RCN chief warns new nursing associate role ‘may put patient safety at risk’

Allowing unregistered nursing associates to give drugs to patients risks safety and is “ridiculous”, the country’s most senior nurse has said.

Janet Davies, chief executive of the Royal College of Nursing (RCN), warned that the new nursing associate role could reduce nursing to a “series of tasks” and there were fears hospitals would try to “dilute” their number of nurses with less-qualified staff.

Ms Davies spoke out after it was revealed that nursing associates will be able to administer controlled medicines and carry out invasive procedures.

The Government has announced plans to create 2,000 nursing associate roles across England, with the first 1,000 due to start training at 11 test sites from December.

Health Education England (HEE), which is overseeing training, has said there has been “huge interest” in the role.

But Unison has warned the new roles should not be used “as a cheap way to replace registered nurses”, while global safe staffing expert Linda Aiken has described the plan as “crazy”.

Nursing associates are intended to bridge the gap between healthcare support workers and qualified nurses.

Officials have said they will work “under the direction” of a fully qualified registered nurse.

But HEE documents seen by the Health Service Journal (HSJ) show that nursing associates will be allowed to carry out invasive procedures and administer drugs without the direct supervision of a qualified nurse.

The documents say that by the end of two years of training, the “trainee nursing associate will be able to deliver planned nursing interventions… in a range of health and/or care settings under the direction of a registered nurse without direct supervision, delivering care at times independently in line with an agreed/defined plan of care”.

Nursing associates will “correctly and safely undertake medicine calculations; administer medicines safely and in a timely manner, including controlled drugs”. This will only happen where deemed appropriate.

In an interview with the HSJ, which revealed the plans, Ms Davies criticised the “lack of transparency” over development of the new role.

She said: “When you’re dealing with a patient you’re not just doing one task.

“Nursing is far more than just a series of tasks and what is beginning to happen is that nursing is being seen as a series of tasks which can be divvied up among a number of people and that is not what nursing is.

“If you divide work into tasks it creates problems in terms of continuity of care, communication and experience of the patient.

“This is starting to revert to the old way of working, which actually gives really fragmented care to the patient.”

The RCN has supported the development of a support worker role, but Ms Davies said she found the new details about nursing associates “a big problem”.

She said: “There is a lack of transparency and things seem to be happening that people are not aware of.”

On the proposal to allow associates to administer controlled drugs, she said: “It is ridiculous. That is not a role for an unregulated worker or a person who is not a registered professional. That is seeing something as a task without appreciating what is behind it.”

She said she did not believe administering controlled drugs was something that should be delegated to a support worker. “This is not about being protective of the registered nurse, it’s about patient safety and quality of care.”

She also spoke about fears that hospitals will employ associates instead of registered nurses.

She said: “We know that’s the absolute danger of this role. We know the numbers of registered nurses has an effect on mortality, that work has been done and we shouldn’t be diluting that skill mix.”

In February, a study led by King’s College London and the University of Southampton found that hospitals with a higher number of healthcare support workers compared with nurses may have have higher patient death rates. But registered nurses looking after small groups of patients were linked to lower death rates.

Lisa Bayliss-Pratt, director of nursing at HEE, told the HSJ that its document had been created as a guide for those institutions that will educate nursing associates “to ensure they provide what the NHS needs within their offer”.

She added: “HEE’s response to the consultation makes clear that this new role will support registered nurses and employers are expecting to deploy them as such.”

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