Nursing Associates and Registered Nurses

Professor Lisa Bayliss-Pratt, Chief Nurse, HEE

Anne Trotter, Nursing & Midwifery Council

Overview

• Nursing associates and registered nurses: the

difference between the roles and the regulation

• How can NAs be used to best support the nursing

workforce

• Regulation and future nurse standards

Draft May 2016

Introducing

the Nursing Associate

Draft May 2016

• a new member of the nursing team providing care and

support for patients and service users.

• key part of developing the nursing workforce.

• addresses a skills gap between health and care

assistants and registered nurses.

• stand-alone role in its own right

• a progression route into graduate level nursing - a

pathway which previously healthcare assistants could not

access.

The role

Draft May 2016

• 2,000 in Waves 1 and 2, in

2017

• First cohort qualify in January

2019

• Retention rate 85%

• 5,000 to be recruited

in 2018

• 7,500 to be recruited

in 2019

The story so far

Draft May 2016

The story so far

• Clear evidence that trainee

Nursing Associates are

moving away from a task-

based role, towards more

patient- and outcomes-

focused role

• Placements are allowing

trainee Nursing Associates to

exchange skills and practice

with colleagues across

different settings.

• Reportedly leading to

immediate improvements in

the quality of care.

Draft May 2016

The story so far

• trainee Nursing Associates are

showing increased assertiveness

and self-belief when entering

placements, and are seeking out

learning opportunities.

• As they develop their skills and

knowledge they are

bringing additional capacity to the

settings or services they are

working in.

Feedback from independent evaluation

• Shift from a task-focused to a patient-focused role:

“Trainees are starting to move away from a focus on tasks, they

are looking at the competencies of care and not just tasks.”

Employer

• Exchanging skills and knowledge between settings:

"As I work in different settings I've been able to help to reduce the

stigma of mental health – as a Trainee Nursing Associate I can

share my skills, principles, values with the staff that I work with."

Trainee Nursing Associate

• Growing confidence and assertiveness about learning

needs

Evaluation of Introduction of Nursing Associates

Phase 1 report for Health Education England

July 2018

Trusts

Higher Education

Institutions

NA stakeholders

Nursing associates and registered nursesHow the NMC regulates

The consultation ran for 12 weeks from 9 April to 2 July

Regulation of nursing associatesThe consultation

Category Examples

1. Areas where we

proposed applying

the existing regulatory

approach for nurses

and midwives

• The Code (as amended)

• Standards of education and training

• Revalidation

• Registration, English language and fitness to

practise requirements

2. New nursing

associate specific

resources

• Standards of proficiency for nursing associates

(including the skills annexe)

• Nursing associate Programme Standards

Regulation of nursing associatesResponse overview

• 1,149 respondents accessed the consultation

• Most popular question received 732 responses

• Majority of responses received from individuals

• 93% of individual respondents resided in England

• 56% of responses from UK-registered nurses

• 24% of responses from nursing associate students

• 113 organisational responses

Standards framework for nursing and midwifery

• 91% agreement

Standards for student supervision and assessment

• 90% agreement

Other areas

• >90% agreement for the same English language and revalidation requirements

• 69% agreement in applying the same fitness to practiseapproach to nursing associates

Regulation of nursing associatesExisting approach

Set out what nursing associates need to know and be able to do at the point of registration

Aims:

• Appropriate level of skill and knowledge to support the registered nurse

• Appropriate skills annexes

• Generic in nature

• Demonstrates the “clear blue water” between the role of the registered nurse and nursing associate

• To facilitate educational transition from nursing associate to registered nurse for those able

Nursing associates and registered nursesPurpose of NA standards ofproficiency

Nursing associates

Six platforms

1. Be an accountable professional

2. Promoting health and preventing ill health

3. Provide and monitor care

4. Working in teams

5. Improving safety and quality of care

6. Contributing to integrated care

Nurses

Seven platforms

1. Be an accountable professional

2. Promoting health and preventing ill health

3. Assessing needs and planning care

4. Providing and evaluating care

5. Leading and managing nursing care and working in teams

6. Improving safety and quality of care

7. Coordinating care

Nursing associates and registered nursesNA vs RN standards of proficiency

Nursing associates and registered nursesDifferent expectation levels

• Research knowledge and application

• Critical thinking skills

• Decision making

• Bringing about behaviour change

• Referral

• Restricted aspects of medicines administration

• Leadership

• Management

• Supervision

• Risk Management

• Evaluation of nursing care

• Discharge

• Health legislation and policy

• Health economics

Regulation of nursing associatesNext steps

Apr – Jul ‘18 Formal consultation on standards (proficiency and

programme), and the Code begins (release 2)

Sept ‘18

Jan ‘19 First cohort of nursing associate students qualify

and apply for registration

Council asked to agree final nursing associate

standards (release 3)

Oct ‘18Publication of finalised standards of proficiency, programme standards and Code

Jul – Aug ‘18 Review and analysis of consultation responses.

Further engagement and refinement of standards

Oct ‘17Early version of nursing associate standards of

proficiency available for test sites (release 1)

Oct ‘17 – Mar ‘18 Open engagement on standards

Discussion