• RCN says national guidance on administration of medicines is not sufficient
  • Nursing professor says situation around the new role is “concerning”
  • HEE chief nurse says “nothing stopping us developing more” guidance

The Royal College of Nurses has branded guidance published by Health Education England for the administration of medicines by nursing associates as “not sufficient”.

The training provider published advisory guidance this month clarifying nursing associates’ role in supplying medicines to patients, including medicines that carry a “higher risk of harm”.

Nursing associates are a new staff group proposed to work alongside registered nurses and existing healthcare support workers. The government announced plans to create the role in 2015 and there are currently 2,000 trainees in NHS providers.

HEE sets out seven recommendations aimed at employers, nursing associates and patients, which include developing proposals for nursing associates to be able to supply medicines using patient group directions, and ensuring adequate levels of supervision are in place.

The guidance also recommends that the Nursing and Midwifery Council should ensure core routes of medicine administration – including oral, topical and inhaled – are included by name in the nursing associate standards of proficiency.

However, the nurses’ union told HSJ it is unclear how the guidance will “serve to mitigate the risks around medicine management”.

Janet Davies, chief executive and general secretary of the RCN said it did not include enough detail. She said: “Nursing associates will be working across a range of settings, so generic training and guidance is simply not sufficient. Drug administration is not a mechanistic task.

“Guidance around medicine management should start with the patient or client, not the role, and it should be managed as part of organisational governance processes,” Ms Davies added.

“The scope of medicine management for nursing associates will need to be set locally by employers, in response to a specific risk assessment, to ensure safe and effective practice. It must also reflect the fact that the nursing associate is a support role and cannot substitute for a registered nurse,” she said.

Alison Leary, chair of healthcare and workforce modelling at South Bank University, London, said the guidance was “concerning”, as it “shows administration of medicines as a series of tasks without any regard to context or level of risk”.

“It is relatively easy to teach a technical task but it takes experience, skill and knowledge to understand the context, for example administration of medicines in stable social environments is very different to administration in unwell, unstable and acutely ill patients,” Professor Leary said.

She also described HEE’s recommendation that nursing associates should be able to administer some medicines under patient group directions as “troubling”.

PGDs are put in place to allow staff other than doctors to supply medicines in specified circumstances without a doctor’s prescription.

“This is an untested workforce and already the boundaries are being pushed,” Professor Leary said. “This falls well short of a framework to protect the public.”

Lisa Bayliss-Pratt, chief nurse at HEE, told HSJ in response it was “important” that the nursing associates’ role was “flexible”, and that they can “be trained to give medicines”.

Professor Bayliss-Pratt said an “expert reference group” was convened “as part of our wider scrutiny work on the nursing associate role”.

“As a result, we came up with the guidance we published last week and it seems to have gone down relatively well with the system,” Professor Bayliss-Pratt said.

“We didn’t feel a need to pilot as we gathered the practice out there as part of creating the guidance,” she said.

She added that “more work will be required” around PGDs. “A really good example is immunisations in primary care. That is further work we will explore,” she said.

In response to concerns around the “generic” nature of the guidance, Professor Bayliss-Pratt said: “If people need more, there is nothing stopping us from developing more.”

“We have gathered feedback and we are more than happy to build in how can it be relevant to you if you work in a hospital or primary care,” she said.