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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)

  • michael stone

    This is a bit worrying:

    '“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.'

    Rushing HCAs into this 'bridging role' without an adequate assessment of competence, is also dangerous - and I wonder how quickly a properly-designed clinical role and adequate 'checks on competence' can be established. It might be shorter than 3 years - but change in the NHS isn't usually rapid and free from problems, is it ?

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  • Oh dear, another crack in the NHS has appeared. Another place for accountability to fall into.

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  • michael stone

    It isn't that I disagree with the new 'role' - I support it.

    But it has to be properly thought-out, and introduced after adequate 'testing'.

    Rushing it, could turn out to be a bad idea.

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  • I hope for their sake they don't have to be regulated by the over priced, ineffective dinosaur that is the NMC!! A good solution would be for the band 4's to have a new governing body, hopefully this would be cost effective, affordable and well run, once this was established RN's should then be given the choice as to whether to go to the new governing body or stick with the NMC and it's anti nurse policies and stance

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  • A proper "skills escalator" where people can choose where to pause, then develop their skills further to a high level isn't something that i would argue against. However, if the intention (which will not be declared as such, of course) is to produce cheaper staff who then find it very difficult to access those high levels (or who have training which is less than they deserve) this will be a problem for years for patients, all staff and health providers. Let's see this consultation and hope that there is some very clear thinking in months ahead by all.

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  • More dumbing down of the profession? There is NO substitution for professional training over 3 5 years full time. assuming the student goes on to take a medical degree.

    At this rate the government will be proposing training monkeys.

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  • I completed the first year of my nursing degree and left because I could not afford to carry on trying to live on £270 a month, bursary and student loan.

    There must be thousands of ex student nurses who have left the course, others who completed access courses and A levels but did not proceed because of finances.

    When I left the course the University nor the NHS are bothered, I now work as a Bank HCA, the NMC needs to modernise and accept new pathways for learning, supporting health trusts to find new ways to educate staff that have the capabilities of gaining registration or go down this route of creating a new role.

    So many people left the course when I left, all people who wanted to work in the NHS, many mature students had left good jobs to dedicate themselves to the NHS and you end with nothing but debt. The NHS must come up with a way of being able to develop the workforce from within as well as from the University route.

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  • This is offensive, I am so glad to be leaving the NHS and going to another country where my, skills, degree, training and experience are in demand at a reasonable wage.

    I pity the public, this is the death of the NHS?

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  • The NMC would probably encourage training monkeys as long as they paid their £120 a year (plus yearly increase)!!

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  • Isn't this the assistant practitioner under another name? We already have this 2year course in place with an added extra year to become a registered nurse. There are very few jobs advertised in my area but we have an (AP) I our area who is still working as an HCA due to this problem. Why do we keep adding more levels. This already exists!!

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