Item 15: APs - Who needs them?

Resolution submitted by the RCN Essex Branch

That this meeting of RCN Congress asks RCN Council to evaluate where, when, and why we need assistant practitioners

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Trevor Allen, Essex branch, proposed this resolution for the RCN to evaluate how Assistant Practitioners (APs) are used in practice and why we need them in the first place. He said there have been many changes to titles and training over the years and he would like definitive guidance on how unregistered colleagues work alongside nurses.

David Cardwell, Weston, seconded the resolution and said "The role presents development opportunities for health care support workers who work in varied and complex levels often at Band 4." He wanted the RCN to do anything it can do to help APs and HCAs in their continuing professional development.

Paul Phillips opposed the resolution and recounted his experience of "nursing snobbery" to unregistered colleagues. He urged the RCN to support accredited training and to push towards registration of APs and HCAs. He said that "The RCN should not decide the where, when and why of APs, this should be up to employers".

Maria Nicholson also opposed the resolution and called for career development for APs and HCAs, said "With higher grading you get higher quality care".

Both Alexander Bauser and Marva Duncan said that APs should not be used as "cheap labour" and as a way for employers to get this in through the "back door" to the detriment of nursing care.

Michael Travis wanted to let APs and HCAs know that he "Really values the work that they do as they are a valid part of the workforce" but they should not be compared to the previous enrolled nurse - as they are not registered.

Gary Roberts, a health care support worker opposed the resolution wanting instead for there to be training for colleagues to move up the pay scale - he said that "Not all support workers want to become nurses even though they have taken on many of the roles that nurses used to do".

Charles Gomedza from London was worried about increasing numbers of APs being used to take on the role of nurses, "The nursing workforce is unsustainable, if we bring in APs to replace registered nurses, what impact will this have on the quality of care?"

For 91 27.33%
Against 242 72.67%
Abstain 13

NOT PASSED

Background

Assistant practitioners (APs) sit at level 4 of the National Career Framework. Their role was originally envisaged in terms of supporting the patient pathway across care settings and professional boundaries, rather than as an assistant to health care professionals, but the role has been implemented in different ways by health care providers.

The exact number of APs currently in employment, both within and outside the NHS, is not known. However the North West Strategic Health Authority in England has had a policy of developing and educating APs within its health care trusts for a number of years, and London South Bank University now provides a range of education courses for AP roles. Predictions about future registered nurse workforce numbers suggest that current numbers cannot be sustained, even with recruitment and retention campaigns. There may also be an impact on the make up of the nursing workforce resulting from the economic downturn and pre-registration nurse education commissions. As a result, there may well be a greater reliance on APs in the future, and it is important to establish a clear career pathway so that APs can progress to becoming registered professionals. As part of its drive to address key workforce challenges for the 21st century, the Scottish Government is currently scoping the work profile, role and salary of APs.

The academic level for appointment to the AP post is a foundation degree or equivalent academic award. The Nursing and Midwifery Council has given assurances that this qualification will be recognised, and will count towards nurse registration if an individual decides to pursue a nursing career.

The RCN has clear policy positions about some aspects of the AP role. The RCN believes that APs and health care assistants (HCAs) and APs can make a significant contribution to nursing care and therefore - when they work with nursing teams to deliver care - are members of the nursing family. The RCN also believes such APs and HCAs should be professionally regulated by the body responsible for the regulation of nurses.

In October 2008, the RCN held a policy seminar to consider a broad range of policy issues and their implications for nursing practice that surround the AP role. The result is a policy discussion paper on the key issues for debate.