Features

What it’s like training as a nursing associate

Recruits to the newest role in UK nursing reveal their experiences in a new study
Trainee nursing associates who were among the first to qualify for the role discussed their experiences of training and on the wards

Recruits to the newest role in UK nursing reveal their experiences in a new study

  • Greater responsibility and a potential route into a career as a registered nurse were factors that attracted many to the role
  • Nursing associates say their experiences during training gave them a new understanding of procedures they had previously undertaken
  • Despite initial scepticism across the profession, the role has expanded opportunities for the existing support workforce

The arrival of nursing associates marked a once-in-a-generation change to the UK nursing landscape.

The first cohort to complete training for nursings newest role joined the Nursing and Midwifery Council (NMC) register at the end of January 2019.

The role promised a number of benefits for individuals

...

Recruits to the newest role in UK nursing reveal their experiences in a new study

  • Greater responsibility and a potential route into a career as a registered nurse were factors that attracted many to the role
  • Nursing associates say their experiences during training gave them a new understanding of procedures they had previously undertaken
  • Despite initial scepticism across the profession, the role has expanded opportunities for the existing support workforce
Trainee nursing associates who were among the first to qualify for the role discussed their experiences of training and on the wards
Picture: John Houlihan

The arrival of nursing associates marked a once-in-a-generation change to the UK nursing landscape.

The first cohort to complete training for nursing’s newest role joined the Nursing and Midwifery Council (NMC) register at the end of January 2019.

The role promised a number of benefits for individuals and the NHS, including:

  • A way to engage with and develop the skills and motivation of workers in support roles.
  • A new route into registration as a nurse, particularly in the light of the loss of the NHS bursary for nursing students in England.
  • Support for the registered nursing workforce, in response to staff shortages caused in part by reduced funding for training and Brexit uncertainty.
  • More efficient division of nursing work.

We asked ‘why were trainees and trusts drawn to the nursing associate role?’

In January 2017, 1,000 trainee nursing associates (NAs) began their training at 11 pilot sites across England.

Since then thousands more have trained, and in March 2019, Health Education England (HEE) announced a further £42 million in funding for 7,500 trainee NAs by 2020.

But what has being a trainee NA meant to those who joined the pilots, when the role was still far from settled? And why did NHS trusts join these pilots when the impact on their own budgets was unclear and no job descriptions had yet been written for this new role?

To answer these questions we undertook a study in early 2017 looking at the introduction of the NA pilots across London, funded locally by HEE.

The first wave of the national pilot included four sites in London (St George’s University Hospitals NHS Foundation Trust, Whittington Health NHS Trust, Bart’s Health NHS Trust and Great Ormond Street Hospital for Children Foundation Trust), involving seven higher education institutions (HEIs), 18 employment partners and 17 placement partners.

Trainees were largely recruited from the existing support workforce, though some were new to healthcare. To evaluate how the London pilots were progressing, from April 2017 to January 2019 we attended seven pilot site steering group meetings and held:

  • Ten focus groups with trainee NAs, with a total of 90 participants.
  • Eight interviews with university leads at seven HEIs.
  • Four interviews with pilot site leads.
  • Five interviews with NHS trust leads.
  • Two focus groups with trainee NA supervisors; and from April 2017 to October 2018.
A trainee nursing associate during the programme. Trainees told the study the course gave them a new appreciation of tasks they had undertaken in previous roles
Trainee nursing associates told the study the course gave them a new appreciation of
procedures they had undertaken in previous healthcare roles Picture: John Houlihan

Reasons for joining the pilot schemes: trust and managers

For senior nurses in NHS trusts, involvement in the pilot presented four key opportunities:

  • To address nursing recruitment and retention issues in their own organisations.
  • To provide an opportunity to develop their support workforce.
  • To inform and shape the emerging NA role.
  • To increase their trust’s reputation, along with a potential accompanying investment.

Here's some examples of what our study participants told us:

‘I think this is a really great opportunity for the people of [our part of] London to get into nursing, and [it] has a different entry level to the traditional degree entry programme. From our perspective… we have been struggling to recruit registered nurses, and felt [as] we’re an area of high unemployment, that it would be potentially a way of assuring that we had a workforce that was able to deliver the care that’s needed, to the people of [this area], from people that live locally.’ (Deputy director of nursing)

‘…from a more personal point of view we are very keen to enhance the opportunities available for our support workforce.’
(Head of professional support and development)

Reasons for joining the pilot schemes: trainee NAs

We asked the trainees about their reasons for applying for this new training. They highlighted career progression, possibly as a route into nursing, the opportunity for professional and personal development while sustaining income and, crucially, recognition for their contribution to patient care in the workplace.

‘I love having more insight into what I’m doing; understanding what things are going on; the reasons for doing certain things the way we do them; and understanding patients’ journeys better’

Trainee NA

There was a sense from many trainees that the opportunity presented by NA training meant they were standing at a potentially life-changing crossroads. The speed at which many had to prepare applications after they learned of the scheme from managers often added to the sense of the significance of their decision —likewise the knowledge of being at the vanguard of a new nursing role.

The risks acknowledged by participants

But there were risks: for senior nurses it was the unknown possible cost for their trust in relation to supervision and time out for training, possible controversy at a time when there was scepticism in the profession about the new role and the challenge of arranging placements for trainee NAs who were both learners and rostered employees.

The future NAs also took a risk by embarking on training course for a role for which all the details, including their future employment status, were unknown. Some registered nurses, managers and even those who were to be their supervisors were uncertain about the role, as one study participant noted:

‘My boss has said I don’t know what I’m going to do with you, there is no such thing as a band 4 in our department.’ (Trainee NA, Year 1 focus group discussion)

Experiences of training: the first NAs and senior nurses

Many trainees told us that their training had enabled an ‘enlightenment’, in that they developed a new understanding of the meaning and significance of procedures that they had carried out many times:

‘I see this training as an opportunity to challenge myself. Before, I’m a supporting worker and I’m just carrying on doing my job without thinking of any responsibility. But now when I’m on the ward, I take responsibilities. I know that I have to check the vital signs – I did that before, I just checked the vital signs and put it on the system without looking at the abnormalities, or how this will affect my patients, but now I know better. Also, I’m looking for a way that this will help me to reach my potential as being a registered nurse.’ (Trainee NA, Year 1 focus group discussion)

‘I love the enlightenment I was able to receive: having more insight into what I’m doing; understanding what things are going on; how things operate; the reasons for doing certain things the way we do them; and understanding patients’ journeys better... it’s nice to know the theory behind things.’ (Trainee NA, Year 2 focus group discussion)

For employers and managers, there was initial concern about how to cover costs related to the nursing associate role, such as backfill for existing staff and supervisor costs
For employers, there was initial concern about how to cover costs related to the introduction
of the nursing associate role, such as supervisors to support trainees Picture: John Houlihan

A lack of awareness of the nursing associate role among the ward team appeared quite widespread in the early days, as some trainees noted:

‘What I’ve heard more than once… while I’ve been on placement, is ‘but you are here to work, anything you learn is just a bonus’. She [registered nurse] doesn’t acknowledge that fact that we are essentially students on placement.’ (Trainee NA, Year 1 focus group discussion)

Some implementation site leads realised the position trainee NAs were in:

‘I would argue that no one really still knows what a nursing associate is, but the actual knowing I think will happen when they are registered and truly are in practice.’ (Implementation site lead, Year 2).

Recognition as a student training for a new role

At a time, early in the pilot, when there appeared to be widespread lack of knowledge about the trainee NA role, the simple act of putting the trainees into a distinctive uniform made an immense difference to their experience, as some pointed out:

‘The surprise for me was the uniform, we had the white uniform as a student and everything changed, because I was a student. For example, when I came to this location, I was a healthcare assistant (HCA), with the HCA uniform. In the beginning I just had a badge that said student. So no one came to explain to me what’s going on, because I’m a HCA. But as soon as I had my uniform even the team came and explained what’s going on, the doctors even delegated some tasks to me and I felt like, “I’m the same person, you know, it’s just the different uniform!”. You feel more important. The uniform makes a big difference. I told my mentor and my manager, it’s different. The team is the same, but the approach has changed. As soon as I got the uniform it’s different, they explain things a bit more.
They look at you in a different role.’ (Trainee NA, Year 1 focus group discussion)

The trainee NAs spoke of their new-found confidence, how motivational they found the course and how peer support helped them through challenging times:

‘Having each other, having that knowledge that I’m not the only one who struggled on another assignment and to be able to talk about it. It’s so important. I think, without each other, we wouldn’t be here now?’ (Trainee NA, Year 2 focus group discussion)

The responsibility and privilege of registration

The trainees were excited and a little daunted by the prospect of being registered and having a PIN on completion of the programme:

‘I think that’s a huge thing and a huge step forward because that is going to give us our own responsibility. Even as HCAs you have a certain amount of responsibility, but ultimately that lays on the nurse you’re working with. And the fact that we’re going to have that responsibility you are looking at care from a whole different angle now because you know that responsibility is yours, you’re taking ownership of that.’ (Trainee NA, Year 1 focus group discussion)

A trainee nursing associate during the training programme
Some recruits described the training as a
life-changing opportunity Picture: John Houlihan

Ultimately, the trainees were appreciative of the array of experiences they had encountered on the programme:

‘I give kudos to everyone, especially those that have put us forward – I’m so grateful to them, and we are being paid and we’re working and I’m really very proud and happy.’ (Trainee NA, Year 2 focus group discussion)

‘Whatever they say, you know this is a good thing, because this is a way to encourage everybody, not just an opportunity for us, but for [a] better environment for everyone as an organisation.’ (Trainee NA, Year 1 focus group discussion)

‘Not only has it empowered, it has given us hope and a future to move ahead in life.’ (Trainee NA, Year 2 focus group discussion)

A life-changing opportunity

Amid the controversy and uncertainty about the introduction and impact of this new role on nursing work, individual trainees experienced the training as a life-changing opportunity.

Senior nurses and other implementation leads who took on the pressures of the first wave pilots witnessed a personal and professional growth in a section of their workforce as they harnessed previously unused potential.


Michael Traynor is professor of nursing policy at Middlesex University

Wendy Knibb is an independent consultant

Want to read more?

Subscribe for unlimited access

Enjoy 1 month's access for £1 and get:

  • Full access to nursing standard.com and the Nursing Standard app
  • Monthly digital edition
  • RCNi Portfolio and interactive CPD quizzes
  • RCNi Learning with 200+ evidence-based modules
  • 10 articles a month from any other RCNi journal

This article is not available as part of an institutional subscription. Why is this?

Jobs