Nurse Associates in ICU/Critical Care
What are people's thoughts on having RNAs in Critical Care?
Our department has recently employed several RNAs to join the workforce. I have concerns about this decision for several reasons, and to be clear I’m not criticising the RNAs themselves—rather, it’s a systemic issue. However, I do feel that this could potentially be dangerous and may lead to a dilution of the workforce’s overall expertise.
We’ve received an email outlining the tasks RNAs are expected to perform in Critical Care:
“level 1 & 2 patients- Can adjust oxygen if given prescribed sats by dr
Can change hi flow settings and BIPAP/CPAP settings including PEEP if given parameters by dr
Can look after pt with epidural but needs RN to check block obs
Once they have done IV training they can give IVs
RNAs can do almost everything for their patients without asking the RN first as long as there have been parameters set.
In other hospital RNAs are looking after level 3s and are doing IVs”
I am particularly uncomfortable with the idea of unqualified staff taking on tasks like adjusting PEEP, HiFlo settings, giving IVs at some point …. especially when caring for the most critically ill patients.
ICU is complex and most nurses working in this area undergo additional, specialised training. If I were critically unwell, I would not feel comfortable being cared for by an RNA, given the level of expertise required in such a high-acuity environment.
This situation mirrors the growing trend of Physician Associates being positioned as cheaper alternatives to doctors, and I’m concerned this is part of a wider issue in the NHS where cost-cutting measures are compromising the quality and safety of patient care.
Additionally, I worry that RNAs may be expected to perform tasks that exceed their scope of practice, yet their pay does not reflect the responsibilities they’re being asked to take on. This creates significant potential for error, which could have serious consequences.
It’d be interesting to hear others opinions on this.