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New 'nursing associate' role receives cautious welcome from unions


Unions and academics have welcomed the introduction of a ”nursing associate” position for senior healthcare assistants, but have stressed the “fundamental” role of registered nurses in ensuring patient safety.

The government announced yesterday its plans for the new role, which is designed to bridge the gap between healthcare support workers and registered nurses. 

Nursing associates will complete ”on-the-job training” through an apprenticeship that will lead to a foundation degree, said the Department of Health in a statement.

The Royal College of Nursing said the new position was welcome recognition of the value of healthcare assistants and agreed with the government’s claim that it would free up time for nurses to use their clinical skills.

“This initiative is about enabling people in unregulated positions, supporting registered nurses, to access training via a clear structure, and this is very welcome”

Janet Davies

It noted the government’s plan for nursing associates to be able to go on to gain a nurse degree in a shorter amount of time.

The union said this would provide a route into the profession to people who would otherwise have been denied the opportunity.

But it stressed those in the new role would only “assist” registered nurses, who it reminded were clinical decision-makers, with degree-level knowledge and skills.

Janet Davies, chief executive and general secretary of the RCN, said: “This initiative is about enabling people in unregulated positions, supporting registered nurses, to access training via a clear structure, and this is very welcome.”

“The fundamental role of the registered nurse does not change - studies show that the number of registered nurses has a significant impact on patient outcomes”

Janet Davies

She added: “The fundamental role of the registered nurse does not change - studies show that the number of registered nurses has a significant impact on patient outcomes.

“A registered nurse is a clinical decision-maker, with degree-level knowledge and skills, considerable experience of caring for people with multiple or complex conditions, plus the ability to supervise and educate more junior staff.”

Ms Davies previously warned the introduction of a role to bridge the gap between HCAs and nurses would be a “retrograde step”.

Unison noted the new role could improve access to training for HCAs, who have previously struggled to get it. But it warned that those who do not want to go on to become a nurse could be “undermined”.

“We need to ensure these new roles are not used as a cheap way to replace registered nurses”

Christina McAnea

It also pointed to concerns about whether the government was trying to re-introduce state enrolled nurses.

Unison head of health Christina McAnea said the new role must not be used as a “cheap” way to replace registered nurses.

“Evidence shows that the greater the number of registered nurses to patients the better patient care outcomes are. And we need to ensure these new roles are not used as a cheap way to replace registered nurses,” said Ms McAnea.

“Universities already routinely provide a range of foundation degrees… but proper consultation on this development is crucial”

Jessica Corner

“If the government is serious about tackling the nursing shortage then they need to develop a long term national staffing strategy in partnership,” she added.

Meanwhile, the Council of Deans of Health – which represents nursing and midwifery faculties across the UK – echoed union comments.

It welcomed the improved education and training opportunities for HCAs, but stressed the plans should not blur the boundaries with registered nurses.

Dame Jessica Corner, chair of the Council of Deans, said: “Universities already routinely provide a range of foundation degrees and other qualifications that can lead on to health professional programmes, but proper consultation on this development is crucial.

“This role mustn’t be used as an excuse to reduce the numbers of graduate health professionals. The evidence is clear that increasing registered nurse numbers with graduate-level education improves the quality and safety of patient care,” she added.

The NHS Employers organisation noted many trusts had already developed  associate practitioner positions and said this would provide a “valuable resource” as the new role is considered.

NHS Employers chief executive Danny Mortimer said: “It’s important however not to pre-empt any decisions about these roles until the consultation has taken place. We will seek the views of employers during the months to come on the training and deployment of the proposed role.”


Readers' comments (10)

  • So after many years and much expense we are going to be back to the equivalent of the State Registered Nurse, the State Enrolled Nurse and the auxiliary.

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  • Another pretend Nursing role to add to the ODP ranks, of pretend nurses.

    These are cheap NVQ based roles lacking full time structured tuition, they lack credibility and a continuation of the dumbing down and undermining of RGN nurses with medical degrees.

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  • They are right to worry that they will be used as a cheaper version of trained staff.
    This already happens with the Assistant Practitioners. For example, a 38 bedded ward is supposed to have 3 staff nurses at night. They end up with 1 staff nurse and 2 assistant practitioners, and the poor staff nurse is accountable for 38 patients, still doing night meds at 1am and still finishing writing at 9am long after the early staff have come on duty!

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  • The advantages with the 'Associate Nurse role', is that it will keep practical nursing within contention of the ward and the bedside remit. It is one of those virtues that just makes common sense. Registered Nurses with Nursing degrees, have so much scope to practice and develop further with opportunities, attracting them away from the bedside.

    The Associate role has been developing since the early Noughties, but until such times that the contingent is sufficient, regulation for practice will not be granted.

    Only with regulation and recognition, can the role be effectively developed. It could possibly address elements of drug administration, that may be adapted within the scope of practice.

    It is such a shame to hear Nurses malign the role. Perhaps, some deeper exploration and research from some of my colleagues may enlighten them.

    Until it can be suitably measured and evaluated in the long term, am personally excited, also keen to embrace this opportunity.

    My hope is that the structure and purpose will remain the focus it was intended for; serving to improve and benefit the patients practical care requirements and to alleviate pressures within the nursing hierarchy.

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  • I am not denigrating bedside clinical care, but why is there so much emphasis on this? We cannot simply look back to a golden era and compare "like for like". There is as a demography of older people and complex health issues. What would be best is a Registered Nurse with a primary case-load, able to have contact with patients and also apply advanced knowledge , trained support staff and associated staff to deal with other issues. I also would question why other health care professionals are NOT so readily embracing the "practical experience" ,,associates if it seems such a jolly good idea. We already have assistant practioners who are underused(Check vacancies and working roles)

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  • there as already been selected trusts that had higher clinical support workers this was a band 3/4 role ! BUT! got rid of them to save money in the trust cut backs this time last year then giving them band 2 posts the must be more money to waste in training to sink a boat?

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  • dtbarron

    Associate Nurse

    This proposal is flawed in so many ways. While being disappointed but not surprised that the government want introduce this role in England I am disappointed that any union would welcome this, especially the RCN (I'm a member).

    An apprenticeship model of "on the job training" - working to what standard of training? Who will assess competency and against what agreed national standard? What will be the scope and range of practice? Will the expertise be equivalent and transferable between organisations? I can assure you that Advanced Practice has numerous non equivalent interpretations between organisations - what will be different here?

    The next ill conceived idea is regulation. Who will regulate these new associate nurses? Do we really expect the NMC to regulate a 'band' within the nursing team? In other words band 4s will be regulated but band 3s will not be!

    In considering regulation - who is going to pay for this? Why would employers pay for it - they can employ staff on band 3 roles and extend the scope of their practice under the delegated direction of a registered nurse at no 'licence' cost - so there's no incentive to them. There is an incentive if they think they can reduce the number of registered nurses on duty - and politically it's a nice game to play on ward boards saying we have x number of nurses on duty, just forgetting to mention that only one is a registered nurse (but maybe I'm cynical and that would never happen)!

    If the NMC is to be the preferred regulator what will the mean for their workload, the current fee and the current regulatory model around Revalidation? It will NOT be done within existing resources!

    In some areas we already have support workers with an extensive support role - however the delegated workload and therefore accountability sits with the registrant who delegates the work. Who will be accountable for the practice of these new associates; and yes I know individuals will be accountable for their own actions, but that doesn't address the wider accountability issue - is it Senior Charge Nurse on the ward, is it the registrant they are working alongside?

    On the bright side Scotland has no intention of introducing such a role - our unregistered staff are excellent, make substantial contribution to the care and treatment of people entering our services - they are however still directed and accountable to a registered member of staff.

    Additionally I pleased to note we wouldn't introduce such a role with zero preparation and zero planning. I'm sure there's an old adage about 'fail to prepare, prepare to .......'

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  • Just wondering how I go about throwing in my band 5 and being a band 4!
    Sounds great and the pay couldn't be that much less! Why would anyone want the hassle of being band 5 when we could go back to bedside nursing which is what I joined to do!

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  • Those who think this is a good idea, presumably think it was a bad idea to get rid of SENs? So why DID we get rid of them? Was it because we though we could afford to have all nursing care delivered by higher level trained nurses? Which makes this all about reducing care and saving money.
    As for freeing up nurses, to do what? Spend three hours at a drug trolley and another three in front of a computer screen? So that less qualified staff can supervise the hands on patient care? No, I think this is wrong. We band 5's don't need an extra tier of work to supervise. The old SENs could definitely help because they could do drug rounds. We need another nursing level, or more registered nurses. Anything else will remove nurses even further from patients.

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  • Care on the cheap. Unlike SENs they won't have a qualification so why the comparisons? they will end up doing RGNs jobs that's for sure and there will be deaths.

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