The Nursing Associate role was introduced in 2017 when Health Education England launched a pilot study across the UK, involving 2,000 trainee Nursing Associates. This initiative was in response to “Raising the Bar – The Shape of Caring Review,” led by Lord Willis (Health Education England 2015), to develop the nursing workforce.
At the time of writing, Lord Willis identified that over 60% of healthcare assistants were delivering hands-on care to patients but had limited access to training and education. Did this lack of education and training therefore suggest that patient safety and wellbeing were being compromised? The simple answer was YES! There was a need to consider whether the education and training of care staff and registered nurses were fit for purpose. Between 2012 and 2014, as many of you will know, several high-profile reports (Willis 2012, Francis 2013) came to the same conclusion: care needed to be person-centred, compassionate, and well-informed. For this to be achieved, a new approach to educating and training for those working in the caring professions was necessary.
In this blog we will explore the nursing associate role and how it can benefit the primary care environment.
What is a Nursing Associate?
A Nursing Associate (NA) can be considered as registrant of the Nursing & Midwifery Council (NMC) once they have completed an NMC approved Nursing Associate programme. The Nursing Associate is a regulated member of the healthcare team who under supervision from a registered nurse provides hands on person-centred care and clinical support for people of all ages backgrounds, cultures and beliefs, across a diverse range of health and social care settings including; prisons, GP surgeries, hospices and care homes. A Nursing Associate must work under the supervision of a registered nurse to monitor and contribute to integrated care.
While some argue that the Nursing Associate role was introduced to compensate for the shortage of registered nurses, its primary goal has always been to bridge the skills gap between healthcare support workers and registered nurses. In light of this, Nursing Associates’ frequent interactions with patients, carers, and families enables them to make meaningful contributions to ongoing health and well-being. Through ongoing training, they become adept at empowering individuals to take control of their health needs and make informed decisions.
Scope of Practice of a Nursing Associate
The Nursing Associate is a regulated profession with a scope of practice wider than that of the healthcare support worker but what does “scope of practice” actually mean? The Health & Care Professions Council (2024) define it as ”the limit of your knowledge, skills and experience and is made up of the activities you carry out within your professional role”.
It is therefore important for Nursing Associates to fully understand their scope of practice but in addition it is vital that employers/managers also have a clear understanding of the NA scope of practice. The Standards of Proficiency for Nursing Associates (NMC 2018) provide clarity and set clear expectations of what a Nursing Associate MUST do or know in order to be capable of delivering safe and effective practice but also are clear on what knowledge and skills other health care professionals can expect from a Nursing Associate, managing professional expectations. NB these are minimum standards. Here are some examples of the responsibilities that the Nursing Associate may have within their scope of practice:
- Monitoring and recording vital signs (escalating when required)
- Assisting with the administration of medication (under supervision of a registered nurse)
- Supporting patients with the management of long term conditions including diabetes, chronic obstructive pulmonary disease (COPD) and heart disease.
- Providing personal care and promote health and well being.
- Wound care and dressings.
What Qualifications does a Nursing Associate have?
A Nursing Associate is educated to a Foundation Degree level, structured around an apprenticeship model, delivered by a Higher Education Institution (HEI). As part of the commitment to study, Nursing Associates combine their work with university-based modules and practice placements to gain the required number of theory and practice hours as stipulated by the NMC (2018) and the Apprenticeship Standards (IfATE 2024). The role is regulated by the Nursing and Midwifery Council (NMC) and those who complete their programme successfully join the Nursing Associate register.
What are the Benefits for having Nursing Associates in Primary Care?
In primary care, where the demand for skilled healthcare professionals is rising, the Nursing Associate role is invaluable and fits perfectly. Nursing Associates can take on routine tasks, delegated and supervised by registered nurses, provide health education and advice for patients, and significantly contribute to the effectiveness of the primary care team. This ultimately focuses on improving patient outcomes and reducing the strain on wider healthcare services such as acute hospitals and nursing homes.
Based of data from an independent evaluation of the Nursing Associate role (HEE 2019) a number of benefits were identified and include:
Improved service delivery and care:
- Nursing Associates can offer an increased number of patient interactions, enabling them to identify and escalate concerns quickly.
- They can assist the healthcare team in delivering a diverse range of skills and interventions.
Increased retention as organisations were able to “grow their own” workforce:
- The Nursing Associate role provides a career path for Band 1-4 staff, with the potential for them to become registered nurses.
- The apprenticeship model offers flexibility and the opportunity for staff to “earn while they learn,” reducing some of the financial strain that comes with traditional routes into higher education.
High-quality education and training:
- Nursing Associates receive excellent education and training and gain a wealth of knowledge and experience, which they can directly apply to their roles, emphasising the theory-practice link.
What are the Potential Challenges that Nursing Associates May Face?
The Nursing Associate role is relatively new and has required significant change for it to be fully embraced by individuals and organisations. As they navigate their roles across various healthcare settings, including primary care, Nursing Associates may face a number of challenges. Let’s explore some of these challenges in more detail:
1. Role Ambiguity
Many health professionals still have a limited understanding of the Nursing Associate role, with some still questioning its necessity altogether. Anecdotally comments such as “what does an Nursing Associate do? Aren’t they just a updated version of the Senior Enrolled Nurse?” can still be heard in practice, although there is evidence to suggest that times are changing!
2. Role Limitations
There are limitations in both the scope of practice and opportunities for continuing professional development for Nursing Associates. While they can continue to become a registered nurse by completing a “top up” registered nurse degree apprenticeship programme, those wishing to progress specifically within the Nursing Associate role face limited options, due to professional constraints outlined by the NMC in the standards of proficiency for Nursing Associates (NMC 2018) and scope of practice.
3. Supervision and Support
It is a mandatory requirement for a Nursing Associate to work under the supervision of a registered nurse, however this supervision may often be inconsistent due to the fast paced nature of primary care and staffing pressures. This inconsistency leaves Nursing Associates vulnerable to working outside their scope of practice which raises concerns around governance and risk. Similarly, the training and development needs can be significantly impacted by work pressures, staffing challenges and individual requirements. These factors all play a crucial role in how organisations can shape the ongoing planning and implementation of education, support and supervision.
Conclusion: Nursing Associates and Their Role in Primary Care
The Nursing Associate role is a potential game-changer for healthcare, offering a practical, cost-effective solution to the nursing shortage while improving patient care and providing new career opportunities. In primary care, where the demand for skilled professionals is rising, Nursing Associates offer much-needed support, ensuring that patients receive high-quality, holistic care. It is clear that the role is becoming more widely understood in primary care, albeit it slowly.
For those staff who are looking to start a career in nursing or for healthcare providers seeking to improve service delivery, investing in the Nursing Associate role is a forward-thinking strategy that aspires to enhance the healthcare workforce for the future.
Looking to Learn More About Training Opportunities For Your Team?
At Health Academy, we offer a variety of courses tailored for professionals in Primary Care, ranging from Health Care Assistants (HCAs) to Nursing Associates, Registered Nurses, and Pharmacists. Whether you need E-learning, Virtual or Face-to-Face training, Get in touch with us to explore how we can support your organisation’s training needs.
References
- Willis (2015) The Shape of caring review: https://www.hee.nhs.uk/our-work/shape-caring-review
- Francis (2013)The Francis report: https://www.gov.uk/government/publications/sir-robert-francis-freedom-to-speak-up-review
- NMC (2018) NA Standards of proficiency: https://www.nmc.org.uk/standards/standards-for-nursing-associates/standards-of-proficiency-for-nursing-associates/
- RCN (2016)Building capacity to care and capability to treat – a new team member for health and social care https://www.rcn.org.uk/-/media/royal-college-of-nursing/documents/publications/2016/february/005500.pdf
- Cavendish (2013) The cavendish review https://assets.publishing.service.gov.uk/media/5a7b9df6e5274a7202e18537/Cavendish_Review.pdf
- HCPC (2024) https://www.hcpc-uk.org/standards/meeting-our-standards/scope-of-practice/
