This week saw a milestone passed in nursing history, with the fifth anniversary of the introduction of nursing associates in England.
To quickly recap, nursing associates were introduced by Health Education England to ‘bridge a gap’ between healthcare assistants and registered nurses.
They joined a newly created register for nursing associates in January 2019, following a pilot programme of trainees that began in 2017.
It can be both a stand-alone role, sitting at band 4 in Agenda for Change, and can also provide another progression route into graduate-level nursing. That’s the idea anyway.
“When used correctly, nursing associates can provide valuable support for their registered nurse colleagues and their patients”
Five years on, there is certainly much to celebrate. It is clearly not an easy thing to create a new nursing role largely from scratch and build education, training and standards around it.
A lot of hard work has obviously gone on by those at HEE, the Nursing and Midwifery Council and the higher education institutions involved in their training.
And hats off most of all to the nursing associates themselves, some of whom I’ve had the pleasure to meet over the last few years. They are pioneering something new in the profession.
At this point, I’d like to give a shout out to all of the past winners of the Nursing Associate Trainee of the Year category at the Student Nursing Times Awards.
Pebbles Day, Valda Adams, Tarnia Lefevre, John Podmore and Lee Pockett were the winners in 2023, 2022, 2021, 2020 and 2019, respectively.
According to the Nursing and Midwifery Council, the number of nursing associates on the register has now passed 10,000.
Initially, I was unsure the numbers would continue to grow once the initial ‘bubble’ of healthcare assistants that wanted to progress to band 4 had moved through training. I was wrong.
The anniversary also seems to have fired a starting gun for other parts of the UK that had initially seemed content to maintain a watching brief on England and not introduce the role.
Last month, the Welsh Government confirmed its intention to introduce nursing associates to Wales and the Scottish Government has told Nursing Times it is exploring the idea too.
Given the nature of politics, this delay could be viewed through the lens of devolution as other parties in power not wanting to be seen to be aligning with the Conservatives in Westminster.
Equally, the last five years have provided senior nurses in Wales, Scotland and Northern Ireland the valuable opportunity to observe and learn from the introduction of the role in England.
However, while all the statements made about the anniversary were very positive, they all completely ignored the heated debate going on, both now and in the past, about the role.
A quick search of Nursing Times articles on the history of nursing associates reveals that the role was almost always described as controversial at the time of its creation.
The fear was and still is that nursing associates would be used to replace registered nurses, leading to a dilution of skill mix and a reduction in patient safety.
Given the ongoing nursing shortage, it was believed that trusts would be tempted to fill nurse vacancies with nursing associates simply because it was better than having no one at all.
A look at social media today suggests that these concerns were well-founded, with claims of substitution of nurse posts, roles or tasks with nursing associates commonly flagged.
An example might be where a nurse post has been advertised by an employer and nursing associates are also encouraged to apply for it.
This is not good for a number of reasons that I am sure are clear. A key one being that evidence shows having more registered nurses is linked to reduced patient mortality in hospitals.
Diluting the skill mix on a ward is also bad for the staff working there, as it puts more pressure on the reduced number of registered nurses and unfair responsibility on the nursing associate.
When used correctly, nursing associates can provide valuable support for their registered nurse colleagues and their patients. But trusts should resist the temptation to use them as substitutes.
I want to end by wishing a happy fifth birthday to the 10,000 nursing associates across England from Nursing Times. Your numbers may be relatively small but you are making a difference.