Nursing associates: the first trainees make their mark

With the pilot cohort due to register in early 2019, two nurse lecturers look at how they have been received

With the pilot cohort due to register in early 2019, two nurse lecturers look at how they have been received

Lecturer Helen Lord teaching trainee nurse associate Hannah Sheldon. Picture: John Houlihan

Changing demographics is one of several significant challenges to the provision of responsive, high quality nursing care in today’s health and social care climate.

Reported shortcomings in care provision have resulted in investigations across England, including the Francis report into care failings at Mid Staffordshire NHS Foundation Trust. A depleted registered nurse workforce has left a deficit in the knowledge and skills required to deliver high standards of care, and other independent reviews have highlighted a need for a radical overview of education and training across the healthcare workforce.  

The healthcare support worker role in particular has been scrutinised, with evidence suggesting that education and training has lacked consistency and regulation, resulting in poor quality care delivery. Healthcare support workers were being relied on to deliver care even though they lacked the relevant education and competency-based assessment.  

These findings provided a catalyst for a new role, and the provision of a work-based programme of education targeting existing and new band 2 staff members. The overarching aims were to improve standards of care while bridging the gap between the healthcare support worker and the registered nurse.  

Mixed reception

In January 2017, the first pilot cohort of 1,000 trainee nursing associates began a two-year foundation degree programme, with 1,000 ‘fast followers’ commencing soon after in April 2017.  

The nursing associate role was developed with the aim of providing hands-on patient care. The role was not intended to replace registered nurses, but to play a support role, allowing nurses to focus on more complex care needs and clinical duties.

Even so, and despite numerous government reports advocating a new nursing role, nursing associates were not welcomed by all initially. Comparisons were made with the state enrolled nurse and fears expressed about returning to a two-tier system in nursing, fragmenting care and blurring professional boundaries. Concerns were also raised that nursing associates would become ‘cheap labour’.  

However, it has been argued that the additional knowledge and skills that will be brought into practice settings can only enhance patient care and outcomes. The proposed regulation of nursing associates by the Nursing and Midwifery Council means they will be subject to legislation in the same way as nurses and midwives.  

National curriculum 

The national curriculum framework for nursing associates was developed by Health Education England (HEE), Skills for Health and Skills for Care. 

Trainee nursing associates work towards competencies across eight domains of practice covering primary, acute, community and social care settings. These domains and expectations for outcomes have been mandated through this nationally recognised framework, but local partnerships have been formed to develop more specific models for delivery.  

In the Greater Manchester partnership, the emphasis has been on the work-based learning programme linking theory to practice. Work-based learning is fast becoming the preferred approach to developing staff, particularly in healthcare.

The opportunity for students to observe and share knowledge and experience with others is fundamental, particularly in a nursing learning environment

Involving the person directly in the learning process, while allowing them to engage with team members, organisational processes and service users, promotes a culture of understanding in both the student and the wider team.  

The opportunity for students to observe and share knowledge and experience with others is fundamental, particularly in a nursing learning environment. But clear assessment of the competencies gained throughout this process is required to ensure quality standards are maintained.

A practice assessment document and personal development portfolio have been created to guide students to complete specific elements of practice. For the student to be deemed competent, these must be signed by a registered practitioner with a minimum of 12 months post-registration experience, the clinical educator and their personal tutor.  

Students are encouraged to consider their experiences from practice, and use approaches such as reflection, case studies, action learning and peer learning to develop professional values and problem-solving skills.

Making a difference 

Despite the challenges presented in implementing a new nursing role, positive outcomes are now emerging in terms of student experience, and practice and patient outcomes. HEE evaluations demonstrate the difference this role is making to care provision. 

The trainee nursing associates on the two-year pilot programme are being well received by service users and carers. Students’ practice assessment documents and wider trust teams are also providing positive feedback.  

Despite initial trepidation, it appears that the nursing associate role is being accepted by and welcomed into the nursing family. Work-based learning has been beneficial, not only for students but for wider multidisciplinary teams, as it is helping the nursing associate role to become embedded in the workforce. 

The professionalism and enthusiasm of the current trainees has motivated high numbers to apply for upcoming training programmes. Ultimately, this will support staff retention in healthcare organisations.

Furthermore, qualified nursing associates will have a career pathway to follow, with the potential for further training to become registered nurses.  

What it’s like to be a trainee nursing associate

Hannah Sheldon 

I began studying to become a nursing associate in January 2017 at the University of Bolton, where the lecturers are engaging, the teaching and assessment methods varied, and there is a wide range of support available for students.  

The lecturers are also passionate about expanding the nursing family. Lectures are informal, allowing us to discuss our thoughts and experiences from practice.  

This confirms the knowledge I am gaining and how it can be used in practice. The lectures also give me an opportunity to debrief from my week in placement. Sometimes there are bad days or upsetting events, and it is useful to be able to talk them through.  

‘Different methods of teaching are used, including lectures, group work, presentations and practical simulations, so the classes suit every learning style’ 

I have had many different assessments during my time at university, including a written essay, a verbal presentation, a written report and a practical examination. Different methods of teaching are used, including lectures, group work, presentations and practical simulations, so the classes suit every learning style.  

The university has provided a lot of support. There have been occasions where I have struggled to achieve a work-life balance, but staff and student services have offered helpful tips. They have provided me with support with assignments, time management and research. I was also lucky enough to participate in a six-week course on well-being for students, which included mindfulness and meditation.  

Overall, I have found the programme rewarding and satisfying, and feel that my time at university has helped me to excel in practice.  

Donna Kelly 

I was excited and scared at the start of the course. It felt daunting and my journey so far has had its ups and downs.

In the beginning, there were a couple of negative remarks from colleagues, but I did not feel the negativity was personal – more that other members of the multidisciplinary team did not understand this new role.  

I am so happy I stuck with the training. At university we learned about different reports, policy drivers and the history of nursing, and this understanding enabled me to explain to others how and why this new role came about.  

‘In the beginning, there were a couple of negative remarks from colleagues, but I did not feel it was personal – more that they did not understand this new role’ 

Now colleagues in practice have become positive about the role. They can see how it fits into the multidisciplinary team and how nursing associates can support patient-centred care. My mentors, and many other colleagues, are only too happy to pass on their knowledge and skills.   

On the wards I find myself in an excellent position to liaise with all my colleagues. As a nursing associate, I have a supporting role in providing holistic, bedside patient care, and collaboration with healthcare assistants will be vital to our success. Those I have met so far on placements have been fantastic; their positivity about the nursing associate role has made it easier to settle into placements. Many have told me they are keen on applying for the nursing associate course in the future. 

My self-confidence has improved greatly since starting the course. I have learned to be resilient and to be forward about volunteering. I want to be involved in the progression and success of this role and continually promote the course to colleagues. 

Yes, it is hard work, but the support I have received from my peers, colleagues, tutors, clinical educators, practice educators, university and the trust’s lead for the trainee nursing associate role is second to none.  

Helen Lord and Siobhan Doolan are lecturers in the school of health and human sciences at the University of Bolton  

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