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Nursing associate role “will lead to less registered nurses”, say RCN members

The introduction of the nursing associate role will lead to fewer registered nurses in the workforce, Royal College of Nursing members have stated.

As part of its consultation on proposals to introduce a “Nursing Associate” role in the NHS, the RCN surveyed its members.

The vast majority (95%) reported that the workforce has insufficient numbers of registered nurses, with 78% believing that the introduction of the new role will lead to further reductions.   

This could occur if employers hire nurse associates instead of registered nurses, or see them both as equals, and there may be a fear that registered nurses could be replaced, an RCN spokesperson explained.

Janet Davies, chief executive of the RCN, responded: “there are worries that these new roles could result in a continuing lack of registered nurses. These new roles must not be used as a method of substituting support workers for the regulated, knowledgeable workforce of registered nurses.”

However, the survey - completed by 5,230 RCN members - shows that most (67%) believe that the new role would provide a work-based route into registered nursing for healthcare assistants.

But the nurses are concerned that registered nurses cannot support/mentor junior colleagues, with six out of 10 saying they felt registered nurses would be 'hardly or not at all able' to provide the necessary support for this new group of staff.

Davies added: “RCN members are clear about the value of a supporting workforce who have a framework for progression and the ability to develop in their roles if that is what they want to do. The RCN supports efforts to develop these staff, while maintaining the supervision of the registered nurse role.”

“Ultimately, the best interests of patients will be served by developing support staff, either through this new role or extending existing ones, and by ensuring that there are enough registered nurses.”

The only way to ensure the right mix of skills for safety and improved health outcomes is a consistent and increased number of education places to produce those registered nurses, she concluded.

Key ideas in the RCN consultation response:
• Responsibility for the overall nursing care of the patient and clinical decision making lies with the RN and cannot be substituted by an HCSW or assistant practitioner (AP).

• The registered nursing workforce should remain an all graduate profession.

• The RCN does not support the return of the second level registered nurse.

• There are defined accountability and delegation responsibilities for registered nurses (RNs).

• All health care support workers (HCSWs) should be regulated in the interest of public protection.

• HCSWs must be supported to develop the knowledge and skills required to deliver competent and compassionate patient-centred care.

• A structured career framework for all HCSWs should be developed.

• Staffing levels and skill mix should be determined appropriately using professional judgement, guidance and tools. 

• In relation to safe staffing, there is an association between the number of RNs and better patient outcomes.