Attempts to shift nursing duties onto cheaper healthcare assistants raise serious patient safety and are tantamount to a ‘deregulation of nursing,’ the Royal College of Nursing has warned.
Last month Nursing Times revealed hospitals were planning to replace some nursing posts and duties with advanced healthcare assistants, paid at the currently little-used band four level under Agenda for Change (news, page 1, 27 October).
RCN head of policy Howard Catton told Nursing Times the plans were now spreading across the NHS in response to the need to save up to £20bn over the next five years.
Managers have told Nursing Times the new advanced assistants will work to strict “protocols” and will be aided by the increased use of electronic monitoring of patient observations, which effectively mean qualified nurses can be replaced with less skilled assistants.
But Mr Catton warned that such a “radical reconfiguration” of the nursing profession to resemble more of a “production line” would lead to serious safety issues. Nurses would be expected to supervise healthcare assistants doing duties previously carried out by nurses such as observations, medication and discharge but the nurses themselves would become deskilled in those areas.
“A nurse who is supposed to be supervising [a task] won’t know how it’s supposed to be done because we will get to the point where they haven’t done it themselves,” Mr Catton said.
He said this “deconstruction” of the nursing profession–with ever more skills and duties being passed to unregistered assistants meant nursing was gradually being “deregulated” as healthcare assistants do not come under the watch of the Nursing and Midwifery Council.
That concern was echoed by nurses commenting on the story on Nursing Times’ website. One said: “I, for one, am not willing to stand in a coroner’s court taking responsibility for an HCA who has failed to deliver care to the high standard demanded by a qualified nurse, who has been led to believe they can take on the role given to them by penny-pinching senior management and yet who has no professional accountability.”
Mr Catton said a further concern was that the move to more “protocol-based care” would almost necessarily “stifle innovation” because “people are working inside the tick box”. He said it was ironic managers were urging such an approach to nursing just as they were supposed to be encouraging innovation to increase productivity and quality.