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Nurse leaders criticise new 'nursing associate' plans

  • 16 Comments

A group of nurse leaders have expressed concerns over the government’s planned introduction of the new nursing associate role, claiming the proposals “fail to recognise the functions and value of registered nurses”.

They also suggested the creation of the new role – aimed at senior healthcare support workers to bridge the gap to degree-level nurses – could lead to an increase in avoidable patient deaths.

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The plans to bring in the role were revealed by Nursing Times in November and confirmed by the government last month.

The new nursing associates will deliver hands-on care and will allow registered nurses to spend increasing time on their clinical duties, according to a statement from the Department of Health, which announced the move just before Christmas.

But in a letter signed by nurse academics, patient representatives and former NHS directors of nursing, warned against substituting registered nurses with the new role and said that it was wrong to suggest basic aspects of care did not require expertise and experience.

They noted that being with the patient and providing direct care gave registered nurses the opportunity to assess and monitor patients. They added that other staff should help nurses with technical tasks, rather than be delegated to.

“The complexity of patients’ care needs means that an apparently simple task, such as washing a patient, requires skill and knowledge for it to be done effectively,” said the nurse leaders in a letter published in The Times newspaper.

“For nurses to make informed decisions about treatment, and carry out their full range of activities, they must be there with their patients observing, monitoring and equally important, doing – not relying on reports from staff without the knowledge to think critically,” they added.

“Increasing the number of lower-skilled staff could increase the number of unnecessary deaths”

Letter signed by nurse leaders

The letter was signed by nurse leaders including Alison Leary, professor of healthcare and workforce modelling at London South Bank University, Trish Morris-Thompson, director of quality and clinical governance at private care home provider Barchester Healthcare, and Helen Thomson, former director of nursing at Calderdale and Huddersfield Foundation Trust.

They claimed the plans ignored research that showed patients achieve better outcomes and lower mortality rates when cared for by registered nurses.

“Every 10% increase in degree-educated nurses is associated with a 7% lower mortality rate after common surgery. Hence, increasing the number of lower-skilled staff could increase the number of unnecessary deaths,” they said.

In response, a Department of Health spokesman said: “The Royal College of Nursing, the Nursing and Midwifery Council and the chief nursing officer for England all support our proposals to introduce a new nursing associate role.

“We have been clear in our announcement that we will maintain nurse training places as the scheme goes forward – 23,000 more nurses should be available by the end of this parliament,” he added.

  • 16 Comments

Readers' comments (16)

  • Pussy

    Too little too late. The big boys agree to this new ridiculous and dangerous role. What a travesty of the first order.

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  • What a laugh. How many degree 'nurses' actually wash and bathe their patients. Have they even been taught how to do it! All they have been taught is how to tick boxes and write essays. Bring on the nurse associates, these will be the proper nurses who will provide the sympathy and empathy to their patients and relatives.

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  • This is back to the days of the Enrolled Nurse. Registered nurses must give hands on care. Nursing in the UK will deteriorate if hands on care is left to Associate nurses. All the government wants to do is to save money!

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  • Hear hear, Anonymous at 6:43pm!

    And am I missing something? I read in the above article: "...in a letter signed by nurse academics, patient representatives and former NHS directors of nursing, it was claimed the plans wrongly suggested hands-on care could be delivered by someone with less knowledge than a nurse."

    Surely hands-on care has been delivered by unqualified people for some years now? In 2006 my mother spent several weeks in a hospital in the South-East where virtually all the care assistants appeared to be agency staff - and different ones every day too. When I eventually managed to find one who understood sufficient English to hold a conversation, I asked her about their training. She told me she hadn't had any. She'd spent half a day working with another care assistant and had then been left to get on with it. She said the agency she worked for had a rule that all care assistants had to do a two-day training course... but only in their first six months, and most didn't stay that long!

    The sooner we bring back the SEN role, the better!

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  • I am an associate 'nurse' following a 2 Year foundation degree, I am patient focused and disgusted at the comments made here and by this article ! I work alongside both 'degree' nurses and nurses who have got to be where they are by working hard and getting by. Both kinds of these nurses agree that the associate nurse is a good idea and will relieve their paperwork !

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  • Hear hear Lily 44

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  • 55HCA

    As I have said countless times even when we had SEN's & SRN's , on many wards NA's as HCA's such as myself where then called delivered much of the fundamental hands on care. And to suggest that experienced NA's such as myself with 30 yrs experience are incapable of checking a patients skin for pressure damage or signs of dehydration or peripheral shutdown is quite frankly an insult. Some RN's must think we learn nothing from them or through our day to day experience of caring for patients over many years. Everyone has their role in the nursing team, I value the nurses I work with and they in turn value me and my contribution to patient care.

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  • Surely the AN will be an asset to the nursing team as a qualified, albeit 2nd tier, nurse? Perhaps the great and the good fear that AN will replace the RN , but as has been said already, basic nursing is being delivered by HCAs at the moment. Wouldn't it be safer to have a trained/qualified person working with them and overseeing what they do?
    Nursing is about caring for the sick and this will provide a career in nursing for caring ,capable people who arent academically inclined. Not everybody wants to rise up the ranks to be a manager or researcher.Just think of the good potential nurses are being lost. We are so desperate for RN at the moment such that we have to bring in foreign nurses, many of whom have very poor English . How safe is that?

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  • Having read the above comments and the 'disgust' at HCA's and Associate Nurses performing patient care... I think we are missing something! Its called accountability and responsibility.
    If I am working with competant and incompetant nurses, associate or otherwise, its ME who is responsible for any problems, accidents, issues, lawful and unlawful conduct etc; towards patients and other staff. That is an issue which unqualified and partially qualified staff, academics and managers are missing here.
    Anyone can learn to take blood from a stable patients, anyone can learn to take observations and understand the basics ie skin changes due to pressure, a patient who is unwell suddenly or is deteriorating etc etc etc. However, the complete, holistic care package including negating deterioration of patients and diagnosing emergency or potentially severe situations, even untoward incidents, clinical or otherwise and then acting on this information is quite another matter. It takes skill, education, expereince and common sense. Some can be taught, some learned via expereince and some is innate in every human being. Collating all and having the clinical acumen eg , cannulating and taking bloods in shocked and severely ill patients and interpreting the results.... is where my skills as an RN (with both a BSc (Hons) and an MSc with vast and broad clinical experience) come into play. This is the fundemental flaw in policital and academic thinking. Our skills as RN's lie in our ability to act when things dont go to plan.... its the difference between being a technician and a professional. Not about freeing RN's to do paperwork. Its about freeing RN's to observe, utilise the staff they have, organise the department and environment, cope with medical and other MDT staff, patients and their families. That level of respect as a Sister/manager or staff nurse at RN level is somehow forgotten by many. Its time this respect as an RN was encouraged and brought back!

    Unsuitable or offensive? Report this comment

  • Having read the above comments and the 'disgust' at HCA's and Associate Nurses performing patient care... I think we are missing something! Its called accountability and responsibility.
    If I am working with competant and incompetant nurses, associate or otherwise, its ME who is responsible for any problems, accidents, issues, lawful and unlawful conduct etc; towards patients and other staff. That is an issue which unqualified and partially qualified staff, academics and managers are missing here.
    Anyone can learn to take blood from a stable patients, anyone can learn to take observations and understand the basics ie skin changes due to pressure, a patient who is unwell suddenly or is deteriorating etc etc etc. However, the complete, holistic care package including negating deterioration of patients and diagnosing emergency or potentially severe situations, even untoward incidents, clinical or otherwise and then acting on this information is quite another matter. It takes skill, education, expereince and common sense. Some can be taught, some learned via expereince and some is innate in every human being. Collating all and having the clinical acumen eg , cannulating and taking bloods in shocked and severely ill patients and interpreting the results.... is where my skills as an RN (with both a BSc (Hons) and an MSc with vast and broad clinical experience) come into play. This is the fundemental flaw in policital and academic thinking. Our skills as RN's lie in our ability to act when things dont go to plan.... its the difference between being a technician and a professional. Not about freeing RN's to do paperwork. Its about freeing RN's to observe, utilise the staff they have, organise the department and environment, cope with medical and other MDT staff, patients and their families. That level of respect as a Sister/manager or staff nurse at RN level is somehow forgotten by many. Its time this respect as an RN was encouraged and brought back!

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