As 2022 marks the first revalidation year since the nursing associate (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.
I’ve been a nursing associate (NA) for three years but started out as a healthcare assistant (HCA). East London Foundation Trust (ELFT) put in a bid as a pilot site for trainee nursing associates (TNAs), as part of the first Health Education England (HEE) NA pilot. There were about seventy TNAs across England in that first pilot, also known as the fast followers programme, and about thirty graduated. I was one of the fast followers at ELFT.
I saw the NA role as a step up and a flexible way to progress into the nursing programme as you can do it part time, so I could work at the same time as completing my degree.
There weren’t many TNAs in the first pilot and it wasn’t Nursing and Midwifery Council (NMC) regulated until six months before the programme ended. It was at that point they introduced medicine management and clinical supervision, which changed the goalposts of the programme part way through, however, I found the challenge quite rewarding.
To undertake the TNA programme, you had to already work in healthcare. The role helps bridge the gap between healthcare workers and nurses and shares the service pressure among nursing roles. It also supports nurses in providing more holistic patient care as it streamlines patient service, for example, NAs can perform clinical tasks that HCAs are unable to perform.
I’m currently the only NA at NHFT but more are due to qualify soon. I feel like I’m helping to set the foundations and build the role here, particularly coming from ELFT where it was well established.
The nurses have made me feel welcome and I’m eager to overcome some of the misunderstandings or lack of knowledge about the role and what the training involves, for example undertaking a degree.
The broader team are excited about the NA role being introduced here, particularly with helping to address the pressures of not having enough registered staff.
Since I’ve been at NHFT, I’ve seen other HCAs apply for the NA role. You get financial support and incentives to undertake the TNA programme and it’s like a less intense version of a nursing degree, that’s accessible and makes people feel empowered to achieve higher professional goals.
I think people that apply for the NA role feel more valued in multi-disciplinary teams, as they have the formal education and knowledge to back up their assessments. You have the knowledge across a broader spectrum of clinical areas to back up your decisions and clinical responsibility.
After I qualified, ELFT wanted to make sure I was able to use the skills that I had learned at university. They saw the potential of having someone who is allocated HCA shifts with the ability to do medication, and I was quickly brought up to speed with the medicines management policy. Throughout my studies and placement, I was involved with medication management, via shadowing and practical placements. Based on this experience, my employers were keen to get me involved with medication management. Once my preceptorship had finished and I had completed my trolley handling assessment, my whole team felt the change.
In that first pilot of ten TNAs at ELFT, seven dropped out in the first nine months, three graduated, and two, including myself, took jobs as NAs. A lot of TNAs were leaving at the beginning but they’ve since made the training more accessible via an apprenticeship route.
The apprenticeship route gives you more time to study and is less intense in terms of the academic side of the training, which from experience, tends to be where people struggle the most.
Although I haven’t taken the apprenticeship route myself, my colleagues who have, have said that the flexibility compared to a full time academic course, took away a lot of the stress of studying. There’s a broad spectrum of NA placements: paediatrics, mental health, palliative care, physical health, A&E, cardiac wards, which provides a competitive edge when streamlining the service.
There is also the opportunity to top up after you complete the NA foundation degree, meaning you can choose between the practice area you wish to work in; mental health or general, paediatric.
For your revalidation, I feel like a lot is expected of you to ensure your skills are up to date. You complete reflective practice in five written pieces on the different areas you’ve worked in. You then write about the stuff you do every day, including development and upskilling. If you start the revalidation paperwork early enough it’s fine, you just need to take the time to read the requirements of the revalidation document, and always keep this in your portfolio in case the NMC requests evidence. The process can seem overwhelming, but if you take the time, it’s actually quite simple.
I enjoy working in mental health the most, it has motivated me more to understand the connections between physiology and psychology and I’m now looking at the advanced nurse practitioner degree as the next step after finishing my mental health nursing.
I’m waiting until October to start the top up degree. You do two years to become a mental health nurse and only do an additional eighteen-month degree to top up. I think this really incentivises the NA role more than anything, as the flexibility makes academic study more accessible and training more manageable. The registered nursing associate foundation degree is something that looks good on your CV as well.