Welcome to the first tranche of Nursing Associates! But for a safe NHS we will need many, many more.

Last week saw early skirmishes in what will be a long-term plan length battle about who should be allowed to do what in terms of NHS healthcare.

In January 1000 nursing associates completed their training and joined the NHS workforce. Given the shocking number of existing vacancies – let alone the number that will be needed to fulfil the requirements of the long-term plan this is a welcome and necessary addition.

But that’s not been the story these last few days. What’s been of note during this period has been the important point that Nursing Associates cannot substitute for Registered Nurses.

3 years’ degree training is more important than 2 sub-degree years and the latter must not substitute for the former.

Let’s test that belief a bit.

  • Registered Nurses need the training they receive to deliver care to the fullest extent. Without that level of skill being there for patients, care is sub-optimal.
  • It follows therefore that the tasks carried out by Registered Nurses cannot be substituted by Nursing Associates so they will need to do something different (and less significant) than the work done by Registered Nurses.
  • Plus, if they do substitute for Registered Nurses it will be to the detriment of patients and their safety.

This all looks pretty tight logic – but it contains an important flaw.

What if Registered Nurses, in their day-to-day work, perform tasks that do not require their skill levels to perform?  What if, on the ward and in the community, they are doing things that don’t need all that training, but could be carried out by someone with less?

If that were the case then some of that work, in 2019, could safely be carried out by Nursing Associates.

I recall back in 2008/9 the NHS Institute for Innovation developed a nurse-led time and motion study colloquially called The Productive Ward – Releasing Time to Care. This was a brilliant self-application of time and motion techniques by nurses themselves to their work on the ward and in the community. I remember a trip to the United State with the excellent Helen Bevan where we sold this NHS-developed work to US hospitals. It had already been bought by the New Zealand health services for use in every hospital.

What this showed – as nurses looked at their own daily practice – was that much of what they did – did not require the skill levels for which they had been trained. By examining their own work the average increase in ‘Time to Care’ was 25%. This extra time to care for patients did not decrease patient safety. Of course not. It increased it.

All of which suggests a reality (rather than an idealised definition of what might be) in which there some things that Registered Nurses currently do that others, (Nursing Associates) could.

In a very real way Nursing Associates can, should and will substitute for this Registered Nurses’ work. But they can’t, shouldn’t and won’t substitute for the work that only registered nurses should be doing.

In the same way as Registered Nurses will substitute for doctors – not in the work that only doctors should do – but for the myriad tasks that they don’t need to.

The real battle of the next few years will be in ensuring that that NHS staff operate to the peak of their skillsets and allow work requiring a lower order of skill to be performed by those being trained to do it.

The long-term plan promises 7500 nursing associates starting in 2019. I expect this to increase by several times that number by the end of the long-term plan.

They will be more than welcome – indeed – they will be absolutely vital.

I promise that throughout and by the end of the long-term plan there will still be enough sickness to go around to keep everybody – and then some – very busy.

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