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