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'The nursing role will continue to evolve'


What should nurses delegate to unregistered staff? 

The introduction of the nursing associate role has resulted in fierce debates about the boundaries of what is nursing, and one of the most contentious issues is whether nursing associates should be able to administer medicines.

‘Doing the drugs’ is often cited as a defining difference between nurses and support workers as well as an essential part of the nurse’s role. We all know that the differences amount to much more than who does the drug round, but on busy wards nurse can spend 40-60% of their time administering medicines. It is not surprising that many organisations are asking if this is the best use of nurses’ time.

Along with delegation to nursing associates, solutions have included expanding the role of the pharmacy technicians to take on drug administration, and there are pilots underway in parts of the country.

In times of staff shortages is it safer to have suitable trained pharmacy technicians administering drugs on wards where they know the patients than redeploying nurses to do drug rounds in specialties they are unfamiliar with?

Many nurses incorrectly believe that the law specifies who can and cannot administer medicines. While the UK law is clear about who can prescribe and dispense drugs, it does not prevent unregistered staff such as healthcare assistants (HCAs) from administering them. However, this should not be a green light to wholesale delegation.

The first article in our archive issue explores the complex issue of delegation of drug administration to HCAs in care homes. The authors provide evidence-based guidance on whether, and in what circumstances, HCAs can administer medicines to residents of nursing homes. What is clear is that training, assessment of competence and ongoing education should always underpin practice.

Another area of care where the issue of delegation is hotly debated is the application of compression bandages to treat venous leg ulcers. Some experts in leg ulcer management have maintained that compression bandages should only be applied by nurses who have been trained and assessed as competent.

However HCAs are undertaking this aspect of care and the second article in this issue discusses whether this delegation is appropriate and discusses the potential role of the nursing associate in leg ulcer management.

Much of the current debate around delegation is driven by the ongoing crisis in nurse recruitment and retention, and the last article in our series looks at how one ED in an acute trust reduced its vacancy rate from 64% to 14%.

The authors demonstrate that there is no single solution but the answers lie in supporting the professional development of junior and experienced nurses; preceptorship for newly qualified recruits; and clear leadership, management and governance structures. They also introduced associate practitioners to support the existing nursing workforce.

Nursing is an evolving profession and the nature of the role has and will continue to change over time. The profession needs to decide is what aspects of the role should be protected and be able to justify and articulate the reasons clearly. What lies at the heart of this debate is patients and what is best for them.



Readers' comments (2)

  • peter rolland

    Thank you for the clarity of discussion and opening of debate in this regard. You have piqued a number of points of interest for me.
    1) It is essential that provider services seek alternative workforce/ structures through which to deliver care. Services are unsustainable without radical re-thinking of the workforce.
    2) It is also imperative that workforce transformation is supported by cultural change in organisations; clinical governance, professional leadership, collaborative teams, and an accountable system.
    3) It is the nursing profession that needs to define the bounds of nursing practice, and this is not about administering medications; it is about leading care and leading services.

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  • Words, words words.

    The nurse associate programme is well under way yet nobody seems to be able to clarify how their position will be utilised on busy wards.

    Far better to have had a proper training course for Health Care Assistants.

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