The nurse associate role carves out a niche for itself

Could the nursing associate role bridge the gap between registered nurses and healthcare assistants? 

Could the nursing associate role bridge the gap between registered nurses and healthcare assistants? 

In January, the first qualified nursing associates will be joining the healthcare workforce as practitioners registered with the Nursing and Midwifery Council (NMC).

Could the new cohort of nursing associates be the answer in fixing the nursing gap?
​​Picture: iStock

The Shape of Caring review published in 2015 and commissioned by Health Education England (HEE) and the NMC, identified the need to bridge the gap between degree-qualified registered nurses and healthcare assistants (HCAs). So the nursing associate role was conceived.

Across England there are currently 2,000 nursing associates in training. The original 11 pilot sites were quickly followed by others. These sites consist of partnerships across higher education institutions (HEIs) and clinical providers, in acute and community settings in NHS and independent sectors. 

Could prove vital

This collaboration leads to trainees having a broad experience of clinical areas, including primary care. With declining numbers of practice nurses and the forecast retirement of approximately 20% current nurses, nursing associates with primary care experience may be vital to address the challenge of meeting changing need in general practice settings.

Nursing associates are not a substitute for general practice nurses. However, they will have a wider range of skills than most experienced HCAs. And it should be noted that many of the trainees will have healthcare backgrounds before starting their course. The skills set by the NMC in draft proficiency standards for nursing associates include care for deteriorating patients, demonstration of critical thinking skills and application of information regarding health outcomes. 

Think points

  • Nursing associates can support registered nurses to practise to the best of their ability. 
  • This role can enable healthcare assistants’ career development.
  • The first cohort qualifies in January 2019.

Nursing associates’ clinical skills are gained in the ‘hub’ area where they are employed, and in additional ‘spoke’ experiences within the partnership group. A total of 675 hours of clinical experience will be achieved by the end of the two-year course.

Future opportunity

The programme is of interest as an apprenticeship model and will soon be offered to BSc nursing cohorts, with many HEIs developing this alternative entry route. With the abolition of the nursing student bursary, apprenticeships may enable those unwilling to acquire a student-loan debt to still join the nursing profession. There will be an opportunity in the future for nurse associates to undertake a two-year training programme to progress to the registered nurse qualification.

I was struck by a recent conversation with a trainee. She described her role as supporting the HCA team and enabling registered nurses to focus on the higher-level aspects of nursing care. Clearly, this trainee embraced her role and saw it as vital to the team. There are many others who have articulated similar feedback. In the hub areas there has been a year to develop how the role can work in specific areas, and teams are now valuing this new model of practitioner.

'Those undertaking the course have paved the way to develop an identity and community of practice of their own'

In clinical areas where we have trainee nursing associates and pre-registration nursing degree students, the trainees are facilitating student learning and learning together. The academic work of the trainees is level 4 in the first year, advancing to level 5 in the second, the equivalent of first-year nursing degree students. This is balanced with the higher level of clinical skills gained by the end of the first year.

Carving a niche nursing identity

The context of practice in hub areas will determine the extended and specific learning opportunities available. Wherever the training, there is an emphasis on developing reflective practitioners who are able to contribute to clinical decision-making and have leadership skills.

In conclusion, those undertaking the course have paved the way to develop an identity and community of practice of their own. The clinical area teams involved have reported the value of this first cohort. HEE has now confirmed that tenders are invited to support the next cohorts. This is good news for those individuals and teams who have already expressed an interest in the role. 

The nursing associate programme is here to stay. I am excited by the opportunities it brings into health and social care for all the nursing family.

NHS England: Nursing associate - A new support role for nursing

About the author

Pam Hodge is a lecturer in practice learning in health and education at Middlesex University, London. 

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