Nursing Associates: What does this new role mean for other Band 4 workers?

Earlier this year, the Nursing and Midwifery Council (NMC) agreed to regulate a new support role which will work alongside care assistants and registered nurses to deliver hands-on care for patients - the Nursing Associate.

This has had a mixed reception from the nursing profession, with some agreeing that it is essential for the future of the role, others seeing this as a diminution of the role of the registered nurse. Whatever your opinion, this decision will have long-term consequences for healthcare.

What does it mean to be registered?

Regulatory bodies like the NMC and Health and Care Professions Council (HCPC) hold a formal register of all those within a profession who use a protected title like nurse, radiographer, occupational therapist etc. You cannot use this title unless you are on the register.

Of course, you have to be suitably qualified and pay an annual fee for this and registrants also need to provide evidence that they keep their education and practice up to date. Registrants would not be able to practice without registration so it is, for them, essential for employment.

But, it is about much more than that. Registration is designed to protect the public from unqualified or unsafe practice. Being on a register offers a level of reassurance that professionals have successfully completed a training period and have agreed to abide by a professional code of conduct. Those individuals who do not demonstrate the required values and behaviours can expect to be removed from a register or have conditions of practice imposed.

In 2013, the Francis Report into the failings at the Mid-Staffordshire Hospital suggested that:

'No unregistered person should be permitted to provide... direct physical care to patients... The system should apply to healthcare support workers whether they are working for the NHS or independent healthcare providers...' (Recommendation 209)

A subsequent report by Cavendish in 2013, suggested that there were 1.3 million unregistered healthcare assistants and support workers working on the frontline of care.

However, in the Health and Social Bill of 2012, the government were clear that compulsory registration would not happen and voluntary registers or negative registers (lists of those who were unsuitable) would suffice.

What do we mean by support workers?

It is easy to think about healthcare assistants in nursing or midwifery roles. Many of us will have encountered them through our own healthcare experiences, but other professions also make good use of support workers too.

Allied health professions (eg physiotherapy, speech and language therapy, radiography) also have support workers who are 'frontline' and assist registrants to deliver high-quality care. Senior support workers will be trained to deliver high quality, hands-on care, which is specific to the professional group to which they belong and are an essential part of those teams.

The National Health Service has a reward system designed to acknowledge the level of training and experience of its workforce. Newly qualified nurses and allied health professionals expect to enter the system at Band 5 and can progress through to very senior roles at Band 8 during their careers.

Support workers usually enter at Band 2 and can, with additional training and experience, progress to Band 4. At Band 4, support workers are described as assistant or associate practitioners, recognising their seniority and support for the Band 5 practitioner role. Usually, workers at Band 4 or below would be unregistered even though they are essential to the workforce and are well trained, although some are on voluntary registers.

New role will buck the trend

The new Nursing Associate role will buck this trend. While not confirmed, the expectation is that they will be at Band 4 when qualified, supporting nurses to deliver high-quality care. They will have been educated to Diploma or Foundation Degree level and will have achieved a certified level of clinical competence.

Registration will give the nursing profession, employers and the public confidence that the nursing associate has 'met the grade' and is safe to practice. The Nursing and Midwifery Council is just at the start of this process. The move to register nursing associates requires legislative change and could take two years to achieve, but the wheels are in motion.

So, what about the other Band 4 workers - the associate or assistant practitioners?

They have been educated to the same level and also achieved a high degree of competence. They too support practitioners to deliver high-quality care. How can we agree that one sector of this workforce is regulated and the other not? How has the decision by the NMC made assistant practitioners feel? Health and social care is a challenging working environment which needs its staff to feel valued and respected. Will this decision demotivate those who will not receive the status and responsibility bestowed by registration?

The government made its position clear in 2012, but we have entered a new age. Registration for the support worker is coming, but not for all. Mutterings have already started, implications are unclear. Is it time to challenge the government once again about registration and regulation for anyone who is employed to deliver care to the public?