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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)

  • I hesitate to welcome this. We definitely need more hands on care from skilled, appropriately trained carers but is this really the answer? And given that they are unregistered and have no professional body (I use the term professional body very loosely here, given the esteem in which the NMC is held by it's members!!) who would be ultimately responsible for their practice? The RN on duty? The unit manager? The DN? I am old enough to remember EN's, most of whom I held in high esteem and I recall the shambolic eradication of their role. The motivation there was to have a one tier system; the motivation here seems to be to save money. How many lives will be placed at risk before the government and the NMC realize that nursing is a combination of art, science, skill, empathy and a large dollop of common sense. We cannot just be replaced because someone, somewhere says it's a good idea.

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  • I the 30 years that I have worked in Nursing Homes I have met many types of Nurses ie RMN's;REN; and RGN's REN(Mental)
    I have always found these Nurses to be dedicated and committed to their work during this time I had the privilage to work with an SEN who was outstanding at caring for the Elderly and she was subsequantly promoted to be the Manager (Matron) of a 40 bed Care Home a role which she excelled at until she retired ( Just out of interest, she was paid the same as any other Manager). We now have a REN /RGN who is our Group Nursing Manager .It is not academic qualifications which makes a good caring Nurse, but then again it doesn't make a good Manager either, maybe Management has forgoten this somewhere down the line?

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  • I agree with some of the above comments in regards to who will be deemed accountable for these associate nurses? they may have responsibility for thier own actions but at the moment its the registered nurse on shift that has overall accountibility. I think this needs to be reconsidered placing the care provider accountable for the associate nurse.

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  • How soon will it be that registered nurses will be drastically reduced to the stage that there will only be 1 band 5 on duty each shift and the rest of the staff made up of band 2, 3 and 4? this is just another cynical way to reduce the overall spend on registered nurses and in turn reduce nursing pay

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  • Now that many nurses no longer nurse in way that I was taught, and many of our original skills have now been taken over by HCAs, I am enormously glad to be on the brink of retirement.

    I valued the practical experience of SENs, but feel sure that there is room for more consideration before we plunge headlong into another level of care - many nurses on wards have barely enough time to mentor student nurses, and preceptorship for newly qualified nurses is a joke. I doubt they have time to take on the added responsibility for teaching, mentoring and supervising more staff.

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  • Yet more bull language of the American lean healthcare system - save more money and less care - why is nobody speaking up to what's behind it all. What are the Unions doing? Lean is the language of tyranny, micromanagement, staff stress and sickness, and less staff to do the job and here in part is the proof - level 4 associate nurses who don't know how to challenge bad systems and government THE ROT MUST STOP.

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  • hazel bankier's comment 8 December, 2015 4:53 am

    Dear Hazel,
    You have no need to worry, the Provider is always responsible, this can be checked out by referal to the CQC.
    We respect ALL our Nurses and they have our full support at all times.
    Many thanks for your support in this issue.

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  • "They would be able to administer medications under supervision of a registered nurse"
    Sorry but this is unrealistic and stupid for 2 main reasons:
    Firstly if the RN has to be supervising then surely that doesn't save any time for him/her... This will lead to the RN telling the assistant to go off and do the meds alone, potentially leading to medication errors which the RN is then (presumably) accountable for.
    Secondly, as a 3rd year nursing student I have been struggling and revising like crazy in order to pass my medication exams so I can qualify as a nurse and do meds! There is a lot we need to know for meds such as interactions with othe drugs, cautionary labels and side effects etc. If an untrained person is giving out these meds then surely it compromises patient safety?
    It also seems unfair that after 3 years training someone will be doing pretty much my job without all the hard work me and other students have been doing...
    Regardless of these points anyway, I'm pretty sure the assistant practitioner job already exists!!!

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  • so are taking the role that the Enrolled nurses did?

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  • wow they got rid of band 3 sinour hca and now they are wasting more money get back the band 3 that the n h s got rid of so the trusts can save money then all they have to do is go to uni one or two days a week to top up for 12 months is that so hard I worked as one for over 13 years?

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