Nursing Associate

Nursing Associate
NA

How new is this role? [1]

The Nursing Associate (NA) role was first suggested in the Willis report (2015) into the Mid-Staffordshire NHS Foundation Trust and announced by the government to be rolled out nationally the same year. Training began in December 2016.
Historically the UK like many other countries had second level nurses - Enrolled Nurses (ENs), until early 2000. Although the NA is not the same as the EN, the roles are similar.

Rationale [2,3]

Reasons for introducing the post include:

a) providing career development for Health Care Assistants (HCAs)

b) acting as a ‘stepping-stone’ to becoming a registered nurse (RN) and helping to fill RN vacancies, and

c) freeing up RN time to focus on clinical decision-making rather than essential care (i.e. moving RNs from working across the range of their licence to focusing at the top of their licence).

Training [4]

There is a 2-year training course integrating academic and work-based learning (foundation degree) provided by approved programmes in English Higher Education Institutions. Training is largely funded via an apprenticeship route. People can apply externally, and provider organisations now recruit directly to trainee NA posts. Placements within training programmes are compulsory and must be in a variety of settings, meaning that a trainee NA from a mental health (MH) Trust will have a general practice placement as well as an acute hospital placement.

Expected pay band [4]

Agenda for Change (AfC) band 3 in training; band 4 on qualification.

Is it registered/regulated and by whom? [4]

NAs have been registered with the Nursing and Midwifery Council (NMC) since 2017 and the role is required to adhere to NMC standards of proficiency. The role is regulated in England only.

What our research found*

Numbers reported in practice

Most Trusts reported employing NAs; 15 Trusts provided specific numbers.
The number of NAs employed was highly variable, ranging from 2 to 120.
Most Trusts reporting figures had between 1 and 20 NAs. A minority employed more than 50 NAs.
Several Trusts with fewer than 25 NAs had larger numbers of trainee NAs.

Insights from qualitative interviews and stakeholder reflection groups (i.e. what is reported to be happening in practice)

NAs were generally viewed positively.
The role was found in a range of MH settings: acute care, older adults services, community services, Crisis Resolution and Home Treatment Teams (CRHTs).
A common driver for implementing the role was staff shortages.

Reported drivers for/advantages of implementing the role included:

- - potential to relieve pressure on RNs
  - offering a career pathway (a ‘stepping stone’) from HCA to RN/RMN
  - acting as a way of ‘growing your own’ nurses
  - providing physical health support to patients on wards including assessment, monitoring and health promotion, which for some helped distinguish the role from RNs
  - potential to attract a more diverse workforce
  - bringing new skills to a team
  - providing useful support for isolated RNs.

Challenges to implementation included:

- - blurred boundaries between NAs and RNs and potentially between NAs and ACPs
  - difficulty retaining NAs in the organisation
  - NAs lacking training in mental health care
  - lack of organisational capacity for supervision and oversight of the role: “we don’t have enough RMNs (Registered Mental Health Nurses) to be able to provide the oversight, supervision and delegated authority that’s required in many areas” [Stakeholder Reflection Group Participant 2-F]
  - the potential absence of NAs in training for a large proportion of time in some Trusts due to “a high placement model with a lot of release time and no backfill funding” [Interview Participant O1]
  - difficulty ensuring NAs are working at the top of their licence and not drifting into support worker roles
  - a historical lack of workforce planning for the role, although some Trusts were now developing “skills and competencies for [NAs] to make sure that we [introduce them] in a safe way” [Interview Participant S1].

Factors facilitating implementation included:

- - introducing a support post to help teams/post-holders understand the role and where it fits within a given team
  - focusing the role on physical health care within mental health services
  - making support/buddying available for role holders
  - being clear on the role’s distinction from nurses
  - providing clear training and apprenticeship routes
  - visible examples of NAs working well, as success in one team was seen to potentially encourage uptake in others
  - ensuring enough places to employ apprentice NAs when qualified
  - availability of funding for backfill and for training the numbers of NAs needed.

* Research findings are based on 1) interviews with heads of HR or workforce leads in English MH Trusts and 2) stakeholder reflection groups with experts on new roles in MH services. The ways in which new roles were reported to be working in practice could differ within and/or between MH Trusts.

Sources [1-4]

Health Education England (2015) Raising the Bar. Shape of Caring: A Review of the Future Education and Training of Registered Nurses and Care Assistants. Raising the Bar. Shape of Caring
Health Education England (2020) New Roles in Mental Health Programme. New Roles in Mental Health Programme.
Coghill E (2018) An evaluation of how trainee nursing associates (TNAs) balance being a ‘worker’ and a ‘learner’ in clinical practice: an early experience study. Part 1/2. British Journal of Healthcare Assistants 12:6 An evaluation of how trainee nursing associates (TNAs) balance being a 'worker' and a 'learner’ in clinical practice
NHS careers guide https://www.healthcareers.nhs.uk/explore-roles/nursing/roles-nursing/nursing-associate