17.11.16
Study raises fears that nursing associate role will ‘put patient lives at risk’
New research suggesting that replacing registered nurses with support staff increases patients’ death risks raises doubts about the role of nursing associates, the Royal College of Nursing (RCN) has warned.
Researchers studied data from 182 hospitals in Belgium, Ireland, Finland, Spain, Germany and Switzerland, covering 13,000 nurses and 19,000 patients.
It found that replacing one nurse per 25 patients with a nursing assistant led to a 21% increase in the patients’ risk of dying.
Janet Davies, chief executive and general secretary of the RCN, said: “This research reinforces the stark fact that for patient care to be safe, and high quality, you need the right number of registered nurses. Substituting registered nurses with support staff quite simply puts patient care and patients’ lives at risk.
“It’s vital that this is not ignored as the new nursing associate role is developed. Support staff are crucial in delivering patient care and the NHS could not operate without them, but they cannot and must not become a substitute for registered nurses.”
The new nursing associate role, which was announced in May and is due to be implemented from the beginning of next year, is intended to transform the health workforce at a time when it faces acute staffing shortages.
However, the authors of the new study, which was published in the BMJ, said that England already has one of the lowest rates of professional nurses in the world, with these making up just 57% of the hospital skill mix. In Germany, the rate is 82%. The rate of nurses within individual hospitals in England also varies from 47% to 79%.
The researchers noted that there is limited evidence to support the theory that a workforce with fewer higher-skilled and waged nurses, supported by more lower-skilled assistants, can reduce costs without adversely affecting patient outcomes.
However, Professor Lisa Bayliss-Pratt, director of nursing and deputy director of education and quality at Health Education England, said: “This research is not about Nursing Associates, it does not mention Nursing Associates and as Nursing Associates are not even working in the NHS yet there are no comparisons to be drawn.
"We have been very clear, all nursing associate trainees in this country will undergo rigorous and robust education and training as part of an accredited two-year programme and that it is a support role, not a substitute for registered nurses."
Professor Jane Cummings, chief nursing officer for England, argued: “What is clear is that we need to ensure that we have the right skills, in the right place and at the right time – although flexibility is needed, all decisions must be based on patient need above all else. The new nursing associate will play an important role as part of a team built around those needs.”
Separately, a DH spokesperson said the nursing associates would “complement, not replace” registered nurses, an important distinction that the director of nursing at Health Education England had previously underlined.
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