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Report warns against ‘role substitution’ of registered nurses

Report warns against ‘role substitution’ of registered nurses

The use of support staff in roles and tasks that require a registered nurse is ‘a very real risk’, according to a new report by the Royal College of Nursing (RCN) Wales.

The study – called Progress and challenge in delivering safe and effective care 2023 – looks into how NHS Wales has implemented the Nurse Staffing Levels (Wales) Act 2016.

The legislation – which applies everywhere NHS Wales provides nursing services or commissions someone else to do so – requires health boards and trusts to ‘have regard to the importance of providing sufficient nurses to allow the nurses time to care for patients sensitively’.

The report states that evidence is ‘very clear’ that the professional knowledge, skills and judgement of a registered nurse in a supervisory position makes a ‘critical difference’ to patient safety and outcomes.

However, it warns against ‘role substitution’ whereby support staff – such as assistant practitioners (APs), nursing associates or health care support workers (HCSW) – are used in situations requiring a registered nurse.

The report recognises such support workers are ‘a vital part of the nursing workforce’ but may have different levels of experience, qualifications and specialisms. This means that their contribution is ‘both invaluable and different’ from that of a registered nurse.

RCN Wales emphasises the importance of support staff having the clinical supervision and direction of a registered nurse.

According to the report, ‘they should never be pressured to work beyond their competencies or scope of practice, nor should they be used to substitute registered nurses or fill registered nurse vacancies’.

This comes after the RCN warned separately of an increasing use of nursing associates in place of general practice nurses in England.

The RCN Wales report is the third of its kind, with the previous examinations of the Nurse Staffing Levels (Wales) Act’s implementation published in 2019 and 2022.

While they have focused on hospital settings, the latest report acknowledges that ‘nursing services are an essential part of all health and social care services and an excellent case could be made for examining the Act in primary care, public health services, care homes, and commissioned social care’.

Helen Whyley, director for RCN Wales, said: ‘The RCN is campaigning for the Act’s full potential to be realised through statutory and operational guidance across all care settings.

‘I’m delighted that the RCN has played such an important role in pioneering this essential work.’

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