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What do you mean when you say 'NA'?

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As with most things in the NHS, job titles represent conflicting interests. 

While those being treated often refer to us uniformed masses as ‘nurse’, the reality is far more complex.

Across and between the Agenda for Change bands are hundreds of job titles, many indecipherable from one another. Often, the only reason we need to distinguish between these titles is for task allocation. Who can give out medication? Who can detain someone under section 5(4) of the Mental Health Act?

There are political and economic reasons for this variety in nursing roles. One could even argue that feminism killed the nurse, as women are no longer thrilled by the mere prospect of entering the workplace and seek bigger, brighter and less gender-stereotyped careers.

“As much as these NAs overlap in practice, and join the ranks of people colloquially called ‘nurse’, they differ professionally”

Nursing was always going to have to be overhauled. For example, mental health nurses are now trained under the same standards as the other fields, but there were disparate routes into become a registered mental health nurse until the 1950s.

During my practice placement experiences, I have encountered an increasing number of ‘NAs’. In my first year, these were mostly nursing assistants, more commonly known as healthcare assistants (HCAs). From second year, I shared placements with another type of NA, the nursing associates. And, in third year, I find my path crossing often with yet more NAs, the nursing apprentices.

As much as these NAs overlap in practice, and join the ranks of people colloquially called ‘nurse’, they differ professionally.

Nursing assistants provide basic care and interpersonal treatment in a range of healthcare settings under the supervision of qualified professionals – usually nurses. This a role with a lot of human contact, from personal care to physical observations to therapeutic conversations with distressed people. There is no formal training requirement.

Nursing associates work alongside nursing assistants and registered nurses in all four fields of nursing. The training for this role takes two years, during which time trainees are employed by an NHS trust or other healthcare setting. The clinical requirements of the role are greater than that of a nursing assistant, and are more likely to include procedures such as venepuncture and cannulation.

Nursing apprentices complete the same qualification as other registered nurses, but without studying full-time at university. Nursing apprentices remain employed during training, but are released to study part-time, and this usually takes four years. It is possible to complete this training in a shorter amount of time if you are already qualified as a nursing associate.

Rereading Felicity Stockwell’s The Unpopular Patient recently, she describes wards filled with pupil nurses, student nurses, nurse auxiliaries and state enrolled nurses. Here we find more NAs, the nurse auxiliaries (equivalent to today’s healthcare assistants). These roles were disbanded with the increasing regulation of nursing, leading to the Project 2000 nurses and culminating in cohorts of university-educated nurses. This added uniformity to the uniforms, and clarity to care. But the devolution has begun, and complexity is creeping back in.

The image overhaul of nursing was inevitable. Nobody can ignore the work being done to alter the perceptions of nurses as educated, autonomous practitioners. However, when nursing reinvents itself so frequently and the job titles are so opaque, it feels like an uphill struggle to pin down what nursing is to give it a credible makeover.

We, as student nurses, have the loudest voice in deciding what the new image of nursing will be, so be your ideal nursing self at every opportunity.

Thank you to Dr Diane Carpenter, University of Plymouth, Dr Stephen O’Brien, University of Northampton, and Dianne Yarwood, RCN History of Nursing Society, for your help with this piece.

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