Are nursing associates a benefit to the learning disability sector?

Health Education England’s £2 million learning disability recruitment drive will include 150 places for the recently created role of nursing associate

• First cohort of qualified nursing associates started work earlier this year
• Role created to bridge the gap between healthcare assistants and nurses
• Nurse academic says learning disability services can benefit from nursing associates, given ‘levels of shortages in the sector’

The announcement that Health Education England (HEE) is to invest £2 million in the learning disability workforce was heralded as a major boost for the sector.

But as well as being aimed at increasing nurse numbers, the package is also targeted at recruiting 150 learning disability nursing associates in England.

• RELATED: £2m investment is set to boost learning disability nursing workforce

The associate role was created in 2017 to bridge the gap between healthcare assistants and nurses and to provide a new route into becoming a registered nurse.

To date the roles have not been targeted at a specific area with trainee nursing associates (TNAs) working across all four fields of practice – although plenty have been funded by learning disability providers as apprenticeships. 

But what impact is the nursing associate role having on the sector? Is it just an attempt to get learning disability nursing on the cheap? Learning Disability Practice spoke to a cross section of people on the front line to find out. 

The nurse consultant: ‘Roles we perform as qualified nurses have changed’ 

Nurse consultant Debra Moore says nursing associate is a valuable role.

‘We do have to acknowledge that nursing has changed in the past 20 years or so,’ she says.

‘The roles we have to perform as qualified nurses have changed and we have taken on roles that used to be medical roles. This has left a gap behind us.

‘We are asking them to do a lot of duties previously done by state-enrolled nurses. 

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‘It is welcome to create a career path for healthcare assistants who want to progress and for them to become fully registered nurses. Equally you may have healthcare support workers who would not be keen to go to that higher level, like to give more direct care and who recognise that if you qualify as a nurse you could find yourself in charge of a ward and opportunities for that may be limited.’

Ms Moore is chief nurse at Cheswold Park Hospital in Doncaster, a medium and low secure unit run by independent Riverside Healthcare, which started training nursing associates last year. Their training is being supported with degrees at the University of Sheffield.

Many TNAs are mature with degrees in subjects like psychology but could not afford to retrain as a nurse through the traditional route, particularly after the loss of the bursary in England.

The nursing associate: ‘It’s a fantastic opportunity’

Levi Kestle is in the second year of nursing associate training. She was taken on by Cygnet, a mental health and learning disabilities provider, as an apprentice after completing a level three diploma in health and social care training. 

She says: ‘It’s a fantastic opportunity. I had tried to get into university, but it is difficult and so expensive now.’

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She is working at the Sherwood Lodge facility in Nottinghamshire, a 26-bed high-dependency unit for men with learning disabilities.

‘I work closely with the registered nurse supporting the people here. The aim is to get them living independently so I help them with activities and developing skills, such as cooking and managing medication. It is rewarding work.’

Alongside her duties at Sherwood, she spends one day a week studying at the University of Wolverhampton. 

The nursing academic: ‘Learning disability services can see benefits of the role’

Trish Griffin knows all about the pressures facing the sector – she used to work as a learning disability nurse and is now helping to train the workforce of the future in her role as associate professor and professional lead for learning disability nursing at the faculty of health, social care and education, run jointly by Kingston University and St George’s, University of London.

The faculty runs one of the original training courses for nursing associates – and Ms Griffin says the response from learning disability services has been significant, even before this HEE announcement.

‘We are already seeing learning disability services showing more interest in sending staff onto the course through the apprenticeship route. This is mainly healthcare assistants and support workers,’ she says. 

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‘When they go back to their organisations they have a much richer range of skills, knowledge and approaches. They learn about things, such as carrying out physical health assessments and medication management and become much more aware of detecting when people deteriorate physically or emotionally. 

‘But it is also about their confidence – they are much more prepared to ask and to question. 

‘Perhaps more than any other area of nursing, learning disability services can see the benefits of the role, especially with the levels of nursing shortages in the sector.’

She says: ‘What I would like to see now is more interest from acute and primary care services to integrate the nursing associate roles as into, for example, liaison posts in areas such as outpatients, emergency departments and in GP practices.’

The nursing associate role, rules and regulation

• Only England has nursing associates. To qualify, students complete a two-year course with half their time spent on placements. This can be through the apprenticeship route whereby an employer sends staff or people can self-fund through the usual university application route.
• In the first two years the government created 7,000 training posts, with another 7,500 now being rolled out.
• The first qualified nursing associates started work in early 2019.
• The Nursing and Midwifery Council regulates nursing associates in broadly the same way that they regulate nurses and midwives. This means that nursing associates are individually accountable for their own professional conduct and practice, must meet the standards of proficiency to join and remain on the register, and are expected to uphold the code.

Training nursing associates: the Oxford experience

Last year Oxford Health NHS Foundation Trust began training 120 nursing associates in three cohorts across the organisation which caters for people with mental health needs and learning disabilities. It is believed to be one of the largest intakes of nursing associates in the country. The trust, based in Oxford but which serves about 750 people with learning disabilities across the county, has about 40 learning disability nurses working in different settings.

The trainee nursing associates (TNAs) undertake a two-year apprenticeship programme. They work four days a week in placements and one day a week on a foundation degree programme with Buckinghamshire New University. They enter as band threes but, once qualified, will be on band four. 

Chance to gain qualifications and become a registered nurse

Many already have experience of people with learning disabilities as support workers. Some already worked for the trust, but there are external applicants, many in their forties and fifties, attracted by the opportunity to gain qualifications and the chance to go on to become a registered nurse by taking a further 18-month apprenticeship once they have qualified as nursing associates.

‘For years I looked on the internet at learning disability nursing but thought I cannot afford to do that. This could be my chance to become a learning disability nurse’

Abbie Rix, trainee nursing associate

Learning development lead for nursing associates and learning disability nurse Jacqui Charrett says: ‘It’s an affordable way to get into nursing.’

Among the TNAs are Lorraine Bowler, Abbie Rix and Jacinta Mallin, who already have substantial experience as support workers and, once qualified, will work in learning disability services. A grandmother, Ms Bowler, has ambitions to become a registered nurse. She says. ‘It is the best thing I have done and I can’t wait to graduate and have all my family there. I will be 57 by the time I qualify but this is not going to stop me.’

Ms Rix moved from Swindon to train with the trust. She failed maths and science at school and thought her dream was unattainable. ‘I always wanted to become a nurse and have been a support worker for 12 years in learning disabilities,’ she says. ‘For years I looked on the internet at learning disability nursing, but thought I cannot afford to do that. This could be my chance to become a learning disability nurse.’

Looking forward to all the learning experiences

Ms Mallin, a support worker with 17 years’ experience, began training once her children reached 14 and 18.  She hopes to qualify in 2021. She says: ‘I am looking forward to all the experiences out there. If I can get through the first year that will give me the confidence to carry on.’

Learning disability lead community nurses Naomi Reeder and Aimee Skinner are positive about the role. ‘They are an asset,’ says Ms Reeder. ‘As nurses we are always so swamped with our caseloads, so it is good to have an extra person.’ 

‘It’s great news these places are being created, but colleges are not filling them. We need to do more to promote learning disabilities careers’

Simon Jones, learning disability nurse consultant

Ms Skinner adds that some of the learning TNAs undertake will be like that of a nursing student and they will be under the guidance of a staff nurse. ‘These are people who have a wealth of experience in learning disabilities,’ she says. ‘There is such a big learning component to their role. But we do not want to deskill them so they have a small caseload and lots of hands-on work.’

Jobs on offer at the trust for qualified nursing associates

Once qualified all TNAs will be offered jobs at the trust. It is hoped that this will go a long way to solving recruitment issues in an expensive city where some nurses commute to London to earn higher salaries.

Learning disability nurse consultant Simon Jones, who also chairs the RCN’s learning disability nursing forum, says the recruitment of nursing associates has had a huge impact.

‘In the past year we have seen our waiting list [in the community team for Oxford city] fall from 34 to 0. That’s not all down to nursing associates but they are a significant factor. They take away some of the tasks nurses do to allow them to work on more complex elements of care. 

‘Locally we use them to complete hospital passports, carry out weekly check ups and accompany people to primary care appointments.’

Concerns that the nursing associate role could be seen as 'watering down' nursing

Mr Jones acknowledges there are concerns the role could be perceived as ‘watering down’ nursing and believes the wider issue of learning disability nurse shortages needs to be addressed. But he says: ‘These roles are registered with the Nursing and Midwifery Council and they have to work within certain competencies. If we police that right, we should not worry.’

However, he also believes there needs to be work done to make the most of this new role.

‘It’s great news these places are being created, but colleges are not filling them,’ he says. ‘We need to do more to promote learning disabilities careers. 

‘That means going out to see school leavers and promoting it to older people.’ 

Associate clinical director Kirsten Prance says: ‘Nursing associates are not a replacement for nurses. There are important competencies that they work to and competencies are different to those of registered nurses. But this is a wonderful opportunity for career progression with the same level of clinical contact.’

Find out more

• Nursing and Midwifery Council (2018) Standards of Proficiency for Nursing Associates 
• RCN (2019) Become a Nursing Associate