Is the nursing associate role an innovation or a step backwards?

When the Shape of Caring review into education and training for nurses and healthcare assistants was published in March last year it highlighted the lack of different career pathways and recommended that the opportunities to enter the profession should be widened.

The review, commissioned by the Nursing and Midwifery Council (NMC) and Health Education England (HEE), suggested the development of more ‘innovative work-based learning routes’.

New pathways for potential nurses

It said these should be standardised to allow healthcare assistants (HCAs) to move into nursing without having to give up work.

Nine months later, health minister Ben Gummer announced that a new role, provisionally called the nursing associate, will be designed to work alongside HCAs and nurses to provide patient care. He said this will ‘open up a career in nursing for thousands of people from all backgrounds’.

In 2014, 37,000 applicants were turned down for nurse training places, but the government claims that the plans to scrap nursing bursaries from 2017 and replace them with student loans will allow universities to offer thousands more nurse training places.

Mr Gummer insists that the new nursing associates will be additional to the planned increases to nursing numbers, not replacements for them.

The proposal for the new role is not without critics who suggest it is a ‘quick fix’ and a return to the days of state enrolled nurses.

In October, the RCN opposed calls for the role to be created, saying it was too similar to the state enrolled nurse post which it said had offered no career prospects. But RCN head of policy Howard Catton recently said that the name nursing associate suggests someone intended to support rather than replace existing nurses and said there is evidence of a planned career pathway for people who choose to take up the role.

Under current plans, nursing associates will learn on the job on a two-year apprenticeship.

Career pathway

The government is considering two options on how the nursing associate can build on their initial training by becoming a registered nurse. One is by completing an 18-month shortened nursing degree and the other is to complete a further two-and-a-half-year nursing apprenticeship. HEE will be running a consultation on the proposed role for England early this year.

England’s chief nursing officer Jane Cummings has said the role will create a bridge between senior HCAs and registered nurses.

Picture credit: Daniel Mitchell

The Department of Health and HEE say that nursing associates will be delivering ‘hands-on’ care to patients, although it is not yet clear what form the care will take.

North Bristol NHS Trust has been spearheading the development of new healthcare roles for more than a decade and apprenticeships and assistant practitioners (APs) for the past six.

It provides a good example of how support workers can be integrated into the nursing team. The trust has 105 APs who work in nursing teams on band 4 at a higher level than HCAs.

The organisation takes in two cohorts of 20 trainee APs a year. They are able to work in a paid job as a trainee and start a foundation degree with the local university or college.

The trust’s director of nursing Sue Jones says: ‘They are absolutely a valued part of the nursing team.

‘The announcement of the nursing associate role is an interesting one as we’ve had so much success with our APs. How the different titles will work is something we will have to wait for, but the important thing is that we produce qualified, competent support staff nationally.’

After the two-year course, the APs can choose to start nurse training. Their AP training counts as part of a nursing degree and they can begin the course in year two.

Assistant director of learning and development Jane Hadfield says: ‘They work in a qualified role in a nursing team under the supervision of registered nurses.

‘They have a different uniform from nurses and HCAs so they are easily recognised by both staff and patients. The role is meaningful in its own right and offers HCAs and those who don’t want to take the traditional route into nursing a chance at career progression.’

Not everyone agrees with the plans. The Safe Staffing Alliance (SSA) wrote a letter pubished in The Times stating that the new proposals for nursing associates ignore evidence that shows patients achieve better outcomes when cared for by registered nurses. It even went as far as saying that increasing the number of lower-skilled staff could result in more unnecessary deaths.

The view of an enrolled nurse

Cheryl Phillips is matron of a care home in Newport, Gwent, and is one of more than 72,000 enrolled nurses listed on part 2 of the Nursing and Midwifery Council register. She trained as an enrolled nurse between 1986 and 1988.

She says: ‘A lot of people are saying that the role of nursing associate is going back to enrolled nurses. It is not going back, it is simply looking at the situation we are currently in within the NHS and finding a solution.

‘What I will say is that as an enrolled nurse I never felt looked down upon by my colleagues and I relished the opportunity to have responsibility and carry out practical tasks.

‘The nursing associate role is a great idea and I fully support it.’

SSA chair Susan Osborne says: ‘This proposal has been slipped in under the radar. It is a quick fix and a cheap option and it is not addressing the real issue of a shortage of registered nurses. We need to invest in education so all those thousands of people who want to study degree-level nursing are able to.’

Unison head of health Christina McAnea says it is important the new role does not marginalise HCAs or undermine AP roles.

The RCN has welcomed the fact that the role should enable staff in support roles to access training via a clear pathway and says it will respond to the consultation to ensure the role is fully funded without detracting from the wider workforce.

NMC chief executive Jackie Smith says: ‘The starting point for any new role in healthcare has to be its contribution to improving patient safety and quality and as such there will be some important considerations, including whether nursing associates should be regulated.’

The consultation is due to start soon and, subject to its findings, 1,000 nursing associates could start training this year.

See letters page 32

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