Matter for Discussion: Nursing associates

The Nursing Associate (NA) England only role was introduced in response to the Shape of Caring Review (Willis, 2015) to help build the capacity of the nursing workforce and the delivery of high-quality care. The role was announced by the Government in 2016 and developed by Health Education England (HEE), who oversaw an initial 35 test sites across England.

Across the other UK countries:

• Work is underway by NHS Education for Scotland to create a national framework to support Health Care Support Worker (HCSW) roles within the NHS. The RCN has raised with Scottish government and employers the need to ensure that HCSWs provide additionality to nursing teams.
• The CNO for Wales is currently reviewing the role and responsibilities of the country’s band 4 nursing support worker workforce. This review is due to be completed by the end of 2023.
• The NA role is not currently established or recognised in Northern Ireland.

The UK health service is under increasing pressures due to an aging population and workforce shortages (The Health Foundation et al., 2018). This role aims to bridge the gap between health care assistants (HCAs) and registered nurses (RNs) with an alternative route into nursing.

Trainee NAs gain a Foundation Degree over two years and, unlike Assistant Practitioners, are required to register with the Nursing and Midwifery Council (NMC) and adhere to the standards of proficiency for nursing associates (Nursing and Midwifery Council, 2018).

Historically, HCAs and similar support roles have lacked formal training and opportunities for career progression, and the introduction of NA training has offered HCAs in England structured career development (Willis, 2015). Since then, an apprenticeship model has also been introduced (House of Commons Health Committee, 2018). For some, NA training is seen as the only affordable route into nursing considering the lack of student nurse bursaries (Health Education England, 2019).

Other high-income countries deploy second level nurses, and the UK has a history with such roles like the state-enrolled nurse, which was phased out in the 1990s.

The introduction of NAs has led to variation in deployment and whilst NAs have the potential to greatly enhance patient care, they are only part of the solution to the current nursing shortage.

The projections in HEE’s Draft Workforce Strategy (NHS and Public Health England, 2017) suggest that ten years from now 17,000 NAs may have progressed to become registered nurses (House of Commons Health Committee, 2018).

Further research to improve occupational identity and role clarity for NAs will be required by policymakers. 

References

Health Education England (2019) Trainee nursing associate numbers continue to grow as thousands more train to become nursing associates, 6 February. Available at: https://www.hee.nhs.uk/news-blogs-events/news/trainee-nursing-associate-numbers-continue-grow-thousands-more-train-become-nursing-associates (Accessed 9 March 2023).

Nursing and Midwifery Council (2018) Standards of proficiency for nursing associates. Available at: https://www.nmc.org.uk/standards/standards-for-nursing-associates/standards-of-proficiency-for-nursing-associates/ (Accessed 9 March 2023).

House of Commons Health Committee (2018) The nursing workforce second report of session 2017–19, HC353. Available at: https://publications.parliament.uk/pa/cm201719/cmselect/cmhealth/353/353.pdf (Accessed 9 March 2023).

NHS and Public Health England (2017) Facing the facts, shaping the future: a draft health and workforce strategy for England to 2027. For consultation. Available at: https://www.hee.nhs.uk/our-work/workforce-strategy (Accessed 9 March 2023).

The Health Foundation, The King’s Fund and Nuffield Trust (2018) The health care workforce in England: make or break? Available at: https://www.kingsfund.org.uk/publications/health-care-workforce-england (Accessed 9 March 2023).

Warner M, Kessler I, Manthorpe J, and Stoye, G (2023) Patterns of employment amongst nursing associates: evidence from the electronic staff record. Available at: https://www.kcl.ac.uk/news/patterns-of-employment-amongst-nursing-associates-evidence-from-the-electronic-staff-record (Accessed 9 March 2023).

Willis, Lord (2015) Raising the bar shape of caring: a review of the future education and training of registered nurses and care assistants. Available at: https://www.hee.nhs.uk/sites/default/files/documents/2348-Shape-of-caring-review-FINAL.pdf (Accessed 9 March 2023).

Abbreviations

AP: Assistant Practitioner; HCA: Healthcare assistant; NA: Nursing Associate; NMC: Nursing and Midwifery Council; RN: Registered Nurse; SEN: State Enrolled Nurse; TNA: Trainee Nursing Associate; HEE: Health Education England.