The care-givers team continues to evolve and diverge and, although nurses are a central part, it is undeniably strengthened by assistant practitioners, healthcare assistants and now – a new addition: Nursing Associates (NAs). From 28th January 2019, the first cohort have been able to join the register and will become a familiar face in a variety of healthcare settings.
Nursing Associates - The Basics
The role is designed to bridge the gap between healthcare assistants and registered nurses and qualifying as a NA means completing a 2-year foundation degree. The programme includes a diverse range of practical clinical experiences and at the end of 2 years, the NA should have attained these 6 Standards of Proficiency:
- Be an accountable professional
- Promoting health and preventing ill health
- Provide and monitor care
- Working in teams
- Improving safety
- Contributing to integrated care
Because this is a more advanced role than that of healthcare assistants, it was decided that NA practice should be regulated, and so they have their own part on the register and have the same revalidation requirements as registered nurses.
Distinguishing between the roles
One of the main concerns that Health Education England has found is the uncertainty regarding the NA role : in other words, who does what?
The differences between registered nurses and nursing associates are mainly seen in Standards 3, 4 and 6 . Whereas NAs provide and monitor care, registered nurses are responsible not only for this but also for assessing, planning and evaluating care.
With standards 4 and 6, registered nurses work in teams too, but also lead and manage the teams and co-ordinate the integrated care.
So what are the Issues?
One of the early criticisms  came from this apparent division of labour, reminding us that nursing is not a series of tasks but rather holistic and integrated care. Helping someone to get dressed is not a menial task to be delegated, but rather a valuable opportunity for the assessment of skin integrity or evaluation of pain medication and is crucial in building the relationship between care-giver and patient. It raises the question of whether a RN can really assess or evaluate care needs when someone else is actually delivering the hands-on care.
The CQC is also concerned that RNs may be substituted by NAs, given the current shortages in RN numbers . However, the advice is clear: service providers need to understand what the role of NAs is and that they have a responsibility to deploy staff appropriately. According to the Health and Social Care Act (Regulation 18), service providers must ensure there are: “sufficient numbers of suitably qualified, competent, skilled and experienced staff to … meet people’s care and treatment needs” .
The good news
These are the challenges to be aware of but there are many positives to the role too. First and foremost, the 2-year course is aligned with the registered nurse programme, which means NAs can choose to continue their education at a later stage and achieve registered nurse status. This alternative route to RN qualification gives flexibility that can only boost future recruitment numbers and may benefit those who are not so confident in their academic ability or have family circumstances that limit their access to the RN programme .
Above all though, people find that any changes which improve “fundamental care, contact time and general communication with patients and their carers”  are what really matters, so congratulations to our new colleagues. Welcome to the nursing establishment.
If you are thinking about a career as a Nursing Associate, you can find some useful pointers here.
If you are a service provider, you may find the information here to be of use.
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