UNISON’s head of health Christina McAnea responds to a recent HSJ comment piece in which June Girvin argued for removal of the bursary – and against the role of nursing associates

In an article this month for HSJ, June Girvin labels nursing associates ‘cuckoos’ who should have no place in the nursing nest. At the same time, she welcomes the government’s withdrawal of the student bursary as a way for nursing supply to finally “find its level”.

The nursing associate initiative is painted as a dangerous experiment, while removing the bursary is presented as the conclusion to the perennial problem of workforce planning.

It’s true that both are experiments. However, nursing associates are at least being piloted, with an independent evaluation, a national curriculum framework and the prospect of minimum competence standards set by the Nursing and Midwifery Council.

On the other hand, the removal of the student bursary really is a reckless experiment, a leap into the unknown

This has allowed UNISON and other unions to secure agreement for a consistent approach to job descriptions, pay banding and support for trainees. It gives us a chance to ensure the role develops with consistency and definition that roles like assistant practitioner have never had.

On the other hand, the removal of the student bursary really is a reckless experiment, a leap into the unknown. The prospect of over £50,000 of debt and increasingly uncompetitive pay for graduating nurses will prove a major deterrent for those thinking of nursing as a career.

A drop in applications of almost a quarter in September led UNISON to call on the Government to reconsider and conduct a proper consultation on the best way to fund healthcare students (followed by a proper pilot scheme for each option).

Glass ceiling

Ms Girvin objects to the concept of a “nursing family”. But modern high-quality healthcare already relies heavily on the team around the patient and nurses have always worked closely with other team members to deliver care.

Nursing support roles have been created ad hoc, with little standardisation in their design, training and education requirements or continued development. As a result, we have an overabundance of job titles, uncertainty around schemes of delegation, varying pay bands for the same types of work and a glass ceiling for many dedicated support staff.

As one respondent to a UNISON survey found: “There are no opportunities to develop beyond my current role, which is most disappointing. Just because I don’t necessarily want to become a nurse doesn’t mean I don’t want, or am not capable of, accepting more responsibility.”

Little wonder then, there has been such a substantial response at pilot sites to the opportunity to train as a nursing associate. Our feedback suggests the calibre of applicants has been high, and a large majority of the successful applicants are existing nursing or healthcare assistants with strong roots in their communities.

Already the experience of recruiting to nursing associate pilot programmes has forced a long overdue focus from employers and workforce bodies on the education and training needs of support workers who may follow after.

The big risk with nursing associate development is that they’ll be used as substitutes for nurses

The reality of removing the bursary is that many working in the NHS who would have applied to study nursing can’t afford to give up their job, and incur £50,000 of debt. For them, the work-based nursing associate training could be an attractive alternative, allowing them to qualify as a nursing associate and then do a further 18 months’ study to become a nurse, while continuing to be employed.

The big risk with nursing associate development is that they’ll be used as substitutes for nurses. Nursing shortages will only be exacerbated by Brexit, the worsening economic outlook and changes to student funding. Employers are bound to try to fill the gaps with nursing associates.

This must be resisted by calling for additional funding, safe staffing regulation, clear role boundaries and by ensuring good union organisation in the workplace.

But even before the nursing associate role existed, nursing shortages and funding cuts had led to support staff taking on more and more clinical duties and responsibilities with no standardised training or competency requirements.

Great struggles

UNISON will campaign, lobby and negotiate to ensure that the nursing associate role offers enhancement of the support workforce skills mix. We will work to make sure the tools this programme has put in place – national curriculum framework, defined scope of practice and pay banding, with professional registration to come – are built on and extended to the entire nursing support workforce from the entry level.

In a previous life, as head of education at UNISON, I dealt with the issue of developing the role of teaching assistants, a subject of great debate. Every profession has its struggles with the development of paraprofessional roles, it’s a sign of a profession’s maturity how well it deals with them.

Dedicated healthcare assistants who commit to two years of education to deliver better patient care should not be branded cuckoos. They should be properly nurtured, protected and empowered as part of the wider nursing care team.

We all need to fight against the loss of the bursary and for the future of nursing education. Birds of a feather should flock together.