Nursing associate (NA) roles have been part of nurse career pathways since 2016, and were introduced mainly due to recruitment challenges and workforce shortages.
Post Covid-19, healthcare is still in a state of flux, which has, to some extent, lent itself to the nursing workforce shortages. Despite an enthusiastic launch, NA roles are yet to realise their full potential in addressing national nursing shortages. In March 2022, 704,520 nurses were on the permanent Nursing and Midwifery Council register. Target NA recruitment figures are agreed by NHS trusts, with a clear line of sight on the timeline and how many are needed by each specialty, but the approach has not led to a significant increase in the number of apprentices or NAs.
“Working to the full scope of practice requires funding and mentoring”
NAs aid wider workforce planning and help registered nurses (RNs) assess a patient’s health and wellbeing, reducing RN workloads and enabling them to focus on areas that require their expertise. There is an appetite and support for the NA role, as long as those in post have the right skills, knowledge and experience to deliver safe, effective care; this improved skill mix composition can improve productivity and performance. NA roles are flourishing in emergency and inpatient areas, but their full contribution in integrated care systems (ICSs) is yet to be realised, especially in helping with the collection and collation of data on the local population’s health and wellbeing needs.
Investment in training in community roles and efforts to scale the practice so it becomes an integral part of workforce planning in ICSs needs urgent attention. It is also a necessity as part of the ‘grow your own workforce’ agenda, with a focus on filling new roles using internal staff development, training and upskilling as part of an attraction and retention strategy. The approach also helps to recruit people from local catchment areas into health and social care roles, and to promote available opportunities and nursing career pathways.
Healthcare assistants (HCAs) and NAs are eager to embrace RN roles after completing their training. To be able to work to the maximum scope of their practice requires funding and mentoring in equal measure. NA apprenticeship takes care of funding to some extent, but mentorship and training often proves challenging.
Due to time constraints and staffing pressures, RNs may not have the capacity for NAs’ or HCAs’ developmental needs, thereby hindering them from acquiring the full breadth of knowledge or skills. In the absence of the opportunity to build mentor–mentee relationships and rapport, the ability to practise confidently, work to role expectations, and commitment is also lost.
Rotational placements in, and across, the system provide rich exposure but do not necessarily lead to the full development of qualified NAs. Some specialties may not need an NA, while others (for example, mental health and learning disability) may have enhanced need due to a skills shortage, leading to high agency spend and a lack of care continuity and support for patients.
Advancing the role as a stepping stone to a nursing career and as part of workforce planning for the multidisciplinary team is a step in the right direction.
Operating in ICSs, collaborating with RNs, absorbing as much knowledge and experience by working across the system, and providing safe care to patients within the remit of the role will lead to success.
Shilpi Sahai is chartered member, Chartered Institute of Personnel and Development