A recent on- and off-line debate revealed the concerns the nursing profession has about the possible impact of creating a new ‘nursing associate’ role.
A debate on 10 May, held simultaneously at London South Bank University (LSBU) and on twitter by WeNurses, raised some serious concerns about Health Education England’s proposal to create a new role of ‘nursing associate’.
The debate recognised the need to educate and develop the unregistered workforce and to create flexible routes to becoming a registered nurse.
However, despite Professor Lesley Baillie putting forward a strong case for how the role might be developed and implemented, the audience remained unconvinced that the role would be any more successful than the existing assistant practitioner role.
”Only 33% felt it would ‘bridge a gap’ and improve skill mix”
Only 39% of those joining on twitter and 30% at LSBU agreed that nursing associates would be a better support to registered nurses than current support workers, and only 33% in both settings felt it would ‘bridge a gap’ and improve skill mix.
There was more support for the idea that the role would create a stable local workforce. However this was still less than a majority (48% at LSBU and 42% on twitter) with a large number of undecided people. There was a view that it might be helpful but that much more detail is required before this can be agreed.
A major concern revealed, and as yet undiscussed by Health Education England or the NMC, was the impact on the existing registered nurse role. 80% of those joining from LSBU and 63% from twitter agreed that it would change the nature of registered nurses’ work, in fact 79% at LSBU and 52% on twitter agreed that you can’t separate excellent care into tasks done by one grade of staff and supervised by another.
“If you take away ‘fundamental care’ from registered nurses, what you have left may well have a use, but it won’t be nursing”
Dr Elaine Maxwell suggested that if you take away ‘fundamental care’ from registered nurses, what you have left may well have a use, but it won’t be nursing.
There was concern about what Dr Maxwell called ‘wilful blindness’ to past history and the weight of evidence about the correlation between educational level of nurses and patient mortality. Only 26% on twitter and 36% at LSBU disagreed with the statement that nursing associates would be less vigilant than registered nurses.
”Health Education England do not appear to have conducted a risk assessment”
Health Education England do not appear to have conducted a risk assessment. In the light of other threats to registered nurses - such as the removal of the NHS bursary, Lord Carter’s Care Hours per Patient Day as well as financial deficits in many trusts - some felt there was an unacceptable risk that the unintended consequence of the proposal might be a return to the ’Christmas tree model of staffing’, with a few expensive registered nurses at the top and most care delivered by unregistered staff and nursing associates.
Dr Susan Hamer raised particular concern about how this new role might be used in the independent sector, with new providers in the marketplace who might not be fully cognisant of the difference between nursing associates and registered nurses.
Clearly, the profession and the public need to be much more engaged in the debate before this proposal is enacted.
Dr Elaine Maxwell is Associate Professor in Leadership at London South Bank University