A key challenge for the first wave of trainee nursing associates has been “limited understanding and acceptance” of the controversial new role among colleagues, an independent evaluation has found.
More positively, it found many of the first wave of trainee nursing associates see the programme as a “stepping stone” to becoming a registered nurse, as was originally intended when it was created.
“Some trainee nursing associates report encountering nurses who have felt threatened by the new role”
In early 2017, Health Education England commissioned an independent evaluation of the two-year test site programme for nursing associates, which began in January that year.
Two cohorts have so far been recruited across 35 sites, each of which comprises at least one employer and education provider, noted a newly-published interim report from the evaluation.
It was based on a survey of around 1,000 trainee associates and four “deep dives” conducted with the East Midlands Collaborative, Somerset Partnership Trust, North East London Partnership and Lancashire and South Cumbria test sites.
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It found high levels of enthusiasm and commitment among the first groups to embark on nursing associate training, as well as some evidence that the scheme was already helping to improve patient care.
But the report, by research organisation Traverse, also revealed room for improvement, especially when it came to managing the workload of trainee associates and ensuring they had enough time to learn and study.
“Placements are allowing trainee nursing associates to exchange skills and practice with colleagues”
Another key issue was the need to raise awareness of the role – designed to bridge the gap between healthcare assistants and registered nurses – warned the report – titled Evaluation of Introduction of Nursing Associates.
Some trainee nursing associates – mostly former healthcare assistants – said they were still seen as HCAs, while others reported colleagues feeling threatened by the nursing associate role.
The survey found 44% reported acceptance of the role among other professionals to be a challenge, while 43% said there were issues around awareness and understanding.
Meanwhile, 10% said they felt the role was a seen as a threat to other jobs, such as nursing.
However, the fact that there were around 8,000 applicants for 2,000 places in the first two cohorts showed there was “considerable interest” in the programme, concluded evaluators.
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More than seven out of 10 of trainee associates surveyed said they applied in order to progress their career and develop their skills and capabilities.
Many also said they were motivated by a desire to improve the quality of care for patients. Meanwhile, 45% of the trainees who completed the survey said supporting and freeing up other professionals, particularly nurses, was a key benefit of the role.
In-depth interviewees with trainees revealed the programme was seen by many “as a stepping stone to nursing and as an opportunity to go to university that might otherwise not be possible because of their personal circumstances”, said the report.
The four “deep dive” investigations included interviews with trainees, supervisors, practice educator, university leads and directors of nursing.
They found trainee nursing associates were “highly motivated and conscientious learners, keen to build on their experience of working in health and care settings”.
Their “wealth of experience” was noted by both universities and employers, stated the report.
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It shows that three to five months into programme two thirds – 66% – of trainee associates were satisfied with the progress they were making, overall. In contrast, 15% were not satisfied.
Three quarters described the programme as “challenging”, while 55% said it was “exciting” and 53% said it was “satisfying” or “rewarding”.
More than a third of respondents – 35% – said it was demanding or a lot of work, while around a fifth – 21% – said it was more work than they expected.
Key challenges including managing the high workload and having enough time to devote to different elements of the programme, said the report. Other difficulties included travel to and from placements and university.
Doing the training had an impact on the trainees’ income due to increased travel costs and the fact they were losing out on shifts that paid a higher hourly rate, said evaluators.
They highlighted the need for more time for academic learning and “sufficient protected learning time” to allow for learning on the job.
When it came to the early impact of the scheme, the report said there was clear evidence trainees were “moving away from a task-based role and towards a role that is more patient and outcomes-focused”.
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There was also evidence the trainees – half of whom had six or more years’ experience of working in health or social care under their belts – were influencing care standards in a positive way.
“Placements are allowing trainee nursing associates to exchange skills and practice with colleagues in different settings. This is reportedly leading to immediate improvements in the quality of care,” said the report.
For example, it found trainee associates from mental health backgrounds had given advice to colleagues, which helped them “understand and manage patients’ mental health needs more effectively”.
However, the report said a “lack of clear parameters for the role” meant trainee nursing associates were “not always sure about what they could and could not do”.
Meanwhile, the researchers found attitudes, awareness and support provided by wider colleagues varied across test sites.
“While many colleagues have been positive and supportive, some trainee nursing associates are still being viewed as HCAs, and some trainee nursing associates report encountering registered nurses and student nurses who have felt threatened by the new role,” said the report.
Other recommendations included the need to clarify the parameters for placements and support trainee associates by “promoting the role and its benefits widely amongst the workforce”.
This should include “robust two-way channels of communication to listen to, and engage with, registered nurses and other staff groups as the role is introduced”, said the report.
Professor Lisa Bayliss Pratt, chief nurse at Health Education England, said the evaluation findings would be used to shape the programme going forward.
“It was really important for us at HEE to ensure that we had a robust and reliable evidence base from which to address any emerging issues within the life of the programme,” she said.
Meanwhile, she said the first phase of evaluation was very promising. “I welcome these findings that show the main motivations for applicants were to make progress in their careers and improve the quality of care for patients and service users,” she said.
“The report also indicates the high level of trainees’ motivation to learn and develop, and includes examples of how the role is already benefiting patient care,” she added.
The Nursing and Midwifery Council recently became the official new regulator of nursing associates and is currently working on a set of standards for the role.
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Geraldine Walters, the NMC’s director of education and standards, said there were “many positives” in the evaluation report but acknowledged there was further work needed to hone the training.
“This report demonstrates the motivation of trainee nursing associates to learn and develop their skills and experience, and support registered nurses to perform their role more effectively so that together the two roles can provide the best care for patients,” she said.
“It’s also pleasing that many trainees value the programme because this has given them an opportunity to access higher education, which was previously not an option open to them, with many hoping to progress to becoming a graduate registered nurse in the future,” she said.
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Ms Walters said trainees had made it clear that protected learning time was important to their development.
“More needs to be done to raise awareness of the nursing associate role and to ensure that the workload of trainees is appropriately managed,” she said.
She added: “We’ll continue work closely with HEE and our other partners to ensure this role is properly understood and successfully implemented and we look forward to welcoming the first qualified nursing associates on to our register in January 2019.”