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Nursing Associates – a new member of the multi-disciplinary workforce – Jane Cummings

For all of us this is a time of great change with many challenges. Those challenges are significant as ongoing demand on our services continues to change in both volume and shape across health and social care.

We witness severe pressures throughout the system on a daily basis, with nursing, midwifery and care staff placed frequently at the front, middle and back end of those pressures. As Chief Nursing Officer for England I am privileged to personally witness examples across the country where colleagues in different roles and organisations continuously demonstrate inspiring skill, compassion and resilience in highly pressured circumstances.

It can often seem that things never stand still long enough without more change coming along; and with this in mind we must be flexible and think differently about how we work. It requires significant leadership by all to shape this new system. However, I would also say that this is where our opportunity lies and now is the time to re-assess what we do, without abandoning what we have already achieved.

One of those opportunities was announced this week by Health Education England, the pilot of a new role called the Nursing Associate. This role will be a key part of the multi-disciplinary workforce in helping to meet the needs of a changing population as set out within the Five Year Forward View.

I am sure that we all agree of the need to build an adaptable contemporary workforce to respond to the changing world as a profession, as other services and industries such as military and police colleagues have successfully done. Additionally as public sector organisations we have a duty to use our resources wisely while ensuring that careers remain attractive and accessible to all.

The Nursing Associate role is part of developing this contemporary workforce and will work under the direction of a fully qualified Registered Nurse (RN). The Nursing Associate is not a RN but will undertake some of the duties that a RN currently undertakes, enabling the RN to spend more time on the assessment and care associated with both complex needs and advances in treatments.

Therefore, the Nursing Associate will have the training and skills to bridge the gap between what Health Care Assistant colleagues routinely do and the practice that is undertaken by a RN. The role is designed to enhance the quality of personalised care, strengthening the support available to registered nursing staff and reducing the reliance and dependency on RNs to undertake elements of care that others can be trained to understand and do.

The Nursing Associate role has additional benefits. Firstly, it widens the access to careers in nursing and potentially for other health professions. Equally, for those who wish to remain as a Nursing Associate the recognised breadth of the training not only provides national recognition and meaningful career development but transferability of skills within different settings such as community and primary care, mental health or social care.

For employers and clinical leaders, this will also offer a much welcomed further option of how to safely align the right staff with the right skills to match patient need, dependency and the environment of care. By using appropriate tools and frameworks that support decisions about safe staffing, employers will have increased options about how to manage resources appropriately in accordance with clear, professional and evidenced based guidance.

Our ability as a profession to adapt and innovate is critical to achieving high-quality care in the right place and at the right time. By modernising, we can shape a workforce that is fit for purpose for the next decade and beyond and positively demonstrate good outcomes, experience and compassionate care for those who need our support. These are just some of the key elements in our new framework for nursing, midwifery and care staff, Leading Change, Adding Value.

I wish the first cohort of Nursing Associates all the very best and look forward to visiting some of the pilot sites myself to see how they develop and the value that these new roles can bring to the delivery of care.

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30 comments

  1. Emma says:

    Hi i have got on the nurse associate course and have 2 make a decision but i am worried that i am no academic enough to do this please could you give me some advise on what this would intale.
    Thank you.

  2. Melanie Tudor says:

    I am a lapsed enrolled nurse having taken 16yrs out. I did a back to nursing course in 2002 passed it but circumstances changed and i couldnt pursue it. 3 yrs lapsed.
    I work as a top band 3 HCA trained in many skills. Have been working within sexual health for 9 yrs almost full time and it has many roles.
    It seems my previous enrolled nurse qualification is ignored where I am and to be recognised to be considered band 4 id have to do this course its going backwards. I find it insulting as my boss just says your qualification has lapsed. I try to point out that yes its lapsed to be a registered nurse but the associate is basically a sen role the registered part comes after further training. If you did o levels 20yrs ago they count why does my nursing qualification not count. Think in 9yrs i have more than proved my worth, I feel my skills are wasted!!!

  3. Marie Thomas says:

    State Enroll Nurse,being recreated.Will this put and end to oversea recuritment a strain on the small budget and draining Countries from keeping their trained Staff.

  4. Amazing how we come round in full circles…I remember the state enrolled nurses, how it was decided that they were no longer needed, were forced to retrain as state registered nurses or leave altogether….now it seems we do need an interim role between the registered nurse and the HCA! I wonder how much money has been wasted over the years in this process!!!
    Saying all of that, I agree that something has to change and there is a need for another level of nursing. Perhaps this time during the selection process, we can choose professionally minded people who have a caring vocation not just somebody who wants a job as in general, my experience of some HCAs are that they are uncaring and unprofessional, being asked to do things way above their capability and training. The associate nurse will have to be regulated. They should also not be instead of fully registered nurses, but as an addition.

  5. Martha Amouzougan says:

    Dear Jane,
    Thank you for your email. I am interested in the Nursing Associates training and would like to register for this training.

    Many thanks

  6. Michael Mulgrew says:

    This new role of associate nurse sounds interesting, I understand the role requires studying for a foundation degree, what will it mean for current band 4’s (Associate Practitioners)? Like myself who has successfully completed a foundation degree and currently work within a clinical setting. Is it the same role under a different name or a new role all together?

  7. Dr. Ian Spencer says:

    This is an interesting re-invention of the Enrolled Nurse. Who will be the regulator of standards? With the SEN it was the General Nursing Council. Now a lot of duties (observations and hands-on nursing care) previously performed by registered nurses are performed by nursing assitants. As Brian Abel-Smith observed, the history of nursing is the history of state intervention. It’s hard to separate this from the piecemeal privatisation of the NHS and the ‘need’ to drive down nurses wages in order that private companies can be profitable. Another feature of it is, of course, that the nursing workforce is resolutely 90% female. A huge part of the British workforce is engaged in care work and wages will be forced down mostly for women. In the absence of an organised trade union movement the government now feels able to ‘take on’ the nursing profession – or rather, deprofessionalise it.

    • NHS England says:

      Thanks for your comment Dr Spencer. The Nursing Associate is a new role designed with the nursing profession following requests from the profession itself to develop a workforce to meet the changing needs of our population. Our expectation, subject to further work on assessing the patient safety impact of the role, is that the Nursing Associate will be regulated. The decision to regulate and the regulator is indeed a ministerial one and the lessons from the work to date and plans for the role will inform such a decision. It will also provide an alternative route to obtaining a graduate professional nursing qualification in future.
      Kind regards,
      NHS England

  8. Denise Carney says:

    I am interested to become a nursing associate. Do you have to be already working in the nhs to become a an associate?
    I have worked in a bank for almost 20 years and have just taken voluntary redundancy. I want to do something completely different and know I want to go into the health profession. When I have come across this new information on the new role, it really appeals to me. I have 4 Gcse’s and an A level. gcse’s in English language and Literature, Maths, Sociology and Psychology and my A level is in Psychology. Do my qualifications meet the entry requirements? I would really appreciate you getting back to me. I live in Liverpool.

  9. Nathan Trevena says:

    So will the nursing associate be listed on a register? surely is this not the role of the assistant practitioner under a different title. Would it not be more beneficial to train existing AP’s in this role and change the education system to reflect any new placements of staff in this role to that of an Nurse Associate instead of AP’s.

    As a student nurse this is also a concern, as it will mean another member of the care team that nurses are legally responsible for overseeing. Will this really be freeing up nurses or simply taking them away from their patients

    • NHS England says:

      Thanks for your comment Nathan. Our expectation, subject to further work on assessing the patient safety impact of the role, is that the Nursing Associate will be regulated and on a register. The Nursing Associate role is a new role being designed to meet the changing needs of people we care for. It is a role that is being designed with our workforce, who themselves have demonstrated and made explicit the need for this new role. Your question is one that we are being asked by several Assistant Practitioners and HEE will be developing a more detailed response for you. We do expect the Nursing Associate to be at the same level and the new pilot sites announced by HEE last month will test the role and any overlap. We see both Nursing Associate and the Assistant Practitioner having equal value but differing roles in health and care settings.
      Kind regards,
      NHS England

  10. Karen L says:

    Please can you define the role of the associate nurse and give a ward based scenario (busy medical ward) of how the 3 roles would work together.

  11. Kassander says:

    @
    Jo Gander says:
    17 October, 2016 at 7:14 pm
    —–
    Christine Leeming says:
    16 October, 2016 at 11:07 am
    —-
    Pauline Ford says:
    15 October, 2016 at 7:59 pm
    ​—-
    With respect to SENs​
    I did wonder 😉
    “plus ça change, plus c’est la même chose”

    Oh look, a wheel !

  12. Kassander says:

    All fluff and puff, and zero content of any substantive information:
    * course content;
    * entry qualifications;
    * assessment modes and criteria (exams; continuous assessment; ..);
    * integration of theoretical with practical;
    * status of final qualification (degree?)
    * possible career progression (in-service units to RN status?);
    * financial aspects;

    There is no reference to these essentials, either in the main text, or in any of the links.

    Has this scheme been thought thru’, or is it an emergency dressing to try to cover up a deep seated failing exacerbated by recent astonishing cuts in nursing education and training support?

    • NHS England says:

      Thanks for your comment Kassander. Earlier this year, Health Education England (HEE) undertook a consultation about the Nursing Associate role and followed this up with several workshops across the country to develop the role. These findings were reviewed and included in the latest proposals. The pilot sites will now work to see how the role will work in practice and the press release issued by HEE does give some further details. The pilot sites will now work to see how the role will work in practice utilising the national curriculum framework that has been developed to underpin the role.

      Kind regards
      NHS England

      • Kassander says:

        “Earlier this year, Health Education England (HEE) undertook a consultation about the Nursing Associate role and followed this up with several workshops across the country to develop the role”
        ==
        Who; What; When; Where.
        What patient input?
        BUT
        Basically you’re saying that you
        # DO NOT have the answers to my specific questions,
        # nor do you know where those answers are,
        # nor has the author of the original article bothered to let you know where the answers are hidden.
        No wonder you remain anonymous!

      • Kassander says:

        HSJ
        RCN chief: New role risks devaluing nursing
        8 NOVEMBER, 2016 BY SHAUN LINTERN

        “RCN chief executive Janet Davies criticises “lack of transparency” over development of nurse associate role
        She says proposals to allow nurse associates to administer controlled drugs is “ridiculous”
        Viewing nursing as a task based role would put patient safety at risk, she says”
        ———–
        Which is basically what most, if not all, of the people who have posted comments here have said.
        When is NHS-E going to start talking with, and listening to, P&P, and those with grassroots experience.
        NOT those from the VCS who purport to speak for us, but don’t & can’t.
        Ms Cummings is arguably allowing this to be messed up, just the same as she is with the re-launch of NHS-E’s CITIZEN, project.
        In those imortal words:
        Perhaps Ms Cummings should very seriously:
        ‘Consider her position.’

        Or if not, then the Board should.

  13. Rachel says:

    Sorry I’m confused, I thought after the Francis report criticism that nurses were no longer caring because they were detached from doing the general care of patients and building therapeutic. Relationships to assist quality and compassion. Why therefore are we returning to the idea that you don’t need a qualified nurse to do such tasks?! Obviously skill mix enhances patient care but the idea of a reliance on qualified nurses with the skills to care and lead services is a negative thing seems to be a dangerous path to follow and one that we will see a costly need to rectifying again in the future (it’s written in history books, and not too distant history). How can one idea contradict itself so obviously, by saying tools and frameworks can replace clinical decisions and clinical knowledge but also that the nursing profession needs innovators and leaders which only comes with high standards of education, not staff just trained to fit into frameworks.

    • NHS England says:

      Thanks for your comment Rachel. The Nursing Associate role will be a key part of a multi-disciplinary workforce needed to meet the needs of a changing population and set out in the FYFV. Discussions across England have demonstrated widespread support for the introduction of this new role for health and care.

      The Nursing Associate role is part of the developing contemporary workforce and will work under the direction of a fully qualified Registered Nurse (RN). The Nursing Associate is not a registered nurse, but will undertake some of the duties that an RN currently undertakes, and is expected to undertake to meet the challenges of the FYFV. This doesn’t mean that the RN won’t have an important role to play in building relationships and we are not saying that RNs having skills to care and lead services is a negative thing. The role of the Nursing Associate will enable the RN to spend more time on the assessment and care associated with both complex needs and the advances in treatments.

      When undertaking a review of skill mix, consideration should be given to the role of the Nursing Associate within the multi-disciplinary team.

      Kind Regards
      NHS England

  14. Jo Gander says:

    Would be interesting to understand how this role differs from the SEN role of the past ?

    • NHS England says:

      Hi Jo,

      Thank you for your comment.

      The Nursing Associate role is a new role being designed to meet the changing needs of people we care for. It is a role that is being designed with our workforce, who themselves have demonstrated and made explicit the need for this new role .The Nursing Associate role will be part of a wider team and will support all who work in the changing landscape of health and care to deliver sustainable services. The Nursing Associate is not a nurse (there are clear standards and competencies for the graduate registered nurse) but we expect the Nursing Associate to complete 50% of those competencies to become a Nursing Associate. The role is therefore designed for the future and is not a role of the past.

      Kind Regards
      NHS England

  15. Christine Leeming says:

    I am currently doing a foundation degree to become an Assistant Practitioner at band 4 where does this leave me? Will Nursing Associates be at the same level , or will Assistant Practitioners have to do further study to be equal?

    • NHS England says:

      Thank you Christine. This is a question that we are being asked by several Assistant Practitioners and HEE will be developing a more detailed response for you. We do expect the Nursing Associate to be at the same level and the new pilot sites announced by HEE last week will test the role and any overlap. We see both Nursing Associate and the Assistant Practitioner having equal value but differing roles in health and care settings

      Kind Regards
      NHS England

  16. Pauline Ford says:

    So, in effect we are bringing back the SEN. How many people have been lost to nursing in the meantime.
    So very very sad

    • NHS England says:

      Thanks for your comment Pauline. The Nursing Associate role is not the same as the SEN, will be part of a wider team and will support all who work in the changing landscape of health and care to deliver sustainable services. It will be a new role designed to meet the changing needs of people we care for. It is a role that is being designed with our workforce, who themselves have demonstrated and made explicit the need for this new role. The Nursing Associate role will be part of a wider team and will support all who work in the changing landscape of health and care to deliver sustainable services. The Nursing Associate is not a nurse (there are clear standards and competencies for the graduate registered nurse) but we expect the Nursing Associate to complete 50% of those competencies to become a Nursing Associate. The role is therefore designed for the future and is not a role of the past.

      Kind Regards
      NHS England

  17. Kassander says:

    “a RN”
    or
    “an RN”
    ?