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Development of nursing associate role too rushed, say nurse leaders

Test sites start in January, but curriculum only just announced

Caroline White

Monday, 21 November 2016

Nurse leaders fear that the development of the new nursing associate role is being rushed through far too quickly.

Health Education England has only just announced the curriculum for the role, but test sites are set to get under way in January next year.

“It is entirely right that support staff be offered a route into becoming a registered nurse, and as a bridging role, this position could be positive for the whole clinical team,” said Janet Davies, chief executive and general secretary of the Royal College of Nursing (RCN).

The curriculum had addressed a key concern of the College by making it clear that role development and allocation of work must always be under the appropriate level of provision.

“However, the RCN remains concerned that with the NHS under so much financial pressure, registered, graduate nurses may be substituted with support staff who do not have the same level of education and experience,” said Janet Davies.

Last week, a large European study published in BMJ Quality & Safety concluded that replacing professionally qualified nurses with lower skilled nursing assistants as a way of cutting overheads was linked to a heightened risk of patient death, as well as other indicators of poor quality care.

For every 25 patients, just one professional nurse substitution was associated with a 21% rise in the odds of dying in a hospital with average nurse staffing levels and skill mix, the study showed, prompting the researchers to conclude that “diluting” the hospital nurse skill mix was not in the public interest.

“The evidence is very clear – without the right number of registered, graduate nurses, patient care suffers and the results can be catastrophic,” said Davies.

“We are seriously worried about the speed at which this is being developed. Test sites have been chosen, and programmes start in January 2017, yet the curriculum has only just been announced. This is such a significant change to the way care is delivered, and to career pathways, that it should not be rushed through.”

But Health Education England (HEE) says the new role will allow registered nurses to spend time on more complex cases “knowing that their patient is being appropriately supported by a well-educated and trained nursing associate".

Professor Lisa Bayliss Pratt, HEE Director of Nursing and Deputy Director of Education and Quality, said: “We are responding to need from the system to increase the flexibility of the available workforce to better meet the needs of patients. The service has asked us to move as quickly as possible to provide this new role that sits alongside care assistants and registered nurses as part of a multi-disciplinary care team.”

The new role also meets the requirement to ensure HEE provided careers that are attractive and accessible, she added.

Training would include medicines management and the ability to administer medicines safely in a timely manner, within the confines of local employer policies, she said. And nursing associates would be trained to work independently under both the direct and indirect supervision of the registered nurse.

She added: “We have only reached this point as a result of lengthy consultation with senior nurse leaders, frontline nurses and support workers and educators and continued dialogue with key stakeholders. This work will continue as safety is of paramount importance to us.”

Professor Jane Cummings, Chief Nursing Officer for England, said: “The test sites delivering the first training programmes will allow feedback which will inform the competencies needed and the scope of the role. The views of directors of nursing, registered nurses in clinical practice and education as well as prospective nursing associates will be vital.”

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