• Royal Wolverhampton Trust to reduce band five nurses and increase band four roles by similar level
  • RCN chief executive says “substitution” of nurses is a “big risk”
  • Move comes despite warnings from national nurse leaders and health secretary over substitution
  • Trust says it aims to enhance quality and “safety remains our priority”

The board of a hospital trust in the West Midlands has agreed to reduce the numbers of registered nurses on its wards to replace them with nursing associates.

Royal Wolverhampton Hospital Trust’s board agreed on Monday to change its nursing establishment after a report by the trust’s chief nurse. It is one of the clearest examples which have come to light so far of nursing associates being used instead of registered nursing staff.

The board approved a reduction in the number of full-time equivalent band five registered nurses by 23.58 to a total of 507.85.

At the same time, the number of band four care staff roles will be increased from 6 to 30.52 to reflect the addition of 24 nursing associate roles.

The decision appears to go against warnings from England’s most senior nurses and the health secretary, who have said they do not support nursing associates being used as substitutes for registered nurses.

The trust carries out a twice yearly adult inpatient skill mix review and in its latest report chief nurse Cheryl Etches told the board it needed an “adaptable contemporary workforce”. She described the nursing associate and assistant practitioner roles as “opportunities”.

In a statement to HSJ, Ms Etches said: “We are always looking at ways to modernise our workforce and respond to the changing world of the NHS. Following discussions within the organisation and taking professional opinions into account, which have been supported by the sisters and senior nursing team, we have decided to increase the number of band four positions to make way for the nursing associate and trainee nursing associate roles.

“By introducing these roles, we aim to enhance the quality of personalised care given to our patients however patient safety remains our priority.”

The trust refused to answer questions about the reduction in registered band five nursing posts directly. It did not explain how it would mitigate risks to safety, or comment on statements from others that the associate role was not designed to replace nurses.

During the development of the nursing associate role it was stated that it was not designed for substituting nurses. Lord Willis, who first proposed the role, previously told HSJ there needed to be a “clear understanding that this is a post to support the nursing workforce. It is not a replacement.”

Research published by the BMJ earlier this year found that for every 25 patients, substituting one nurse with a non-nurse increased mortality by 21 per cent on an average ward.

Janet Davies, chief executive of the Royal College of Nursing, criticised the trust’s decision. She said: “This is substitution. Our position is really clear that there may be a role for these staff but not as a substitute for nurses. The evidence is really clear about the risks to patients.

“This doesn’t make sense. They have got the skill mix the wrong way round and I think the trust is taking a big risk.”

She said the RCN was concerned at increasing numbers of trusts replacing registered nurse posts with nursing associates.