CQC warning over use of nursing associates

In a briefing from the watchdog to coincide with the first cohort of 2,000 nursing associates being able to join the Nursing and Midwifery Council register, the CQC said it would demand assurance from providers that they were applying a “systematic approach” when deploying nursing associates.

There have been concerns that the development of nursing associates during a time of acute registered nurse shortages would lead to registered nurse roles being substituted with NAs.

Several NHS trusts have reduced their registered nurse establishments after planning to introduce the NA role. Research has demonstrated a link between increases in mortality and the use of non-registered care staff, while other studies have repeatedly identified an association between registered nurse staffing levels and improved patient mortality and outcomes.

In its briefing, the CQC said: “As nursing associates are not registered nurses, providers need to understand the role and how to deploy them appropriately in a way that is safe and supports delivery of high-quality care.”

It added: “As registered professionals, they are individually accountable for their own professional conduct and practice. However, it is important to understand that nursing associates are not registered nurses and we expect health and care providers to consider this when deploying them. As with the introduction of any other new role, we are not prescriptive about how you deploy nursing associates, but we need assurance that using them is safe and supports you to deliver high-quality care.”

The regulator said trusts should use evidence-based decision tools to determine staffing levels and would need to demonstrate how they had set their staffing levels.

“We expect you to clearly articulate how you have counted nursing associates into the staffing establishment and to carry out regular staffing reviews after deployment, ensuring that nurse-sensitive quality indicators are taken into account to improve quality and safety for people who use services,” the CQC said. “We also expect you to develop local guidelines to ensure that existing staff understand the rationale for deploying nursing associates, the benefits of the role, and the process for escalating any concerns.”

It also told trusts to ensure they had processes in place to audit the impact on quality and safety of using nursing associates.

The CQC said it would review the provider information returns to specifically consider the use of nursing associates in workforce deployment and that during inspections trusts will be expected to provide evidence. It warned it would take action for any breach of regulations where nursing associates were asked to work beyond their competency or without necessary supervision.