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Nursing associates' impact on healthcare


The structure and responsibilities of the nursing workforce is set to undergo a change with the introduction of the nursing associate role

Lisa Bayliss-Pratt

Lisa Bayliss Pratt

Professor Lisa Bayliss Pratt

When the news broke on the morning of 25 January that the NMC Council, after two hours of thorough and thoughtful discussions, had concluded that it would regulate the nursing associate role, I was truly delighted.

It is clear that this decision is in the best interest of patients and the right thing to do for our profession. The NMC council view is supported by many others who care passionately about patient safety and the future of the nursing workforce as evidenced by the response to the extensive engagement Health Education England carried out last year, with stakeholders from across health and social care. Our consultation showed that there was strong support for regulation and we have been clear from the outset that we are in favour of regulation.

In 2014, when Lord Willis of Knaresborough, chief executive of the Nursing and Midwifery Council Jackie Smith and I began our work to explore the future education and training needs of the nursing workforce, a key issue reiterated to us was the need for a ‘bridging role’ between the support worker and the graduate level registered nurse.

What it means for patients

Patients told us they want to feel confident in support workers who provide the majority of ‘hands-on’ care, to know that they have been trained to a recognised standard, and that they are accountable to a registered nurse. The decision to regulate the nursing associate will meet these important requirements.

What it means for support workers and assistant practitioners

Support workers tell us that they want to be trained for, and recognised as having, more responsibility. Further education and training and a recognised role with national standards will enhance their ability to provide person-centred care.

The introduction of the assistant practitioner (AP) role in some trusts has, without doubt, enabled staff to undertake more complex caring interventions.

But the role, as it stands, is not consistently replicable across England. This also makes accreditation of prior learning challenging for APs who wish to progress to graduate roles.

HEE recognises the value and potential of the AP role and strongly believes there is room for both roles; and also that a nationally-approved accreditation of prior learning framework will support APs who wish to become nursing associates.

What it means for graduate-level registered nurses

The greater degree of clarity about what the role can do will free registered nurses to take on greater leadership and advanced practice and care for patients with increasingly complex requirements, many of whom may have two or more comorbidities. A recent study, Mind the Gap, confirms why registered nurses leave and what we can do to help them stay (Narrowing the Gap).

By regulating the nursing associate’s role, this unfortunate scenario will be ameliorated.

Benefits for all…

The final key benefit is that the title nursing associate will be protected and will also provide a key public safety mechanism. We often hear about the plethora of nursing titles that confuse not only the public, but, on occasions, our nursing and wider workforce colleagues too!

Along with a protected title comes a professional register, code of conduct, national standards and expectations and revalidation. This has to be safer for patients, service users, carers, communities and our profession.

What next…

I am privileged to have played an instrumental role in the development of our new nursing family member - the nursing associate. However, this is just the beginning.

Although there is emerging evidence suggesting that patients are safer when cared for by graduate-level nurses, this is largely based on international care settings and concentrated in hospital environments. We still need to build further evidence on the benefits of upskilling the support workforce, and its impact on the safety and effectiveness of nursing practices in different care settings.

This is why I am setting up a Scrutiny Group, under the chairmanship of respected academic and educator professor David Sines. It will undertake a systematic and independent ‘stocktake’ of the professional challenges involved in the role; identify the key issues we may need to tackle; call for further evidence if needed; and provide assurance to the nursing profession and the public.

This work will also support the robust evaluation of the nursing associate test sites, which will begin in the coming weeks. With a sample size of 2,000 trainee nursing associates involving 61 education providers and 201 employers to date, the evidence created promises to be illuminating indeed.

Alongside the nursing associate role, another key piece of the jigsaw to support the development of the profession is the NMC review of pre-registration nurse standards, due to be published this spring. It will define the requirements of the registered nurse for the next decade and probably beyond, making clear the differences between the scope of practice of the registered nurse and the nursing associate.


The vision set out in the Shape of Caring review is that each one of us has the potential to raise the bar within a professional system, to enable us to progress from achieving the Care Certificate standard to nursing associate status, to graduate status and beyond.

The nursing profession is the driving force behind the delivery of high-quality, person- centred care and we must all ensure that this remains our priority.

Professor Lisa Bayliss Pratt is director of nursing at Health Education England


Readers' comments (3)

  • "Although there is emerging evidence suggesting that patients are safer when cared for by graduate-level nurses,"
    - Surely not a great surprise!!

    "this is largely based on international care settings and concentrated in hospital environments. We still need to build further evidence on the benefits of upskilling the support workforce, and its impact on the safety and effectiveness of nursing practices in different care settings."
    - Are you actually suggesting that there is doubt about the above?! That makes me incredulous.

    "This is why I am setting up a Scrutiny Group"
    - But surely this ought to have been set out before and properly investigated before creating and bringing into play a new role by force without the absolute assurance that delivery of direct care of patients by individuals with no training whatsoever isn't going to endanger those patients!

    It beggars belief, Florence Nightingale must be turning over in her grave, all the advances since her time are slowly being dismantled. What is the incentive for anyone at all to follow a nursing degree now? Where will all the necessary background knowledge and critical clinical judgement come from, you don't get on the job when you dealing with daily pressures?

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  • This background shows the importance of "Nurses’ regular, close proximity to patients and scientific understanding of care processes across the continuum of care give them a unique ability"
    - the key here is the scientific understanding!

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  • I am currently doing the foundation degree for assistant practitioners. It is extensive in underpinning knowledge gained on the job, and I feel disheartened when registered nurses think we don't know how to use our skills with patient's. I don't want to be a staff nurse because as an assistant practitioner I actually have more to do with patient care than the registered nurses.

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