References

Centre for Public Scrutiny. Independent review of governance for the Royal College of Nursing. 2020. https//tinyurl.com/3pjhvphf (accessed 10 April 2024)

Nursing and Midwifery Council. Standards of proficiency for nursing associates. 2018. https//tinyurl.com/hv958bej (accessed 10 April 2024)

Nursing and Midwifery Council. NMC responds to Welsh Government's intention to introduce nursing associate role. 2024. https//tinyurl.com/3yth9j2j (accessed 10 April 2024)

Royal College of Nursing. Royal College of Nursing sounds warning over Welsh Government introduction of nursing associates in Wales. 2024a. https//tinyurl.com/yxnd7ybr (accessed 10 April 2024)

Royal College of Nursing. What the RCN Does. 2024b. https//www.rcn.org.uk/About-us/What-the-RCN-does (accessed 10 April 2024)

RCN issues ‘warning’ over nursing associates

18 April 2024
Volume 33 · Issue 8

In a press release issued by the Royal College of Nursing (RCN) Welsh office in January 2024 (RCN, 2024a), the RCN Wales Director delivered a warning over the introduction of registered nursing associates (RNAs). This suggested there was a ‘real danger’ that, as a result of financial pressures, health boards in Wales will see the employment of RNAs as a potential alternative to the employment of registered nurses (RNs), creating a risk for patients. According to the RCN this is a radical change in patient care in Wales and it was disappointed there had been no public consultation or scrutiny by the Senedd, the devolved parliament for Wales. The RCN's press release said it will do everything to work with the Welsh Government ‘to minimise this risk to patient safety and enhance nursing care to provide the best possible outcomes to patients’.

The narrative here needs to be changed; RNAs are not a danger to patient safety. Low staffing levels, poor pay and an inability to recruit and retain nurses are the danger. The introduction of RNAs in England did not receive public consultation and the role is now embedded, with no evidence of any danger to patients. The protection provided to patient care by the Nurse Staffing Levels (Wales) Act 2016 should mitigate any substitution of RNAs for RNs. The RCN's concerns regarding the role of registrants must be explained further – if not for the more than 10 000 RNAs on the Nursing and Midwifery Council (NMC) register, then for the public in general. If the RCN has concerns about RNAs it must make the NMC aware of these.

In my view, the RCN should be mindful of the language it uses and the impact this could have on those RNAs who are providing outstanding safe and high-quality care and support to patients under the auspices of the NMC's (2018)Standards of Proficiency for Nursing Associates. The NMC (2024) welcomed the request from the Welsh Government to regulate RNAs in Wales. It highlighted that the role of the RNA has proved a successful pathway for nearly 1500 professionals who have gone on to become RNs, and that RNAs have made valuable contributions to safe, kind and effective care for people who use health and social care services.

The RCN, the world's largest professional body and trade union for nursing staff, represents around half a million nurses, student nurses, midwives and nursing support workers, playing a dual role as trade union and as professional body. The RCN is served by ‘dedicated, experienced and passionate people … committed to supporting and representing the wider membership’ (Centre for Public Scrutiny, 2020).

The RCN takes a subscription fee from a good number of RNAs. Is it really a ‘member-led organisation’ (RCN, 2024b) of which RNAs are a valued group? The inflammatory press release can do little to say to RNAs ‘we value you and we support you’. It came across as elitist and privileged, as if little thought had gone into the potential consequences of its publication. The RCN cannot hunt with the hounds and run with the hare, trying to be on both sides of an issue or trying to please everyone involved when there are clear interests that are conflicting.

Was there RCN membership consultation prior to the press release, given the negative impact this could generate? All members of the RCN should be disappointed in how the concerns have been (in)articulated.