How do you involve staff in understanding the need for and placement of trainee nursing associates?

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HEE's phase 1 Evaluation of the introduction of nursing associates report (pdf), and Chesterfield Royal NHS Trust’s evaluation of the trainee nursing associate programme, both suggest a number of recommendations for successfully embedding trainee nursing associate programmes into your organisations. We have used this intelligence to suggest ways in which you can use this learning throughout the implementation phases. Since publication of this guide, HEE has published a second phase of evaluation for the nursing associate role. 

Introduction phase

  • Accept that the process will take time to fully embed.
  • Establish a project team with a clear, unified vision on strategic and organisational objectives for introducing the trainee nursing associate role, ensuring that trade unions are involved in the conversation and this initiative is delivered in partnership.
  • Consider carefully the settings in which you wish to introduce these trainee roles and whether to complete a quality impact assessment. Take into account the culture and climate within these settings to ensure that the role is embraced and supported throughout its development.
  • Consider whether your service would benefit more from larger cohorts of trainee nursing associates, in order to enable a step change in skills across the organisation, or a small group of pilot areas to test how the role is received before scaling up. This will largely depend on the current attitudes, appetites and actions of the existing staff and leaders in these areas, as well as the capacity for placement support in different settings.
  • Ensure that the purpose, scope and plans for the role are set out clearly to staff, to help foster acceptance and support for the role from the full team. Provide information about their scope of practice, supervision arrangements and plans for rotation into different settings to support awareness and understanding of the role.
  • Identify suitable candidates. Consider whether you want to initially offer the trainee nursing associate opportunities to internal candidates, and the role that service-users can play in the recruitment and selection of these posts.
  • If you are planning to deliver your nursing associate training programme through an apprenticeship, ensure that staff have information about what this will mean for them, the organisation and the education provider.

Practice example

Chesterfield Royal Hospital NHS Foundation Trust engaged its staff to redesign team structures and introduced the trainee nursing associate and assistant practitioner roles. Read the research report which contains key points of learning and recommendations from this.

Communication and management

  • Conduct an introductory engagement activity with the teams who will be hosting the trainee nursing associates, for example skills mapping exercises to communicate the concept of introducing trainee nursing associates and to help staff feel involved.
  • Ensure clear communication of the agreed organisational objectives for the introduction of the role.
  • Use practical examples and case studies to demonstrate where the roles will fit in the care delivery team.
  • Ensure private communication and feedback channels are used so staff at all levels have ways to raise concerns or discuss anxieties.
  • Ensure strong and consistent messaging from the leadership team throughout planning and introduction.
  • Engage with other organisations who have already introduced the role.

Practice example

City University of London set up a feedback wall on its work-based learning website where you can see the answers to questions posed to trainees, supervisors and managers on the nursing associate role, including top tips for managers and trainees, and information on embedding the role.

Implementation phase

  • Establish a communication structure for all levels that is accessible to all, so all staff have a direct method of communication and information sharing.
  • Provide key information updates as the introduction of the role develops.
  • As this role is new it may be perceived as a threat to other roles. Continue to have open and honest conversations to mitigate this.
  • Be clear what the role is and where it will be used. Ensure that line managers and colleagues supporting the role understand trainee nursing associate’s responsibilities so that they are able to work within this capacity consistently.
  • Identify and deal with dissatisfaction proactively, through exploring and identifying the source and focusing on remedial actions.
  • Involve external support if needed, such as facilitators to enable an open feedback culture.
  • Maintain strong and consistent leadership and messaging.

Establishment phase

  • Introduce further stages of transformation once the pilot is established.
  • Pilot further ideas and developments from the initial programme.
  • Assign ambassador roles to individuals involved in the first cohort of the pilot.
  • Organise review activities with staff. Consider using similar methods as used in the skills mapping activity to gather feedback and learning from the initial pilot.

NHS Improvement offers a range of advice and tools to support you to introduce, lead and embed change across clinical areas.

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