The Shape of Caring Review (Willis, 2015) identified a need to bridge the gap between healthcare assistants and registered nurses. The pilot launched in January 2017 with test sites across England. The Nursing and Midwifery Council (NMC) register has over 1000 registered nursing associates (NAs) as of June 2019 (NMC, 2019).
I have followed the trainees as a clinical educator in practice and later a lecturer at the University of Derby. In fact, the reason I moved to higher education was because of the excitement and buzz around what was known locally as the ‘legacy’ cohort; legacy referring to the first registered NAs to become NMC registrants.
One of the more concerning aspects of the development of the new role, though, is the perception of NAs by members of the nursing community. NAs have been compared to enrolled nurses on an anecdotal level; however, this comparison is simply not accurate. The NA programme achieves a foundation degree on completion that can be utilised as a springboard into further learning, enhancing future development opportunities. NAs are certainly not ‘cheap nurses’.
Thankfully, a recent visit to the Royal College of Nursing (RCN) Congress, dispelled some of the negativity around the role. I visited with three NA students who found positive allies in Andrea Sutcliffe CBE (Chief Executive and Registrar, NMC), Professor Anne-Marie Rafferty (President, Royal College of Nursing) and Professor Ian Peate OBE (Editor-in-Chief, BJN); esteemed company who understand the social context of the NA role. However, work to change entrenched views must continue to attain wider acceptance across the UK.
As a lecturer, I am often asked why the students do not simply step onto a degree nursing programme and here is the crux of the problem. Many NAs are experienced practitioners but life events have meant that access to higher education (HE) has been difficult for a variety of reasons. Common themes are family commitments, cost, traumatic life events or poor experiences in school settings that have inhibited access to HE. The NA route through an apprenticeship removes some of these barriers.
NA education from the outset under the Health Education England (2017) curriculum framework has included the four fields of nursing; mental health, learning disabilities, adult nursing and children's nursing. This is a positive step towards interprofessional education that ensures registrants are well-rounded practitioners who meet the needs of the population they serve. This is vital as staffing levels in nursing are described as ‘critical’ and currently total 41 000 across the UK (Buchan et al, 2019).
Would you value the opportunity to work with another registrant? If the answer is yes, then the NA role is something that you should consider in your practice area. The NMC (2018)Standards of proficiency for nursing associates highlighted the range of skills that an NA can bring to a clinical environment. They are not going to take the jobs of registered nurses; they are in practice to improve the quality of patient care and are passionate in the pursuit of improved outcomes for all.
Longitudinal research of the impact in practice of NAs isn't yet available, however, the current Government is committed to the future of the role. The NHS Long Term Plan (NHS England and NHS Improvement, 2018) suggests that 7500 NAs will commence in HE in 2019 joining the 5000 that started in 2018. The majority of the 7500 students will access HE through funding from the apprenticeship levy.
The University of Derby has already appointed an associate lecturer from the first group of registered NAs. Therefore, I would like to think that as an inclusive, forward-thinking profession, nursing will welcome the role and recognise the significant contribution that NAs will make to care provision for patients across a range of health settings, NAs will more than ‘bridge the gap’.