Using nursing associate roles in the NHS

What is a nursing associate?

The nursing associate is a generic nursing role in England that bridges the gap between healthcare support workers and registered nurses, to deliver hands-on, person-centred care as part of a multidisciplinary team in a range of different health and social care settings.

Nursing associates are members of the nursing team, who have gained a Nursing Associate Foundation Degree awarded by a Nursing and Midwifery Council (NMC) approved provider, typically involving two years of higher-level study, enabling them to perform more complex and significant tasks than a healthcare assistant but not the same scope as a registered nurse. With additional training, the role also provides a progression route into the registered nursing profession.

The role has been introduced to help build the capacity of the nursing workforce and the delivery of high-quality care while supporting nurses and wider multidisciplinary teams to focus on more complex clinical duties.

The nursing associate is a protected title in law and the role is regulated in England by the NMC, which means that you can only employ people into the role who are qualified and registered as nursing associates.

Skills for Care and the NMC have produced case studies which share more details about the nursing associate role and where it can be deployed, including a short film, which features trainee nursing associates and registered nurses, describing how they see the nursing associate role contributing to better patient and service-user care.

NHS England has also produced the below video which shows what a nursing associate is, and where they can be deployed.

Training and funding nursing associates

Most nursing associate training programmes are being delivered through the apprenticeship route.

Individuals can also self-fund their training through college or university. Employers can also support retired nurses to retire and return or overseas nurses to become nursing associates.

The your future nursing associates infographic sets out the different routes available for organisations to train nursing associates and any costs to employers.

Skills for Health have published a Nursing Associate apprenticeship information pack with useful links, case studies and resources to support employers in navigating the apprenticeship. This can be downloaded from the HASO website. 

What does the nursing associate programme include?

• A foundation degree training programme is usually taken over two years. During this time, the trainees must complete at least 2,300 programme hours which are divided to achieve an equal balance of theory and practice learning. This equates to half the hours required for a registered nursing qualification.
• To meet the requirements of the training programme, trainee nursing associates must work in a range of settings and situations to gain as much experience as possible across different age groups.
• The trainees must complete at least two substantial placements (totalling 675 hours) in settings other than their primary place of employment.
• As part of the nursing associate apprenticeship, trainees must meet the 15 standards set out in the care certificate. If they do not already hold level 2 English and maths qualification, these should be achieved before or whilst completing the programme. NHS England and education providers can support with this.
• Requirements for training and education are set out and regulated by the Nursing and Midwifery Council (NMC) in its standards for pre-registration nursing associate programmes.

Can colleges deliver nursing associate programmes?

Yes, provided the college is approved by the NMC to deliver the training. South Devon College become the first further education provider to be approved by the NMC to deliver the training in 2021. 

Find out more on the Nursing and Midwifery Council (NMC) website.

Clinical placement activity

Trainee nursing associates (TNAs) must complete at least two substantial placements (totalling 675 hours) in settings other than their primary place of employment. It is up to the employer and provider to agree how these placements are delivered which can include subcontracting and third-party arrangements.

If you deliver training to TNAs as part of their clinical placement you may need to be registered on the register of apprenticeship training providers (ROATP). Employers may be able to claim up to £2,500 of apprenticeship funding to spend on eligible placement costs.

The NMC has developed supporting information that provides a definition and examples of protected learning time while training nursing associates, and sets out two options for how time spent learning in practice can be protected for trainee nursing associates.

Option A

Nursing associate students are supernumerary when they are learning in practice.

Option B

Nursing associate students who are on work-placed learning routes:

• are released for at least 20 per cent of the programme for academic study
• are released for at least 20 per cent of the programme time, which is assured protected learning time in external practice placements, enabling them to develop the breadth of experience required for a generic role
• must have assured protected learning time for the remainder of the required programme hours.

It is for the education provider, working with you and the other practice placement partners, to determine how programmes are organised. You will need to share any preferences you have about the structure of the programme as it is being developed by your education provider.

Hub and spoke models

Many employers already offering the TNA programmes have adopted a hub and spoke model. This is where TNAs split their time between their primary place of employment and spoke placements, to broaden their skills and experience and maximise their learning opportunities.

There are broadly two approaches to how academic learning has been structured, one involving a block approach and the other an integrated learning approach. The block approach is usually a week of academic study a month. The integrated learning approach will typically see academic learning undertaken one day a week.

The number and length of placements a trainee nursing associate will undertake can vary with the duration and type of placement being shaped by what is available locally.

What funding is available to support training?

For TNA programmes running in 2022/23, the following financial support has been approved from NHS England:

• For each TNA, an employer will be eligible for a total funding sum of £8,000 over two years (£4,000 per year). 

• For trainees working at least 50 per cent of their practice time with people who have a learning disability and/or autism, an employer will be eligible for a total funding sum of £15,800 over two years (£7,900 per year). 

• Direct entry TNAs will attract Placement Tariff Value. 

• For each direct entry TNA starter, NHS England will provide one payment of £1,000 to each TNA to cover the entire two-year programme. 

• Primary Care Networks will be able to claim 100 per cent of the TNA salary through the Additional Roles Reimbursement Scheme. 

This funding is reviewed on an annual basis. For more details, visit NHS England employer resources.

Self-funded nursing associate route

Guy's and St Thomas' NHS Foundation Trust is looking to recruit more than 400 nursing associates in the next five years to build its nursing teams and sustain the nursing workforce within the organisation.

In May 2020, the trust in collaboration with Coventry University, started its first self-funded nursing associate programme. The trust allocated approximately 25 places on the programme to self-funded nursing associates, which they are looking to expand to 60-80 places in future. A larger cohort in September aimed to maximise uptake by aligning with the clearing process and university starters. At the end of a completed self-funded nursing associate programme, trainees will be offered a nursing associate role at the trust.

The apprenticeship levy can be used to fund trainee nursing associate programmes and will cover the cost of the training and assessment (including end-point assessment) up to the maximum of the assigned funding band, which for the level 5 nursing associate standard is set at £15,000. However, education providers are likely to offer conventional or fee-paying routes to train to become a nursing associate as well, if the demand is there.

Employers may be able to claim up to £2,500 of apprenticeship funding to cover the costs attributed to providing clinical placements for nursing associates but only if they are delivering an activity that is an eligible cost as defined by the funding rules.

For further information regarding the apprenticeship funding arrangements for nursing associates, read the Education and Skills Funding Agency’s updated guidance.

What supervision do qualified nursing associates need?

As registered professionals, nursing associates are individually accountable for their own professional conduct and practice. It is likely that nursing associates will typically work under the direction of a registered nurse or registered professional but may not require direct supervision. They will also be able to support, supervise and act as a role model to TNAs, healthcare support workers and those new to care roles.

Providing preceptorships for qualified nursing associates

Good quality preceptorship programmes can benefit individuals and employing organisations as they help to build confidence and competence, consolidate learning, and reduce attrition within the first years of employment.

Shared learning

York Teaching Hospitals NHS Foundation Trust developed a preceptorship programme aligned to the NMC standards of competency for qualified nursing associates. The preceptorship programme is also attended by newly qualified nurses to build relationships and understanding of how the two roles will work together. Nursing associates are welcomed into their new position with an introductory goodie bag which includes details about their preceptorship, competency documents and promotional items as a welcome to the trust.

Each newly qualified nursing associate spends a week at the start of their preceptorship undertaking scenario-based learning in topics such as pain management and diabetes management. They spend a day with senior nurses to build relationships and ask questions in a safe space. Every other month for the remainder of the year, newly qualified nursing associates will have a study day away from the ward to focus on topics such as nutrition and end-of-life care. There is also the option to pick a topic of their choice for the last training session of the preceptorship.

Revalidation

Once qualified, nursing associates are subject to regulatory requirements such as revalidation and fitness to practise. More information about how the role will be regulated is available on the NMC website.

Career development pathways

The nursing associate role can be used to provide a development pathway for those wishing to train as a registered nurse. The qualifications gained can be accredited against a nursing degree or a nurse degree apprenticeship to shorten that training.

The NMC standards of proficiency for nursing associates have been designed so that education providers can easily develop programmes that build on nursing associate proficiencies, and enable students to progress on to registered nursing programmes.

Deploying nursing associates

The Nursing and Midwifery Council (NMC) has developed and published standards of proficiency for nursing associates. These standards set out the knowledge, competencies, professional values and behaviours expected of a nursing associate at the point of registration. They will help employers to understand what nursing associates can contribute to patient and service-user care.

As employers are becoming more familiar with the role, we’re seeing it expand in a variety of acute, mental health, community, primary and social care settings. Within these areas the nursing associate role is utilised in medical and surgical wards, in-patient wards with older people or children, outpatients, community nursing and mental health teams, theatres, accident and emergency, and inpatient learning disability settings.

The Devon healthcare system has introduced and deployed nursing associates across the ICS by creating a sustainable model and clear and accessible pathway for nursing associates. The trust has seen substantial benefits including reduction in vacancies and evidence of improved patient experience, read more about the case study from University Hospitals Plymouth NHS Trust.

Watch our past webinar which showcases examples of acute, community and social care employers using the role.

Case studies

Surrey Heartlands Health and Care Partnership

Organisations in the Surrey Heartlands Health and Care Partnership have worked collaboratively as an Integrated Care System (ICS) to look at how they can use the nursing associate role within their nursing structures. Across the system there are a number of nursing vacancies they have struggled to recruit to, so the partnership took a fresh look at how care is provided and what skills are needed.

Adopting a ‘grow your own’ approach, trainee nursing associates (TNAs) were recruited from the healthcare assistant workforce. Primary care was supported to pilot TNAs by the Surrey training hub with CSH Surrey, a local community health provider which was a trailblazer organisation, involved in early pilots. Working at a systems-level, opportunities were created across the ICS to share the role and rotate the TNA placements across services, for example, in acute and community services and within primary care including GP Practices. This arrangement not only provides a good experience of different settings for the trainees but they also get to appreciate how an ICS works.

Previously many healthcare assistants saw a nursing career as being out of reach, either they couldn’t afford the university fees or didn’t feel their knowledge and skill base was enough for them to make the transition. It is now anticipated that some of these TNAs will progress onto a nursing programme.

Rycroft Primary Care Centre

Rycroft Primary Care Centre, an NHS GP surgery, supported one of its healthcare assistants to undertake the nursing associate apprenticeship. The practice understands the value of offering development opportunities to its existing staff and staff appreciated being offered these opportunities and felt valued. Rycroft Primary Care Centre was able to offer this apprenticeship due to transferred levy funds that were gifted by a local NHS Trust, with the support of the West Yorkshire and Harrogate Excellence Centre.

While working in the practice, the trainee nursing associate (TNA) completes tasks including ECGs, blood clinics, smoking cessations, chronic disease reviews and spirometry tests. This allows the registered nurses to concentrate on more complex patients and tasks while the less complex patients still receive high quality care from the TNA.

To ensure the TNA was well supported, they were allocated a nurse mentor. This helps the TNA improve their knowledge through peer support and to ask questions to an experienced nurse. The TNA's line manager, an advanced nurse practitioner, was also allocated as their mentor, which was a key factor in making the TNA role successful.

The training undertaken by TNAs in primary care includes placements in a range of settings such as hospital wards and in the community. Since starting the course in September 2019, Rycroft’s TNA has had nine weeks on placement. The practice has managed this time away and found forward planning was key to ensuring that backfill was available. It has used this time to provide further development opportunities to its phlebotomist and upskilled her to a healthcare assistant role. Rycroft is part of its local advanced practice training hub which operates a hub and spoke model. The centre is a 'spoke' practice, which hosts student nurse and trainee nursing associate placements, covering primary, secondary, and social care settings, as organised at the 'hub' practice at College Lane, Ackworth.

The practice anticipates that when the TNA becomes a qualified nursing associate, she could go on to complete cytology training, in which there is currently a shortage of expertise for the practice. There would then be an opportunity for her to progress further on to a registered nursing degree, with completion within eighteen months. The practice aims to use the role as a way for its existing staff to progress but would also consider recruiting externally into a role, should there be demand.

Useful resources

In this series of blogs, we speak with different employers and nursing associates from across England to find out how the role was adopted and continues to develop as an integral part of the NHS workforce: 

• Nursing associates at Leeds and York Partnership NHS Foundation Trust 

• Nursing associates at Northamptonshire Healthcare NHS Foundation Trust 

• Nursing associates at Chesterfield Royal Hospital NHS Foundation Trust 

• Nursing associates at Derbyshire Community Health Services NHS Foundation Trust 

We have recorded a series of Nursing Associate webinars to help employers scale up the role in their organisation on: 

• Deploying nursing associates in different settings 

• Nursing Associates administering drugs and IV 

• Nursing Associates in community and mental health settings 

• Attracting and retaining people into the Nursing Associate role