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Exclusive: New band 4 ‘associate nurse’ role set to be created


Government plans to introduce a new nursing role designed to bridge the gap between registered nurses and senior healthcare assistants are to be launched in the coming weeks, Nursing Times has learnt.

An announcement on the creation of the new role is expected to be followed by a consultation shortly afterwards.

Nursing Times understands the role will be assigned to band 4 and is expected to be given the title “associate nurse”.

“There is a shortfall of nurses on the ground, and we can’t continue working the way we are”

Eileen Sills

However, question marks are thought to remain on whether those employed in the new post will be regulated by the Nursing and Midwifery Council.

There has been increasing support among directors of nursing for the role’s introduction in recent months, but the Royal College of Nursing warned the move could mark a “retrograde” step.

First recommended in a major review of education and training standards for nurses in England earlier this year, the role is already due to be piloted at 30 sites next year, as revealed by Nursing Times last month.

However, it is understood that plans to introduce the role will now go ahead before the pilots begin. National training and workforce planning body Health Education England is working on the plans alongside the Department of Health to develop a role that “gives patients the best possible safe and effective care”.

HEE has previously said it was looking into how to make it easier for people with care experience to complete a fast-track nurse degree.

Dame Eileen Sills, chief nurse at Guys’ and St Thomas’ Foundation Trust, told Nursing Times she wanted to see the introduction of a regulated associate nurse.

“It’s like we fall into the same trap we have done before, after fighting so hard for a graduate profession”

Janet Davies

She said she would want those in the role to be able administer medicines under the supervision of registered nurses. The position would require a “clear title and boundaries” as any member of the care team does, said Ms Sills.

“There is a shortfall of nurses on the ground, and we can’t continue working the way we are. Whatever happens with students, we have three years to wait so we have to do something different to protect the patient,” Ms Sills told Nursing Times.

She added: “I have no problem supporting the associate nurse role. It needs to be regulated and the scope of practice must be broad enough to add value to the nursing team.”

There was also support for the introduction of the role among other trust chief nurses at Nursing Times’ Directors’ Congress last month.

Janice Stevens, interim chief nurse at Barts Health Trust in London, said “something different” was required to tackle workforce vacancies, claiming the new role would not “dumb down” the profession.

“It is about recognising care is complex and spans lots of needs… We’ve got to get off our professional high horse for the sake of quality,” she said. Ruth May, nurse director at regulator Monitor, also voiced her support for the role and that it should be regulated.

“We’ve got to get off our professional high horse for the sake of quality”

Janice Stevens

However, the RCN’s chief executive and general secretary Janet Davies told Nursing Times that the introduction of such a role would be a “retrograde step”.

She said the profession risked recreating a “second level nurse” – also known as state enrolled nurses that were phased out during the 1990s, who required less training than nurses.

“We are moving towards a second level nurse and we know the outcomes. It’s like we fall into the same trap we have done before, after fighting so hard for a graduate profession,” she said.

“I understand – and have every sympathy with – directors of nursing who want this role. But it is a short-term solution to a problem created by the cutting of posts and [training] places,” she said.

Ms Davies noted it was important for HCAs to be able to advance in practice, but any creation of a senior assistant care worker should be “supplementary [to] and not a substitute” for nurses.

A spokeswoman for HEE said it was looking at a new role as a way of “building capacity to care” and “capability to treat” and said it would be a “new team member for health and social care”.

“A key part of this work is to continue engaging with our stakeholders and listening to their views on how best take this work forward to ensure we have the right people with the right values, skills and behaviours in this profession,” she said.

A Department of Health spokeswoman told Nursing Times it was working with HEE on plans for the new role. She said a joint decision on a public consultation would be made once this work was completed.




Readers' comments (43)

  • There are many people who have completed the 2 year AP course but there are not many jobs around, which seems a massive waste. Also the route to registration was not that clear, I am not sure if this has now been resolved by the NMC but I understand they would not recognise the qualifications and skills the APs had.

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  • Well fancy that - they want to bring back the SEN! I fought very hard to keep the SEN role, but senior nurses and regulator said they knew better!!

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  • I agree with the previous commenter. The Assistant Practitioner role already fills this position at band 4. Why is this being completely overlooked? Could it be the instigators of this initiative are unaware that APs exist?!

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  • Having nursing associates may have positive benefits in decreasing the workload of a nurse's duties however it can come with many negative implications such as; a nurse having to observe many tasks a nursing associate has to carry such as medication administration which will waste the nurse's time. Also it will cause confusion to patients as they won't know the difference between the occupation of a nurse & nurse associate. Also a registered nurse is normally allocated to a student nurse for their placement, how is the nurse supposed to observe & train a student nurse & nurse associate together, it will be more stressful for the nurse. Plus most likely the nurse will end up asking the nurse associate to train the student nurse rather then themselves which will lead to inadequate student nurse training. If some wards there are many healthcare assistants that have more competency skills according to the type of ward they work in, why can't they start training healthcare assistants the necessary "nursing associates" skills so they can assist the nursing staff.

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  • Here we go again!
    The return of the second level nurse - Enrolled Nurse which we fought so strongly to remove to have the single first level nurse - Registered Nurse.
    We have come a complete circle back to the RN and the EN nurse.
    This will be something we will regret like we did before.

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  • Those of us who have been in our Profession for a good few years will remember this role being very similar to that of the State Enrolled Nurse. Time to retire now the wheel has gone full circle again!

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  • The Tory government should never have pulled the pug on the Status of the Enrolled Nurse. It is an insult to all the Nurses who put in two years of Hands on Nursing which is lacking on the wards today. Can't wait to retire in 7 years time.

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  • I work in the NHS as a band 4 Assistant Practitioner. I spent 2 years at uni getting a foundation degree to be able to do the Job. The band 4 role is not a new role it's what used to be the SEN nurse. As usual it's the BHS going round in circles. I support anyone who goes on to do the role and yes you have the option of continuing with the nursing degree.

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  • Whilst I applaud an initiative that could mean more 'care' for patients in the wards, I do have misgivings. I have experience of band 4 workers who have allocated patients and are able to carry out many tasks previously carried out by registered nurses. They do a grand job, however, as a registered nurse in charge of shift I am responsible for everything they do. Yes I am responsible for health care assistants too, but they are not working at the same level so risk is so much less. How do I know they are skilled enough or professional enough? Surely providing they are trained to the level the employing hospital deems necessary and they are only undertaking those tasks specified then the hospital should take responsibility.

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  • Oh, what an original idea ...I know we could call them Enrolled nurses!

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