be people on the way to something else – they were a bedrock of services.

And I wonder if, in some respects, that is exactly what nursing wants of the new NA role? Skilled, capable and engaged clinicians who may want to simply carry on being at the bedside?

I confess that, personally, I don’t trust a policy initiative that seeks to provide that sort of presence for less money than it warrants, but if it is going to happen I would suggest it needs to be accompanied

by two essential things. The first is appropriate supervisory systems that protect and enhance the NA’s practice and wellbeing. The second is a more widespread capacity to value what it is that

NAs will actually do.

Because, paradoxically, one of the things the role will do is institutionalise fundamental bedside care as being less valuable (lower pay, less status) than the registered nursing role, which will perhaps

edge further away from the bedside. That is interesting in social terms I think. And maybe quite signifi cant to people who want to nurse in the future?


Mark Radcli e is senior lecturer, and author of Stranger than Kindness. Follow him on twitter @markacradcliffe


Readers' comments (19)

  • I think this is such a negative attitude and think the nurse associate role will be good in filling the gaps in nursing

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  • I have found comments on the whole to be very negative regarding the NA role, as a qualified AP I find all discussion around the subject highly demoralising. I worked extremely hard to gain my many qualifications over a great many years and am a thoroughly competent valued member of my team. My team however accept me and my role and we support each other daily. Being in this profession brings me a great deal of pride. I understand people's mistrust of the government and anguish over the nursing profession being pulled to pieces and under valued but as an AP I'm on the frontline to. I have no idea where I fit into this new NA role and if there is a place for me in the future of the NHS. I give my all on a daily basis, then come home to read page after page of worrying articles that make it quite clear nurses and other professionals do not want us with them. Whatever our reasons for being HCA's, AP's or any other names we will have in the coming years, I can quite honestly say I have never loved a job so much in my whole adult life, to care for strangers and make them feel safe whilst helping them to heal and providing clinical care is an honour and a privilege and I will continue to do so regardless of a grade or name.

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  • michael stone

    'I confess that, personally, I don’t trust a policy initiative that seeks to provide that sort of presence for less money than it warrants'

    I'd agree about that - and also about this suggestion that 'the effect of this will be to make RNs 'even more 'hands-off''.

    But I agree with 31st/6:48 pm - there is a lot of negative comment about this idea of using better-trained HCAs (whatever they are called) to sit just-below RNs 'in terms of competence'.

    And personally, I have no problem with Mark's:

    'And, if we are being creative, might it be a way of designing NAs with specialist skills in, say, older people’s care? Mental health care? Children’s services? To eschew the normal “generalise before you specialise” route and instead prepare practitioners for specific clinical areas and needs?'

    Being 'good at what you actually do' is something to be encouraged.

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    Who is interested is what you have and do not have problems with on a professional forum? Go and seek out the sports pages and try posting your vacuous opinions there for a change.

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  • michael stone

    Anonymous1 June, 2016 8:04 pm

    Please prove your 'vacuous' assertion.

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  • Observation of your commentary over time since it first began and your most recent characteristic defensive projection!

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  • michael stone

    ANONYMOUS 2 JUNE, 2016 11:10 AM

    'your most recent characteristic defensive projection'

    What is that supposed to mean, in normal English ? What the heck do you mean by your term 'defensive projection' ?

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  • Can I just ask, particularly of Anonymous number one, where am I being negative? I am saying that it is important that we value the role and that we do not use the fact that the people are doing it on a band 4 as a way of ever suggesting the work they do is not as important as we all know it is.
    How on earth is that negative?

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  • MICHAEL STONE3 JUNE, 2016 1:49 PM

    it is very obvious but you can look it up in any book on Freud, Wikipedia or a text book on psychology.

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  • I'm entirely with Mark on this (and incidentally all his pieces, he shows real insight), he isn't being negative. His waryness over the underpinning agenda of cost cutting which undervalues the skill and education required in direct care of patients is entirely warranted in my view. We live in a warped society where care and service are generally undervalued by government agendas, profit and unsustainable growth reigns. I speak as someone who has nursed for 40 years in two concurrent and complementary roles - as a staff nurse and a clinical researcher.

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