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Nursing associates and assistant practitioners: let’s end the needless rivalry

These nurse support roles are similar but different, and deserve equal respect

These nurse support roles are similar but different, and deserve equal respect


There can be hostility between the two occupational groups. Picture: iStock

In the red corner we have the nursing associates. In the blue corner… the assistant practitioners.

Will the nursing associates have what it takes to knock the assistant practitioners out? Or will the assistant practitioners hold their ground? 

I’m joking, of course, as both roles are valuable assets to the healthcare team and should not be in competition with each other. But not everybody sees it this way.

Tensions in the workplace as assistant practitioners feel undermined

The introduction of the nursing associate role has caused tension in the workplace, with some assistant practitioners feeling their role is being undermined.

The assistant practitioners were first out of the gate. As a band 4 role, this was an exciting prospect for healthcare assistants, care support workers and nursing assistants. The competencies were specialised to their place of work and they gained a level 5 foundation degree at the end of two years’ training.  

The nursing associate role is also band 4, and an exciting prospect for healthcare assistants, care support workers and nursing assistants. The competencies are more generic, and you gain – yes, you've guessed it – a level 5 foundation degree at the end of two years of training.

Get the picture?

My career has given me a dual perspective

I started as an assistant practitioner in 2013. I sweated over the assignments and worked hard to get my competencies completed on time. I took the science exam, attended university one day a week, loved my role in the catheter labs and made some great friends.

‘Assistant practitioners are highly skilled and should not be underestimated. But I have heard rumblings that some feel their role is no longer valued’

Then in 2014, I was diagnosed with ovarian cancer. I tried hard to stay on the course and complete everything, even while going through chemotherapy, but it all became too much and I had to withdraw, which broke my heart. 

Now here I am, six years later, one year into the nursing associate degree. I am sweating over the assignments, working hard to get my competencies in on time and attending university one day a week. My job on the hyperacute stroke ward is fantastic, and I have made good friends along the way. 


All roles in nursing are necessary and complementary and a strong team ethic is essential.
Picture: iStock

Here’s where the roles differ

The nursing associate and assistant practitioner roles offer career progression for support workers and are designed to bridge the gap between healthcare assistants and nurses. Although similar, they should not be confused with each other.

‘This is not a competition – both roles are equally important and there is no reason for us to be on different teams’

Nursing associates have to complete 670 placement hours, while no placement hours are required for the assistant practitioner role. After completing a medication module and achieving competency in this area, nursing associates can administer some medications. Although assistant practitioners can also administer some medications, this varies across the UK and not all areas and employers allow this.  

And while the assistant practitioner role is unregistered and unregulated, nursing associates are registered and regulated by the Nursing and Midwifery Council. They also have a progression route into graduate-level nursing.

Hostility between the two groups

Assistant practitioners are highly skilled and should not be underestimated. But I have heard rumblings from assistant practitioners who are ticked off about the introduction of nursing associates, with some feeling their role is no longer valued.

I have had to deal with outright hostility from some, while some assistant practitioners have experienced similar hostility from nursing associate trainees.

The biggest grumble is that the courses are almost identical, so why can’t assistant practitioners do the same as nursing associates?

Essentially, it is because they don’t have the placement hours or the medication module, but that is not the fault of anyone in either role. Both have a place in healthcare.

I understand assistant practitioners’ frustration

Having been in both roles, I understand the frustration of the assistant practitioners. But I also understand the position of the nursing associates, who are just trying to do their job.

The bottom line is that this is not a competition. Both roles are equally important and there is no reason for us to be on different teams. With short-staffing and increasingly heavy workloads, NHS staff are under enough pressure as it is.

The last thing we need right now is a them-and-us approach. So can we please get out of our respective corners, be kinder to each other and all start working together?


Su Hickman is a nursing associate trainee at the John Radcliffe Hospital in Oxford

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