Position statement

Background

The registered nursing associate is a generic nursing role in England designed to bridge the gap between the healthcare support worker and registered nurse roles.

Nursing associates are valued members of healthcare teams and deliver hands-on, person-centred care as part of multidisciplinary teams in a range of health and social care settings.

Nursing associates receive foundation degrees awarded by Nursing and Midwifery Council-approved providers, which typically involve 2 years of higher-level study. This enables registered nursing associates to perform more complex and significant tasks than healthcare assistants.

The role was introduced to help build the capacity of the nursing workforce and support the delivery of high-quality care, allowing nurses and other members of multidisciplinary teams to focus on more complex clinical duties.

This training does not have the same scope as that of registered nurses; but with additional training, the nursing associate role can provide a progression route into the registered nursing profession.

Use of nursing associates in maternity settings

The use of nursing associates in maternity settings has been explored by a number of organisations, and in summary:

The Nursing and Midwifery Council, Royal College of Midwives, and Royal College of Nursing are in agreement that it is not appropriate for this staff group to work in maternity settings.

They conclude that it risks undermining, and duplication of, the well-established role of the maternity support worker.

Moreover, the nursing associate role was not designed or intended to deliver maternity care; and as a result, nursing associates are neither trained nor prepared for working in maternity services, which presents serious concern in relation to the provision of safe care.

Delegation to nursing associates

Where trusts have employed nursing associates, registered midwives may be delegating to them.

However, the NMC code refers to safe delegation from registered nurses to registered nursing associates. Section 11 of the code which relates to delegation and accountability is clear that it does not refer to delegation from registered midwives to nursing associates.

The section also highlights the risk to registered midwives and nursing associates in the event of an incident or harm.

Registered midwives and nursing associates should therefore be aware that, if there is a risk of patient harm or actual harm, the employer or service provider will need to review the decisions and actions of both parties and establish whether the root cause of an incident was unsafe delegation and/or inappropriate acceptance of a task.

This may raise concerns about the practice of one or both parties.

Nursing associates in the workforce

• We understand that providers have been adopting innovative workforce solutions to support service delivery in maternity services.

• The Nursing and Midwifery Council Standards of proficiency for nursing associates were written to support care provision in nursing settings, not maternity settings, and the standards of that programme align with nurse education. As a result, there is no mention of the use of nursing associates in maternity settings.

• Similarly, while the Nursing and Midwifery Council has provided delegation and accountability guidance about the deployment of nursing associate’s in nursing environments they have not done so for maternity settings. As a result, student nursing associates do not gain experience in maternity settings as part of the nursing associate apprenticeship programme.

• Should a safety incident occur in a maternity setting, nursing associates’ actions would be assessed against the standards for nursing associates and those of midwifery. This poses a risk to the individual nursing associate and any midwifery registrant who has delegated to them, as it is the responsibility of those delegating tasks to ensure they are within the other person’s scope of competence.

• The Nursing and Midwifery Council describes additional skills, training and development that can be pursued after registration as a nursing associate; these only refer to skills within nursing, not midwifery.

• Of note: the law prevents accreditation for prior experiential learning (APEL) into midwifery programmes, except in the case of registered adult nurses. This means there is no shortened route for nursing associates to become registered midwives.

• The only additional tasks a nursing associate can do that a maternity support worker (who meets the national Maternity support worker competency, education and career framework at level 3) cannot do is administer drugs. However, nursing associate education does not cover administering drugs in maternity settings, and therefore this could place women and babies at risk.

• It may therefore be concluded that deploying nursing associates in an area of care for which their undergraduate education has not prepared them risks undermining safety.

Classification: Official
Publication reference: PRN00943