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Focus on nursing associates and you’ll miss the big picture

Knee-jerk reaction to nurse shortages is not a solution, says Dame Jill Macleod Clark

Knee-jerk reaction to nurse shortages is not a solution, says Dame Jill Macleod Clark


Picture: Alamy

The needs and demands for health and social care in the UK are set to escalate for the foreseeable future. Traditional professional role responsibilities and boundaries are no longer sustainable or affordable and a different kind of skill mix will be required. 

Sadly, efforts to transform and future-proof the health and care workforce have failed dismally to date.  

Successive workforce strategies and plans have been resourced and managed in a way that perpetuates existing professional silos and blocks the ability to transfer investment into areas of greatest future need. Ultimately this results in panic reactions to perceived shortages and knee-jerk decisions about the numbers of people required in particular roles.

The government’s expensive solutions

Recent examples of such knee-jerk initiatives in England include the government’s ambitions to increase the number of general practitioners by 5,000 and to have a further 7,500 trainee nursing associates in place by 2020, on top of the 7,000 already recruited.

These endeavours are fraught with difficulty and reflect the lack of a whole-system, multidisciplinary approach to developing a sustainable future workforce. Both are also very expensive solutions.

‘There is no money in the non-medical postregistration career development pot and no appetite for reallocating some of the substantial medical budget to support new roles’

The route to fully fledged general practitioner status is a long and costly one, and there is no way of ensuring that new graduates will indeed work as general practitioners.

Enhancing access to primary care services through the development of a robust advanced practitioner workforce would be much quicker and much more cost-effective. However, there is simply no money at all in the non-medical postregistration career development pot and no appetite for reallocating some of the substantial postregistration medical budget to support new roles. 

Look at the whole workforce picture

The route to qualified nursing associate status is short, but is also extremely costly and resource intensive for the organisations responsible for training and supporting them. While there is a strong case for welcoming such roles, the huge implications have not been properly thought through.

The decision to support the nursing associate role was made at a time of unprecedented registered nurse shortages, which also prompted a commitment to increase the number of students training to become registered nurses.

It also coincides with the implementation of the new NMC Future Nurse standards, which will influence the expectations placed on existing registered nurses. Yet, nursing associates are being focused on as if they will exist in isolation – there has been no attempt to look at the whole picture.

‘We know that access to career and personal development opportunities is one of the most significant factors in decisions to stay in the profession’

At the chief nursing officer for England’s summit this month, health and social care secretary Matt Hancock acknowledged that the nursing workforce will be required to play an increasingly pivotal role in the leadership, management and delivery of care and the Long Term Plan.  

In order to maximise its contribution, the nursing profession must have the necessary structures, resources and career pathways in place to respond to future needs for nursing intervention and support. 

Too little, too late

Now, more than ever, energy should be focused on investing in and retaining the existing registered nurse workforce. We know that access to career and personal development opportunities is one of the most significant factors in decisions to stay in the profession. Successive draconian and short-sighted cuts to non-medical continuing professional development budgets mean that opportunities for upskilling and career progression are now severely compromised. 

NHS chief executive Simon Stevens has announced that this will be addressed over the next five years, but it is far too little, too woolly and much too late. 

In spite of the hot air generated around the nursing associate role, there can be no doubt that it has real potential to enhance the nursing care team. 

The role was specifically introduced to support registered nurses in the delivery of high quality, evidence-based nursing care and to provide a different route to graduate registered nursing roles. 

However, this will only work if nursing associates are appropriately supervised and supported by registered nurses, both during training and as qualified members of staff.   

No nursing associates without registered nurses

Registered nurses are vital to achieving a solid pipeline of nursing associates; without sufficient numbers of registered nurses, the government’s aspirations to generate a large critical mass of nursing associates in record time are doomed to failure. Registered nurses also play an essential role in the supervision and support of degree nursing students and new graduates. 

There simply has to be sufficient registered nurse capacity to meet these huge requirements for supervision and support in order to develop and lead strong nursing teams.   

The key to meeting people’s needs for care in the future lies in securing a stable and valued registered nurse workforce, equipped to fulfil increasingly demanding roles.

Unless the government takes urgent measures to invest in, support and retain existing and future registered nurses, we will have the makings of a perfect storm.


Dame Jill Macleod Clark is emeritus professor, health sciences, University of Southampton. She was lead adviser to the NMC for the Future Nurse standards

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