• This article draws from the first national sample survey evidence and detailed case studies of both the long-standing grade of Nursing Auxiliary/Assistant and of the new grade of ‘Health Care Assistant/Support Worker’ in the NHS.
• It argues for a fundamental re-evaluation of the real competencies of non-registered caregivers, and of their potential to progress into registered nurse training.
• The study demonstrates their real maturity, experience, competencies, roles and responsibilities, along with the extent to which they perceive themselves as ‘substituting’ for registered nursing staff.
• It is shown that many have been blocked from entering registered nurse training due to domestic and financial constraints.
• The rise of NVQ accreditation has now provided both the potential for a formal recognition of their experiential learning and also the means by which they might progress into registered nurse training or even along parallel – and more practice-orientated – lines.
• It is argued that registered nurses should welcome a more fluid and progressive role for these team members, since, failing such a welcome, managers will otherwise continue to ‘undercut’ registered staff with their ‘cheaper’ non-registered caregiving colleagues.