As 2022 marks the first revalidation year since the NA role was introduced, we have spoken to a variety of employers and NAs from across England to find out how the role was adopted and continues to develop as an integral part of the NHS workforce.
Kate Ward, allied health professions workforce lead and occupational therapist at Leeds and York Partnership NHS Foundation Trust, tells us how valuable the nursing associate (NA) role has been in freeing up capacity in clinical teams, and how they are adapting and developing the role to help improve patient care in mental health and learning disability services.
We started with a small cohort of NAs, as part of the first pilot in 2017, and now have 16 registered NAs across different clinical areas, including adult inpatient, forensic inpatient, and community mental health teams.
NAs have been invaluable in freeing up the capacity of nurses to take on leadership roles and clinical duties and are also supporting by developing clinical skills in their role. In some cases, they have taken the lead in monitoring the physical health of mental health patients (co-morbid physical conditions) and working in infection control and tissue viability in inpatient services such as pressure sores. The recent events and pressures related to COVID-19, have also shown how NAs can support registered nurses even further, with mental health and pastoral support.
A lot of NAs are happy in their role, but some want to develop. A few have completed supplementary skill training for their relevant areas, for example, nasal gastric feeding. We have created opportunities for NAs to work in infection control teams delivering training and training to become learning disability (LD) nurses. For the first time in our organisation, we are supporting an NA to complete a learning disability nursing apprenticeship at masters level. This will allow them to develop their critical thinking and research skills as well as forward their professional development in nursing . We are also looking at how to develop NA roles from a community perspective, and currently have trainees in intensive community service which is an acute service that provides an alternative to hospital care.
As part of our recent evaluation of the role, we asked our NAs to provide feedback. We asked about how their role contributed to a registered nurse being able to better practice their breadth of skills within their work areas. One NA commented:
“I am able to complete care plans and update risk assessments which aids to ease their workload. I am able to conduct pieces of work with service users which helps to ease nurse capacity.”
We also asked how NAs felt about their contribution to improving person centred care for the service users in their area. One NA commented:
"Offering emotional support to patients and family members. Communicating effectively with patients and family members. Involving patients in their care and them being at the centre of their care."
The most valuable contribution of NAs is having a registered associate who has the skills and knowledge to recognise physical deterioration in a mental health patient. They bring interpretive skills and knowledge of physical health screening and assessment and know how to respond, treat and escalate their observations. NAs contribute to the improved assessment, treatment, and care of patients in mental health settings as they have trained across all fields of Nursing, and this adds to the holistic nature of assessment and treatment of our service users.
There needs to be a longer-term workforce plan for NAs and some external support organisations with developing this. We need to look at what we invest and what the return is on NAs in four or five years’ time, to support the ask for financial investment in the role. We have recently undertaken an evaluation of the NA role, and this is something we would like to repeat in the future, particularly to further explore some of the feedback we have already received from NAs about distinguishing between their role and the role of a nurse.
We have also considered how a bank NA role could be developed and utilised and the risks and benefits of deploying NAs as part of the bank workforce, such as supporting with the gaps in registered nurses, but while providing sufficient support for the bank NA and not looking at them as a substitute for nurses. We will continue to liaise with partner organisations within the system to understand the scope of the NA role in mental health and LD settings. We are continually improving and strengthening governance and policy to mitigate for any risks in terms of patient safety, quality, staff experience and knowledge of the role.
We use the NHS Futures platform to engage and share successful work around the NA role. There is a lot of interest in the role, particularly the opportunities it provides in terms of skills mixing, and we predict it will only grow and diversify in the future. We are involved with the NAs regional development group with HEE, where we share good practice and operational updates. It is important to work in partnership with your local trusts to support the development of NAs, from a systems collaboration perspective . The NA role provides an alternate professional route into nursing, and the diversity and potential of the role helps to sustain and support the nursing workforce and wider clinical teams.
For more information, contact Kate Ward: email@example.com.