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'Today we celebrate nursing associates joining the register'

Lisa Bayliss-Pratt
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Today, the Nursing and Midwifery Council opens its register to nursing associates (NAs). 

What a significant moment, not only for our newly-qualified NAs, but also for colleagues across the health and care system; and our education partners, who saw the need for such a role, and supported Health Education England’s (HEE) vision of how it could fit into the nursing team, and who worked so hard to make it a reality. 

It seems hard to believe that it was only two years ago, January 2017, when a cohort of 1,000 trainees took their first steps into this pioneering role – part of a two-year pilot programme across England.

Another 1,000 recruits swiftly followed in April 2017, when HEE expanded the programme in response to widespread interest and enthusiasm for the role. We had four applicants for every place. 

The idea for a role that would bridge the gap between care assistant/support worker and a graduate-level registered nurse came about through HEE’s national review of nurse education, Shape of Caring, which began in 2014. 

During the review and follow-up consultation, we heard time and again – from employers, nurses and patients – of the need for a bridging role, which would also offer the unregulated workforce a progression route into graduate level nursing.

It would also be a means of recognising the value of healthcare assistants and support workers, building on their experience and skills and improving recruitment and retention.

“Trainees from very early on demonstrated how the role supports – not replaces – their registered nurse colleagues”

In the coming year, we will see almost 2,000 NAs from the test phase joining the workforce as newly-qualified professionals. But this doesn’t mean that it was always a smooth ride for them or the system around them.

When a new role or change is introduced, it inevitably generates some fear or anxiety, and our pilot programme was no exception. The NA role was always intended to help build the capacity of the nursing workforce and free up senior nursing staff to focus on more complex care and planning. 

We know that there was concern from different quarters at the start of the programme that the NA would be seen, or used, as a substitute for the registered nurse. And we know from the independent evaluation’s interim report that, although in the main NAs in the test sites were warmly welcomed, in some instances our pioneers experienced hostility to their role, or confusion and limited understanding about their purpose. 

But trainees from very early on demonstrated how the role supports – not replaces – their registered nurse colleagues. On visits to the test sites, we saw for ourselves the enthusiasm, commitment and patient-centred approaches of the trainees and had similar reports from staff, managers and educators.

Supporting the introduction of this new addition to the nursing family, there have been important milestones along the way. The curriculum framework HEE produced, the decision for the NMC to regulate the role, the robust proficiency standards and the requirement for revalidation. They all provide assurance to patients, the public and the health and care system that NAs can and do provide safe, patient-centred care in a variety of settings. 

These benefits were also confirmed by the independent evaluation, which found that trainee NAs were indeed helping to improve care, moving away from a task-based role and towards one that is more patient and outcomes-focused. 

“The successful completion of the test phase and the increase year on year of trainee numbers are testament to the partnership working”

A further expected 5,000 NAs entered training in 2018 and we’re looking forward to the recruitment of another 7,500 in the next year. It is clear that this addition to the workforce is becoming ‘business as usual’. 

This month, the National Quality Board has produced a guide for secondary care on how to deploy NAs in their clinical teams. Meanwhile, NHS Employers has launched a guide for employers, providing information, signposting, advice and ideas for the role.

The successful completion of the test phase and the increase year on year of trainee numbers are testament to the partnership working and commitment we’ve seen right across the system.

The fact that today we are able to celebrate the register opening to NAs gives me great confidence that together we can continue to deliver and embed this new role in our nursing workforce.

Lisa Bayliss-Pratt is chief nurse and interim regional director for London, Health Education England

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