Nursing associates ‘exploited’ in community, claims QNI

The QNI said some primary care employers and educators have been using and training nursing associates inappropriately, and warned of “widespread exploitation” of this workforce unless regulators and the NHS step in.

The organisation made the claims in a position statement on the “safe and effective” use of nursing associates, published today (7 February).

The QNI acknowledged, in its statement, the “invaluable” contributions of nursing associates, but clarified that they have a different place in the workforce to registered nurses.

Members of the QNI network said they had seen nursing associates running “independent clinics” in prisons and general practice settings, despite the role not covering patient assessment, care planning and care evaluation.

“This is unacceptable and serves both to exploit the registered nursing associate and to place patients at considerable risk,” QNI said.

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

The QNI called on the Nursing and Midwifery Council (NMC) to issue clearer guidance on the "scope and limits" of the nursing associate role.

It added: “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.”

Sam Foster

In response to the QNI’s statement, Sam Foster, NMC director of professional practice, said the nursing regulator was too concerned about the reports of “inappropriate use” of nursing associates.

“Over 10,000 nursing associates play a vital role caring for people across health and care in England," said Ms Foster.

"In the vast majority of cases, the role successfully bridges the gap between healthcare assistants and registered nurses, working as part of the nursing team and contributing to the delivery of care.

“We share the concerns of the QNI about any inappropriate use of the nursing associate role by providers and we’re committed to working with NHS England, [the Care Quality Commission] and other partners to better understand and act on any concerns.

“Providers are accountable for making safe decisions about role and skill mix, in the specific context in which care is being delivered.”

Meanwhile, the QNI said the lines between nursing associates and registered nurses in education had also become too blurred.

It pointed to the commissioning of identical primary care courses for both registered nurses and nursing associates.

One NHS England-commissioned course named Fundamentals of General Practice includes teaching on the administering of vaccinations and is offered to both cohorts, claimed the QNI.

The QNI explained: “Vaccines are predominantly administered under Patient Group Direction (PGD).

“The Human Medicines Regulations 2012 only permit registered nurses and other types of registered healthcare professionals to work to a PGD.

“This means it is illegal for registered nursing associates to administer vaccines under a PGD, which may not be understood by their employers.”

Further, the organisation said some universities offered continuing professional development (CPD) courses to nursing associates in skills that went beyond the scope of the role.

“The QNI believes that all practitioners should undertake CPD, but that such courses must be commensurate with the practitioner’s role,” the statement read.

On the QNI’s education and training concerns, Ms Foster said: “Our standards are clear about what every nursing associate needs to know and be able to do at the point of registration, and the clear differences between nursing associates and registered nurses.

"Like registered nurses, nursing associates may, with the right additional training, education and appropriate clinical governance, go on to undertake aspects of care over and above what is covered in those standards.

“Our Code makes clear that any professional registered with us has a duty to raise concerns if they think something isn’t safe, and a duty not to work beyond their proficiencies.”

NHS England has been contacted for comment on the QNI’s claims.