The Queen’s Nursing Institute (QNI) has called for ‘clear guidance’ on the ‘scope and limits’ of nursing associates amid reports of those in post running independent clinics in general practice.
The nursing charity has today issued a position statement on the ‘safe and effective deployment’ of nursing associates in community settings, outlining ‘significant concerns’ about their scope of practice.
Without new guidance – ‘ideally’ from the Nursing and Midwifery Council (NMC) – the QNI said it was concerned there will ‘continue to be inappropriate extensions of the role in many settings, creating significant concerns for standards of care and increasing the risk to patient safety’.
Nursing associates were introduced in England in 2019 and were designed to bridge the gap between healthcare assistants and registered nurses. Plans have recently been announced for the role to be introduced to the NHS in Wales.
While recognising the ‘invaluable contribution’ of nursing associates in assisting registered nurses, the QNI stressed there were ‘significant differences’ between the two posts and that nursing associates ‘should not be used in role substitution’.
Nursing associates ‘support registered nurses to provide and monitor care and contribute to integrated care’, while registered nurses ‘assess, plan and evaluate care, as well as providing the leadership and management of the team’, the QNI explained.
Within its statement, the QNI reiterated concerns around nursing associates being offered places on a university course typically designed for registered nurses new to general practice.
Offering both nursing associates and registered nurses the Fundamentals of General Practice programme, with ‘exactly the same content for both types of practitioner’, would potentially lead to ‘misunderstandings about the scope of practice of registered nursing associates’, the charity warned.
The QNI continues to seek ‘urgent clarification’ from NHS England about the Fundamentals of General Practice courses, ‘to ensure a clear delineation of the role of registered nurses and registered nursing associates’.
In addition, the QNI said it had been informed by members of its nursing networks that there had been examples of nursing associates running independent clinics in general practice and prison settings.
This was ‘despite the nursing associate role not being associated with patient assessment, care planning and evaluation of care’, it added.
‘This is unacceptable and serves both to exploit the registered nursing associate and to place patients at considerable risk,’ the statement warned.
Meanwhile, the nursing charity was also aware of ‘a number of universities’ offering continuing professional development (CPD) courses to nursing associates, ‘which could lead them to be involved in the undifferentiated diagnosis of patients in community settings’.
‘The QNI believes that all practitioners should undertake CPD, but that such courses must be commensurate with the practitioner’s role,’ it said.
There had also been ‘numerous’ job advertisements that ‘ask for applications from nursing associates, but describe a role way beyond that envisaged when nursing associates were introduced into the workforce’.
The QNI said it was concerned the nursing regulator was ‘powerless to intervene in these cases’ and instead referred issues to others, such as the Care Quality Commission (CQC).
‘The NMC has also indicated that it is for employers to determine the scope of practice of the nursing associate role, not the regulator,’ the statement said.
‘This can only lead to widespread exploitation of registered nursing associates and significant and high-risk variation across the country, which raises concerns about the safety of patients.’
It added: ‘The QNI is seeking clear guidance on the scope and limits of nursing associate practice, ideally from the NMC as regulator.
‘We are concerned that without this there will continue to be inappropriate extensions of the role in many settings, creating significant concerns for standards of care and increasing the risk to patient safety.’
In the meantime, the QNI pledged to ‘monitor the situation’ and raise concerns with the CQC where employers in community settings inappropriately advertise nursing job roles.
Responding to the QNI’s position statement, Sam Foster, director of professional practice at the NMC, highlighted the ‘vital role’ the more than 10,000 nursing associates in England played in caring for people, but recognised concerns about ‘inappropriate use’ of the role.
‘In the vast majority of cases, the role successfully bridges the gap between health care assistants and registered nurses, working as part of the nursing team and contributing to the delivery of care,’ she said.
Though she added: ‘We share the concerns of the QNI about any inappropriate use of the nursing associate role by providers and we’re committed to working with NHS England, CQC and other partners to better understand and act on any concerns.
‘Providers are accountable for making safe decisions about role and skill mix, in the specific context in which care is being delivered.’
Ms Foster said the NMC’s ‘standards are clear about what every nursing associate needs to know and be able to do at the point of registration, and the clear differences between nursing associates and registered nurses’.
‘Like registered nurses, nursing associates may, with the right additional training, education and appropriate clinical governance, go on to undertake aspects of care over and above what is covered in those standards,’ added Ms Foster.
‘Our Code makes clear that any professional registered with us has a duty to raise concerns if they think something isn’t safe, and a duty not to work beyond their proficiencies.’
