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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)

  • Feel there should have been more thought, planning and consultation with nurses and healthcare assistants involved with direct patients care.
    The whole of nursing should be regulated to ensure high quality and standards of patients care. If the majority of the workforce are unregulated, how can this be really good for quality, it's just a rhetoric to say there is quality, when in reality nothing is there to enforce it.
    Planning should include structured career pathways where progression should not be based on waiting for someone in a higher grade to move on, but rather be based on those who are willing to develop their skills and experience and to get 'promoted' into a higher grade if they have the right competencies, attributes, skills and knowledge. There will be people who are happy to work at specific levels, for those, there should be other incentives and development options to facilitate these people to continue to develop and enhance their practice too.
    However it all feels that there are too many glass ceilings. Nurses are being kept down with more mechanisms to dumb-down skills, keeps nursing pay low.
    Seems like at every grade it is very difficult for nurses who would like to progress, without having to quit their job and applying for another one elsewhere. Internal development is very slow or non-existent.
    Senior managers are rarely seen being involved with direct patients care, involved directly with problem solving or looking for solutions to facilitate improving patients care. Those that do, do make fantastic role-models for others to aspire to, they also help and develop their colleagues - but they are very rare.

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  • I fully support the reintroduction of a second level registered nurse as currently exists in most other countries. Not all patient care needs to be carried out by graduate level registered nurses. Making beds, carrying out routine observations, inserting urinary catheters,dressing uncomplicated wounds, taking blood, checking for pressure sores, dispensing tablets etc. could all be safely performed with someone with an intermediate level of training. Some of the best nurses I've worked with have been state enrolled nurses with their two years of practical training (most of whom are now sadly retired). Registered nurses could then focus on those areas of healthcare activity that really require the critical thinking skills that come with their graduate level education - ward management, teaching, research and nurse practitioner roles all come to mind. The pay and status of registered nurses would probably also improve at the same time. At the moment, rightly or wrongly, the public view registered nurses as overqualified and overpaid for some of the types of work they do as part of their role. In the public's mind you don't need a degree to carry a bedpan, clean a bottom, make a bed or to be taught how to recognise if a patient's blood pressure is abnormal and report it to a doctor.

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  • I don't think the existing role of AP or the proposed 'new' role of nurse associate equates with the EN role. ENs had more responsibility. Existing ENs in our Trust are band 5, and with on-going professional development (which is essential for all nurses) over time, are indistinguishable from the RN role. The drawback for them is any promotion, which seems unfair. However, with hindsight, I think they should have never got rid of the EN, but kept open opportunities for upgrading to RN and career progression.

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  • The assistant or associate practitioner role is not new! It was actually first developed in 2002, and is becoming increasingly used in many Trusts. It allows career progression for HCA's.
    A foundation degree is undertaken by many, so I find it somewhat rude to call this a dumbing down.

    Much of the direct "hands on" patient care is now performed by the support workforce as degree level qualified staff are required for higher level activities. So to have someone with more training and qualifications performing this role must be an advantage.

    The main problem with the role is a lack of clarity. AP's work under supervision and perform tasks within specific competencies. They are not a nurse substitute or replacement but can perform additional tasks.

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  • As a band 4 Assistant Practitioner on a surgical ward I find this introduction of another tier in the services but also a little degrading. My role is extremely valued amongst my colleagues and fits in perfectly with the needs of the service.
    I perform the same duties as the qualified staff managing my own case load from admission, through their whole care episode to discharge. The only downfall is the dispensing medications issue which is overcome by a nurse dispensing as and when required.
    If they add another tier would this then be a band 4 1/2? Just curious as I'm already a band 4 yet the next level is band 5....stating the obvious to those who don't seem to understand the payback system...and it appears there are many in the profession who don't!
    We SHOULD BE REGULATED as the role we undertake is not only leaves us as band 4 in a position of uncertainty but also means that although we are working to such high levels of care and standards we are open to litigation with no backup.
    A very precarious role such as this needs to be monitored closely and regulation would ensure this.
    I am lucky enough to have amazing colleagues who have embraced the role and use it to the fullest....I do know however there are many not so lucky...maybe it is management who needs to be made more aware of the increasing value of the band 4 role and push for regulation.
    More thought as always needs to be put into the new role they are planning to introduce.....WE ARE ALREADY IN PLACE!

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  • I second that, this role does already exist, and in my area at least, causes more problems than it solves.

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  • if there was a shortage of bankers the government would be paying more to bankers to get them to stay, as there is a shortage of nurses the government looks to find others prepared to work for peanuts

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  • As a long serving senior HCA I agree with anonymous 1.44 pm, I did the first year of the foundation degree. But the pay difference between top band 3 & band 4 is approx. £ 50 per week , hardly worth it, after deductions you would probably be about 35 to 40 pounds a week better off. Besides I think band 5's offer more flexibility in the workforce, as they have a wider range of the skills required by a team e.g IV's more complex assessments syringe drivers etc. A band 4 will never be able to give trusts this variety of skills. I am in favour of a role more akin to SEN I worked with them they were not delegated to as Band 4's are they could dp the drug round injections Etc and often left in charge of shifts on the unit .

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  • So if they are short of nurses, how about keeping the bursary or even salary instead of discouraging people from training?

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  • I am old enough to remember the way Enrolled Nurses were used and abused! If I remember well enough they came into being as a consequence of a skill shortage so...."What experience and history teaches us is that people and governments have never learned anything from history, or acted on principles deduced from it.” Hegel.

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