Regulation and recognition

Lindsay Cardwell says it’s time for assistant practitioners to be regulated

Many column inches in the nursing press have recently been dedicated to the new nursing associate (NA) role in England. It’s good to see more band 4 support workers being recruited to our health care teams and the ground-breaking news that they will now be regulated by the Nursing and Midwifery Council (NMC) is really welcome.

However, skilled and essential band 4 nursing staff have been around for years and many support workers, including assistant practitioners (APs), are already working safely at this level. 

I’m very proud to be an AP and I worked extremely hard to get my degree to allow me to practise at this level. We’re an essential part of the health care team. We take on more responsibilities than level 2 and 3 health care assistants, under the delegation of registered practitioners in a range of settings.

The importance of regulation

The RCN has always been clear that the NA role mustn’t be a substitute for registered nurses, but we must also consider the impact their introduction may have on other support roles. I believe that the NMC’s decision to regulate them is an opportunity to campaign for regulation for APs and other health care support roles too.

Regulating, clarifying and standardising support roles will benefit patients and staff in the long run. I’ve achieved the standard that’s needed to safely care for my patients in my AP foundation degree but regulation will give me recognition and acknowledgment that I’m accountable and that I take responsibility if I make a mistake.

At the moment if an unregulated practitioner makes a serious error in their practice they may be dismissed. Worryingly though, they could potentially start a new job without having addressed the error and could potentially begin a new job caring for patients. 

Where’s the patient protection here? I believe that patients will feel more confident in our care when they know that there are standards that all support roles have to be educated to and maintained to protect registration.

Regulating, clarifying and standardising support roles will benefit patients and staff in the long run

Staff would also be better protected from employers who may ask support workers to do more than they should, because the regulator would set standards for proficiency for what individuals in a role could do. 

Patients would be better protected and practitioners would be acting to a standardised role and level of practice. I’m concerned that everything is employer-led at present.

Recognition is important for individuals too. APs could potentially be competing with NAs for jobs in the future with the only difference between our roles being that one is regulated and the other isn’t. Good employers could see regulation as an extra benefit. This makes me feel that despite being equally suitable for a job I might miss out.

Getting our role regulated may not be easy of course; there are many issues to consider, including the cost implications for practitioners. 

Get vocal

I’ve made my career choice and I’m extremely proud of my AP qualification. But whatever our job title, regulation status or banding level, we’re are all one big team, working together for the benefit of our patients. 

NAs will be great, but so are APs and those in other support roles. We must all be valued so we need to make people understand the importance of what we all do. It’s time for support workers to have their say on this important issue.Tell your representative on the RCN Health Practitioner Committee what you think so we can speak out on your behalf.

The RCN position

Stephanie Aiken, RCN Deputy Director of Nursing says: "The RCN has a clear view that all health care support workers (HCSWs) should be regulated in the interests of public protection and patient safety."

The RCN's current position is that HCSWs who deliver direct clinical care alongside registered nurses in the nursing body should be regulated by the Nursing and Midwifery Council.

Stephanie adds: "However we acknowledge the complexities that surround the implementation of HCSW regulation and the need to explore whether the current way we regulate the nursing workforce is the most effective way to manage risks around public protection."

Lindsay answers questions about her AP role

Lindsay Cardwell

Why did you decide to become an AP?

I fell into nursing when I was really young. I didn’t want to be a registered nurse (RN) but becoming an AP was a natural next step for me as I wanted to develop my skills. I trained in 2012 – it was a new role for my trust – but I’d been a HCA for 18 years before that.

What’s your background?

I worked for two years on the orthopaedics ward before moving to endoscopy as a senior technician. I was in this role for 16 years and was supported to complete NVQ level 3 in health and my foundation degree in health and social care practice.

I cared for patients before, during and after the procedure. I also admitted and discharged patients and had responsibility for enema administration and cannulation. 

I really enjoyed teaching staff and supporting them to get the knowledge and confidence they needed; “handing up” equipment to consultants during endoscopic procedures and teaching all elements of endoscopic decontamination. I only left when I wanted to get back to more hands-on nursing care.

What does a typical day involve?

I usually start at 8.30am. I see patients with type 2 diabetes who require insulin, suppositories and bowel care or an early morning TWOC (trial without catheter). But my role varies. I could be taking blood, checking international normalised rate (INR) levels, changing catheters, dressing wounds, applying compression, or administering injections or pain medication.

No two days are the same

I undertake full assessments, welfare visits and make referrals to other services. I could be asked to see a patient with a blocked or bypassing catheter, undertake urgent skin inspections for pressure damage or wound and dressing reassessments. No two days are the same and this keeps me on my toes!

Do you work independently?

Yes, within a framework of delegated responsibility. In some situations tasks may be delegated on a named patient basis but would always fall within the level of my skill, experience and the scope of my training and competency. As an AP working alone with a delegated workload I need to have the confidence and knowledge to be able to recognise, raise concerns and take immediate action with patients who are unwell. I might request a GP, community matron or emergency services to attend.

How do you build a relationship with your patients?

I see patients regularly which means I can build strong relationships, based on trust and respect. You can find out so much by asking questions and investigating their medical backgrounds and lifestyles.

If you’re not registered with the NMC are you still accountable?

Absolutely. I’m accountable and responsible for my practice to my patients, my employer and in law.

Do you have ongoing training?

Yes. As an AP I attend the same sessions as RNs in my workplace on subjects like bladder and bowel care, pressure ulcers, leg ulcers, wound management, catheters and sepsis. I also attend medicine management training specifically designed for APs. We must have signed off competencies before we can practice independently and it’s essential to maintain competences and keep up-to-date with best evidence-based practice and training.

It’s essential to maintain competences and keep up-to-date with best evidence-based practice

Are you currently undertaking any education or training programmes?

 I’ve just completed my degree in health and social care management. I joined the third year as a top-up flexible student so I could continue to work full time. It was hard work but I enjoyed it.

Further information 

Lindsay Cardwell works in a busy district nursing team with North Somerset Community Partnership and she’s been an AP for six years. Lindsay also represents members from the South West Region on the RCN Health Practitioners Committee.

Get in touch with your RCN Health Practitioner Committee representative.

Find out more about the AP role and watch Anita Prince talking about her AP role in a short film

Interview by Sharon Palfrey

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