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RCN Congress: Nurse substitution risks ‘exploitation’ and undermines safety

RCN Congress: Nurse substitution risks ‘exploitation’ and undermines safety

Workforce decision making in some areas is prioritising affordability and undermining patient safety and care, members of the Royal College of Nursing (RCN) have warned.

Nurses from various settings took to the stand during a discussion at this year’s RCN Congress which centred on the ongoing issue of registered nurse substitution.

This has been a cause for concern particularly within general practice nursing in recent months, amid an increase in nursing associates.

Leading the discussion was Samantha Spence, chair of the RCN’s Outer North London West Branch, who warned that substituting registered nurses with other – sometimes less qualified – staff put those staff members at risk of ‘exploitation’ and saw them practising with ‘inadequate support and supervision’.

It also ‘raises concerns about safety and patient care’ she added.

‘It’s important to remember that this [substitution] is not caused by or within the control of those filling these gaps, or those that use available opportunities to develop themselves in roles,’ she noted.

However, Ms Spence stressed the need for ‘stronger, visible nurse leadership’ to ensure nurses can ‘shine’ and are in the ‘driving seat’ when decisions are being made about the workforce.

She added: ‘Decision making isn’t based on safety; it’s not based on patient care. It’s governed and led by financial decisions.’

Dionne Daniels, RCN Southwest London Outer Branch member, explained the ‘difficulty’ of discussing nurse substitution, acknowledging that some nursing staff may feel they are not ‘valued’ as part of the ‘nursing family’.

Ms Daniels said: ‘I just want to be clear, it’s not the case. But we will not find our value as a registered profession if we don’t know who we are, and what we are.

‘And right now as we speak, senior nurses have a difficult decision to make when organisations are expected to reduce costs.

‘There’s a danger that thinking that we can save money in the short term. It can have an impact on our patients and our staff, and this will impact retention and recruitment in the future.’

Evaline Omondi, RCN Eastern region member, warned: ‘We’ve been campaigning for a pay rise, we are campaigning for better patient-staff ratios, but instead of addressing these issues, the government is taking shortcuts.

‘We welcome the nursing associates, they’re brilliant to work with, but the government needs to make sure that they’re trained properly so that they take full responsibility.’

And Michael Wincott from the RCN’s District and Community Nurse Forum suggested NHS trusts that were ‘facing financial struggles may opt to build nursing gaps with lower band staff’ and use Band 4s instead of Band 5s, and Band 3s instead of Band 4s.

He warned that this substitution ‘might have the effect of lowering the role distinctions for management’.

‘While demands obviously fluctuate we must guard against the creep of replacing higher bands with lower ones,’ Mr Wincott added.

Also taking to the stand, Katie Neal, RCN District and Community Nursing Forum member, shared experiences from her and her sister’s role in the community to illustrate how nursing associates can sometimes put additional pressure on community nurses delivering care.

She explained that when community nurses have nursing associates as their secondary in a team, they are overseeing and made accountable for these team members.

Ms Neal suggested ‘less experienced’ staff ‘may not recognise’ cases of patient deteriorations that comes with that expertise, education and knowledge of a registered nurse.

‘They are not able to do IVs and are not able to discharge patients or have some of the skills or procedures required. So, ultimately, it’s been more work,’ she added.

Frustrated by the discussion, nursing associate and RCN Mental Health Forum member, Tania Lefevre, told congress: ‘I’m a nursing associate and I will be honest, I’m very upset with some of the language that’s being used.

‘Please do not refer to us simply as “those Band 4s” – we are registered professionals.

‘I have skills, I am trained in all four fields of nursing and some of the words that are being used today are hurtful.’

The discussion at RCN Congress this week follows warnings from nurse leaders over the increasing substitution of registered nurses with nursing associates – especially since the introduction of the Additional Roles Reimbursement Scheme, which funds the salaries of some roles, including the nursing associate.

Earlier this year, the Queen’s Nursing Institute (QNI) also called for ‘clear guidance’ on the ‘scope and limits’ of nursing associates amid reports of those in post running independent clinics in general practice.

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