The nursing associate role is a new role in the NHS, bridging the gap between a healthcare support worker and a graduate registered nurse. Nursing associates are qualified at foundation-degree level and work with individuals of all ages / backgrounds, across a range of health and social care settings.

Nursing associates work alongside registered nurses, carrying out much of the same clinical duties and care, but they do not share the same status and therefore cannot perform certain tasks

The nursing associate role was introduced in 2015, in response to the Shape of Caring Review from Health Education England. This document stipulated that healthcare assistants and nurses require high-quality education and training, if they are to provide the highest standard of patient care, and identified three key problems within primary care:

• A lack of training / development opportunities for HCAs, despite their supporting the bulk of over 60% of care work
• An aging population with increasingly complex needs which demanded nurses delegate tasks more, so that they are able to focus on these complex issues
• A shortage of nurses in the NHS and social care

Including nursing associates in your MDT will help address these issues and convey the following benefits:

• Improved service delivery and patient care
• Improved staff retention
• A ‘grow your own’ nurse workforce
• A tried-and-tested nursing programme, accredited by the NMC
• Nursing associates, once qualified, can go on to registered nurse status
• Providing supervision and preceptorships can improve recruitment and retention rates

Sources

HEE’s Why hire a nursing associate?

HEE’s Nursing Associates page

The Standards for Proficiency for nursing associates, as set out by the NMC, outlines six standards:

• Be an accountable professional
• Promote health and prevent ill health
• Provide and monitor care
• Work in a team
• Improve safety and quality of care
• Contribute to integrated care

Two annexes emphasise that nursing associates should be able to communicate effectively and sensitively, and to manage relationships with people, too.

For more information, please read the Standards themselves, by clicking the button below.

Nursing associates work with people of all ages, in a variety of settings in health and social care; contribute to the core work of nursing; and free up registered nurses to focus on more complex clinical care.

Duties / areas nursing associates cannot perform:

• Act autonomously to change the prescribed plan of care
• Act autonomously in situations where there may be limits to confidentiality – for example, in safeguarding situations
• Decide to make specialist referrals
• Decide to share information across multiagency boundaries
• Interpret and resolve risk issues (they must be able to identify risk and halt practice if necessary)
• Decide to discharge an individual from a service
• Manage situations of conflict or risk beyond immediate actions to maintain safety
• Administer medicines under a patient group directive
• Prescribe medicines

In addition to complying with the NMC’s Standards for Proficiency, registered nursing associates must have completed a foundation-level qualification approved by the NMC over the course of two years. This usually involves 2,300 hours of training and studying, split between academic and vocation-based learning.

A condition of the programme is that nursing associates must gain experience of all nursing areas: mental health, learning disability, adult, and children, to ensure they have the breadth and depth of knowledge and experience needed to support and enhance the quality of care. This is achieved by trainees taking on placements outside of their usual employment setting.

As an employer, you can fund your nursing associate programme through the apprenticeship levy scheme. This is paid by all employers who have an annual bill of £3 million or more, which they can claim as funding for a max of 15,000 per employee.

Nursing associates are commonly taken on by employers via the apprenticeship route, but there are a number of self-funded university-level courses.

You can find out more about how you can employ nursing associates through the apprenticeship route below.

• NAs and the apprenticeship levy: A quick guide for employers
• Apprenticeships Procurement Toolkit: Guidance for Employers
• Using the apprenticeship levy
• Your Future Nursing Associates infographic

There are a number of case studies available from HEE, with many NHS Trusts across England – including Devon, Birmingham, Pennine, and Mersey – having employed nursing associates.

You can access these studies below. Please do note, though, that many of them pertain to settings other than primary and social care.

Employers with a payroll of more than £3 million can use their apprenticeship levy contributions to pay for places on apprenticeship programmes. Any business with a payroll below £3 million is eligible for government funding that will cover at least 95% of the cost of an apprenticeship course.

As an employer, you must be able to meet any costs exceeding the 15,000 per employee allowance, and this includes clinical supervision. For more information, please click the button below.

A nursing associate should have:

• A foundation-level qualification accredited by the Nursing and Midwifery Council, completed over two years
• This must include 2,300 hours of on-the-job training and academic study, with varied clinical placements
• This is principally achieved through an apprenticeship or self-funded university route

Additionally, trainee nursing associates must:

• Be employed within healthcare, for 30 hours+ per week
• Have the support of their employers
• Confirm eligibility for apprenticeship funding *
• Have evidence of study at level 3 (e.g., A Levels, BTEC Health & Social Care, or evidence of ability to study at or above this level)
• Level 2 / GCSEs in Maths and English, at C+
• Have an Enhanced DBS Adult and Child Workforce, dated within the last 12 months
• Have occupational health clearance from their employer

* Please note: entry requirements will vary between universities

At present, HEE have not issued any job description for the nursing associate role. However, it is clear that this will likely cover and include experience, skills, and attributes described in previous sections as core to the nursing associate role.

Once qualified, a nursing associate will be able to undertake skills including, but not limited to, compression bandaging, drug administration, cervical cytology and childhood immunisations.

At present, there are no guidelines on job interview questions. But HEE shall be releasing some guidance on the job description details for nursing associates in the near future.

Trainee nursing associates are assigned a practice supervisor, a practice assessor, and an academic assessor. Practice supervisors can be any registered health and social care professional, though it is typically a registered nurse, in the case of nursing associates. Practice assessors cannot simultaneously be the supervisor for a student.

Supervision is outlined by the NMC’s employer guidance as follows:

• Sharing, demonstrating, and providing support
• Confidence building
• Encouraging and developing reflective practice
• Developing appropriate skills and competence
• Supporting learning
• Providing any required guidance, signposting, and information
• Helping the trainee nursing associate to make progress

Additionally, whilst in your employ, trainee nursing associates should have:

• A thorough induction into work
• Preceptorship * and mentoring (especially if newly-qualified)
• Ongoing access to professional development

For more information on supervision standards, supervision codes of conduct, and the * principles of preceptorship, please look below.

• Standards for student supervision and assessment
• Practice supervisor preparation
• Principles of preceptorship

The curriculum framework states that supervision can be provided by an appropriate manager or any registered health professional (e.g., a registered nurse (across any of the professions)) working in practice that has been prepared to take up the role and is up-to-date on the knowledge and experience relevant to the student.

Supervision can be provided directly / face-to-face or indirectly / virtually.

You can:

• Assign supervisors for each trainee nursing associate on placement
• Manage both poor performance and recognise good performance — and, legally, you are responsible if a nursing associate carries out duties beyond their defined capacities and this results in errors or harm
• Conduct annual appraisals, to review the progress and performance of nursing associates in your practice
• Take all steps to improve management of the employee’s fitness to practice

You can read more about the support you should provide and your responsibilities by clicking the button below.

To download HEE’s easy-read guide on nursing associates, click here.

[This video was published on 25/10/19]

[This video was published on 08/01/20]