Nursing associates in maternity settings
Nursing associates (NAs) are valued members of the healthcare team who have gained a foundation degree and are registered with the Nursing and Midwifery Council. They are not registered nurses but help bridge the gap between healthcare support workers and registered nurses.
We are aware that some providers have deployed nursing associates in maternity settings or are exploring doing so. We have therefore collaborated with key stakeholders to agree a position statement on this issue.
The position statement below outlines the challenges to deploying nursing associates in maternity settings, including issues that have been identified with profession-specific education and training, delegation of tasks, safety, accountability, and scope of practice.
The Royal College of Nursing (RCN) and the Royal College of Midwives (RCM) have also published separate statements that align with the position of this statement:
- RCN position on registered nurses and nursing associates working in maternity services across the UK
- RCM position statement – nurses in maternity
In summary it has been concluded that the safest and most sustainable way to support the maternity workforce is the current expansion of the midwifery workforce and the development of maternity support workers aligned to the maternity support worker competency, Education and career development framework rather than in the deployment of nursing associates
Nursing associates in maternity settings: position statement
Background
The registered nursing associate (NA) is a generic nursing role in England designed to bridge the gap between the healthcare support worker and registered nurse (RN) roles. NAs are NMC registrants and valued members of healthcare teams, delivering hands-on, person-centred care in a range of health and social care settings.
Nursing associates receive foundation degrees awarded by Nursing and Midwifery Council (NMC) approved providers, which typically involve 2 years of degree level study. They are registered with the NMC.
Midwives receive degrees awarded by NMC approved providers following a minimum of 3 years of study or 2 years of study if a registered adult nurse registration is already held by the individual.
Nursing associates in the workforce
Whilst it is important that trusts develop local flexible multidisciplinary team (MDT) models to deliver the best services for patients, implementing new workforce models is complex.
Where trusts, and specifically their midwifery teams, are considering employing NAs, they should be aware that the NA’s pre-registration education, and hence their initial scope of practice, is primarily orientated to nursing settings and therefore consider whether this aligns with the specific, complex care requirements of maternity settings.
Whilst the NMC Standards of proficiency for nursing associates are written to apply to all health and care settings, the pre-registration NA standards do not cover pregnancy and birth. So, although in common with other NMC professions, nursing associates can extend their knowledge and skills post-registration, there is a significant challenge presented in delegating midwifery specific tasks when the NA does not have education and training in delivering maternity care required as part of their core pre-registration programme.
The NMC Standards of proficiency for midwives state that at the point of registration, the midwife will be able to:
1.6 be accountable and autonomous as the lead professional for the midwifery care and support of women and newborn infants throughout the continuum of care.
11.1 only delegate tasks and duties that are within the other person’s scope of competence, making sure they fully understand your duties.
11.2 make sure that everyone you delegate tasks to is adequately supervised and supported so they can provide safe and compassionate care.
The accountability for delegation therefore sits with the midwife and this should be undertaken in line with NMC supportive information for the Code on delegation and accountability.
The role of the maternity support worker
The maternity support worker (MSW) role was introduced to provide support to midwives in maternity settings as part of the MDT approach. The MSW role therefore acts in a similar fashion to the NA, bridging the gap between healthcare support workers and the registered midwifery role as they are specifically trained in maternity settings. The only additional task that may be undertaken by a nursing associate that is outside of the scope of the MSW is drug administration. However, NA pre-registration education does not cover drug administration in maternity settings, therefore deploying nursing associates without consideration of the additional education and training required could place women and babies at risk.
In summary therefore, key stakeholders have concluded that the safest and most sustainable way to support the maternity workforce is the continued development of the midwifery workforce and maternity support worker roles aligned to the maternity support worker competency, Education and career development framework rather than in the deployment of nursing associates.
References
Nursing and Midwifery Council (2018) The Code Professional standards of practice and behaviour for nurses, midwives and nursing associates London: NMC
Nursing and Midwifery Council (2019) Standards of proficiency for midwives London: NMC
Nursing and Midwifery Council (2019) Delegation and accountability. Supplementary information to the NMC Code. London: NMC
Classification: Official
Publication reference: PRN00943