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February 2024

Potential for confusion, unsafe care and exploitation over nursing associates

The Queen’s Nursing Institute has raised the alarm about potential confusion between the roles of registered nurses and nursing associates.

In a position statement published this week (7 February 2024), the QNI says that nursing associates – although they are registered with the Nursing and Midwifery Council – are not registered nurses and should not be used in role substitution.

It has expressed concern that NHS England have commissioned and promoted identical courses for both registered nurses and nursing associates to prepare them to work in general practice. But the course, ‘Fundamentals of General Practice’ has exactly the same content for both types of practitioner, potentially leading to misunderstandings about the scope of practice of nursing associates.

For example, the course covers vaccinations most of which are administered under a patient group direction (PGD), but it is illegal for nursing associates to administer vaccines under a PGD – which may not be understood by their employer.

The QNI is also aware that a number of universities are offering continuing professional development courses to registered nursing associates, which could lead them to be involved in areas of practice outside the scope of their role, such as undifferentiated diagnosis. The QNI says it ‘believes that all practitioners should undertake CPD, but that such courses must be commensurate with the practitioner’s role’.

QNI network members have provided examples of nursing associates running independent clinics in general practice – and in Prison healthcare settings – despite fact that the nursing associate role does not include patient assessment, care planning and evaluation of care.

‘This is unacceptable and serves both to exploit the registered nursing associate and to place patients at considerable risk,’ the QNI says.

In addition, the QNI has seen numerous job advertisements that ask for applications from nursing associates, but describe a role way beyond that envisaged when nursing associates were introduced into the workforce.

The QNI is concerned that the NMC is powerless to intervene in these cases, instead referring concerns to other system-based regulators such as the Care Quality Commission (CQC). The NMC has also indicated that it is for employers to determine the scope of practice of the nursing associate role, not the regulator.

‘This can only lead to widespread exploitation of registered nursing associates and significant and high-risk variation across the country, which raises concerns about the safety of patients,’ the Institute says.

The QNI is seeking clear guidance on the scope and limits of nursing associate practice, ideally from the NMC as regulator. It says: ‘We are concerned that without this there will continue to be inappropriate extensions of the role in many settings, creating significant concerns for standards of care and increasing the risk to patient safety.’

The QNI is also seeking urgent clarification from NHS England about the Fundamentals of General Practice courses which they have commissioned, to ensure a clear delineation of the role of registered nurses and registered nursing associates.

The Queen’s Nursing Institute. Position Statement – nursing associates in community nursing settings. 7 February 2024.

Practice Nurse 2024;54(1): online only