trainee nursing associate essay example

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Writing a personal statement for a Nursing Associate application

This is your chance to set yourself apart from the competition - sell yourself..

Your personal statement is your chance to set yourself apart from the competition.

First of all, remember your personal statement should be  personal . This is your chance to sell yourself and explain to the university why you are a potential nursing associate.

You should avoid plagiarising content from another applicant’s personal statement – even if you have their permission. Similarity detection software can be used to highlight any duplication and it could lead to your application being rejected.

Treat it like an essay. Before you start writing, take the time to make bullet points of everything you want to include and order them in terms of importance.

Make sure you have done your research – look at the admissions criteria and read through the professional standards that are set out by the Nursing and Midwifery Council.

Your personal statement should flow and have a clear introduction and ending.

Be honest! Exaggerating or including fictional situations in your application could catch you out at a later point.

Play to your strengths.

Tell them who you are.

Discuss the personal values and qualities you hold that are needed to become a good nursing associate and show evidence of these.

There is likely to be some emphasis on a values-based selection process that demonstrate how your own values and behaviors align with the seven core values of the  NHS Constitution .

Only mention interests or hobbies that reveal something relevant about you.

Avoid being too generic – “I am a caring person” or “I like caring for people” doesn’t offer the interviewer any insight.

Why do you want to be a Nursing Associate?

Speak with passion but try to avoid clichés.

There is so much more to being a nursing associate than giving our medications – show you understand the reality of being a registered healthcare professional in the twenty-first century.

Demonstrate you understand the demands the course will have – placements with a mixture of shifts alongside academic writing and pracitcal learning.

Speak about any existing care experience you might have that gives you an insight into the role.

If you have attended an open day or recruitment event – mention it.

Relevant interests, skill and experience.

Don’t simply list things you have done – you need to relate it to the role.

Transferable skills are key. Take any relevant interests, skills and experience you have and demonstrate how they are transferable to your chosen career.

Discuss and evidence your communication, organisational and time management skills.

Mention key professional issues.

Taking a look at one of the many nursing or midwifery professional magazines or speaking to somebody already on the course can help you identify any current professional issues – but try to stay away from politics.

Ensure you relate any relevant content to the Nursing and Midwifery Code of Conduct alongside professional values such as  the ‘Six C’s’ .

Understand the limitations of the role and how the role came about.

Talk about your ambitions.

The competition for the nursing associate courses is fierce, and consequently, they want to ensure only candidates who genuinely want to become a nursing associate are successful.

You don’t have to have a dedicated ‘five-year plan’ but having an idea of what interests you about the profession is a good start.

Make it clear you would strike to provide good quality and evidence-based care.

Avoid getting caught up in the moment and submitting your application without checking it.

Correct spelling and grammar is absolutely vital and demonstrates you have taken care and attention on your application.

Try to include in-line citations if you refer to a study, document, policy or procedure.

Follow CustomWritings.com can help you write your nursing school personal statement.

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The experiences and expectations of trainee nursing associates

Identifying the different healthcare settings and specialities supporting the trainee nursing associate role.

Researchers

• Joanne Brooke
• Victoria Skerrett
• Cathy Poole
• Kathryn Sethi
• Katy Sutherland

Research background

The nursing associate role was introduced by Health Education in England in 2017, with the aim to bridge the gap and create a new tier between health care assistants/support workers and registered nurses, to address the shortages of registered nurses and to provide an alternative route to access the registered nurse programme. 

The Nursing and Midwifery Council (NMC) are the official regulator for nursing associates. Trainee nursing associates (TNAs) complete a two-year programme, which requires them to be exposed to multi-disciplinary working and is designed to give them the ability to work in a variety of settings with a range of population groups and conditions. 

The programme consists of one day a week studying at university, one day a week in placement, and the remaining hours in their usual workplace, although with protected hours for further learning. The nursing associate national training programme contains eight key domains:  

• Professional values and parameters of practice  
• Person-centred approaches to care  
• Delivery care  
• Communication and interpersonal skills  
• Team working and leadership  
• Duty of care, candour, equality and diversity  
• Supporting learning and assessment in practice   
• Research, development and innovation  

An initial evaluation of the training and development of the nursing associate programme was commissioned by Health Education England, which identified the impact of nursing associates within clinical practice and the clear benefits and challenges (Vanson and Beckett, 2018).

Benefits included:  

• TNAs had moved away from a task-based role, towards a role that is more patient and outcomes-focused;
• TNAs were exchanging skills and practice with colleagues in different settings; therefore, reportedly leading to immediate improvements in the quality of care provided;   
• TNAs showed an increased assertiveness and self-belief on placements and sought seeking out learning opportunities;   
• TNAs new skills and knowledge enabled them to bring additional capacity to their team and workplace.   

However, challenges included:

• TNAs were not always sure about what tasks they could and could not do due to a lack of parameters for this new role;   
• TNAs were on occasion still being viewed as healthcare support workers;   
• TNAs reported some staff and colleagues felt threatened by this new role (Vanson and Beckett, 2018).    

Research aims

The aim of this study is to identify the different healthcare settings and specialities supporting the nursing associate role and to explore trainee nursing associates’ experiences and expectations, both present and future. 

The objectives of this study are: 

• Identify the different healthcare settings and specialities supporting implementing the nursing associate programme 
• To begin to understand the perspective of TNAs regarding their role, experiences, and expectations, both present and future  
• Development of a questionnaire to explore the role of nursing associates, experiences, and expectations 
• Identify similarities and differences of the nursing associate role across different healthcare settings

How has the research been carried out?

A sequential mixed methods study, collecting both qualitative and quantitative data, qualitative data will be collected through the implementation of focus groups with TNAs, these will be constructed to bring together TNAs from similar healthcare settings to explore their role, experiences and expectations, both present and future.

Qualitative data will be analysed to understand TNAs role, experiences, and expectations, which will inform the development of a quantitative questionnaire.

All TNAs at BCU will then be provided with the opportunity to complete the questionnaire, this approach will support the understanding of TNAs role, experiences, and expectations on a larger scale.

Outcomes and impact

The results and methods applied in this study will be applicable, informative, and useful for all involved in supporting and delivering the nursing associate programme, and the development of this role across different health specialities.

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Health Foundation. A critical moment: NHS staffing trends, retention and attrition. 2019. https://tinyurl.com/y4gfrwlm (accessed 6 June 2019)

NHS England. NHS Long Term Plan. 2019. https://tinyurl.com/ydh7y999 (accessed 6 June 2019)

NHS Pay Review Body. Thirty-first report. 2018. https://tinyurl.com/ycdkkn9z (accessed 6 June 2019)

Nursing and Midwifery Council. The Code: professional standards of practice and behaviour for nurses, midwives and nursing associates. 2018a. https://tinyurl.com/gozgmtm (accessed 6 June 2019)

Nursing and Midwifery Council. The standards of proficiency for nursing associates. 2018b. https://tinyurl.com/yc4zj8em (accessed 6 June 2019)

The vital role of nursing associates

Patricia Robinson

Senior Lecturer, Community Health Team, Brighton University

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The dangers of a diminishing community nursing workforce have been highlighted in many reports ( NHS Pay Review Body, 2018 ; Health Foundation, 2019 ). Since 2009, there have been significant falls in the numbers of nurses working within community health services, with increased pressure to provide more complex care closer to home. There is now a major drive to implement a new role to support the nursing workforce—that of nursing associates. The number of new nursing associates is projected to increase by 50% in 2019, with 7500 new nursing associates starting on a programme over the year ( NHS England, 2019 ).

The nursing associate role is designed to stand alone alongside the registered nurse workforce; it aims to support but not substitute the registered nurse. Trainee nursing associates (TNAs) undertake a 2-year apprenticeship and, on successful completion, they will join the Nursing and Midwifery Council (NMC) as registrants regulated by a professional code of practice that was updated in 2018 to include this new role ( NMC, 2018a ).

The TNA's journey starts at the work place with their employer prior to application. They apply to the university after completing an internal process with the employer that identifies their role development from a personal development plan and the need for nursing associates from the employer's workforce development plan. The role of the course team in this 2-year foundation degree programme is to nurture the TNA by providing an enriched curriculum to enhance their skills, abilities and professional and personal responsibilities and potential. One of the strengths of the course is that all TNAs are employed, promoting partnership working between the university and employer to support them to complete the course with a recorded qualification with the NMC.

TNAs have a wide range of backgrounds, with a significant number working within community teams, where they work under the leadership of a registered nurse. They work within all aspects of the nursing process, providing high-quality holistic and person-centred care to individuals. They will also support the RN in the assessment, planning and evaluation of care. Additionally, TNAs will be expected to undertake medicines management and develop transferable skills by having external practice.

For those NAs who wish to progress into registered practice, the apprenticeship can provide credits into some higher education programmes and makes them eligible to enter year 2 of BSc Hons Nursing. TNAs will have a registered nurse/nursing associate identified as their practice supervisor throughout practice and a registered nurse/nursing associate practice assessor who can undertake the assessment of skills in practice. A learning agreement will be developed between the TNA and the practice supervisor with support from the university and a personal tutor.

TNAs attend university 1 day a week during term time and have 1 day per week off-the-job training when not attending university. In addition, TNAs must achieve 675 hours of protected learning time in external placements in each of the following areas: in-hospital, close-to-home and at-home care. During the remaining time in their homebase (the primary site where the TNA is employed to work), TNAs receive a minimum of 7.5 hours per week of protected learning time for practice learning (this is in addition to the 7.5 hours of on-the-job-training received each week). The skills outlined in the NMC standards are completed in all the work-based learning settings ( NMC, 2018b ). Struggling community nursing teams should consider supporting the recruitment and development of their own nursing associates as soon as possible.

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Department of Health and Social Care, Gummer B. Nursing associate role offers new route into nursing. 2015. https://tinyurl.com/2p9pc7df (accessed 9 March 2023)

Department of Health and Social Care. Regulation of nursing associates in England: Government response. (Response to consultation on amendments to the Nursing and Midwifery Order 2001 and subordinate legislation to regulate nursing associates in England by the Nursing and Midwifery Council.). 2018. https://tinyurl.com/yck9ah48 (accessed 9 March 2023)

Lucas G, Brook J, Thomas T, Daniel D, Ahmet L, Salmon D. Healthcare professionals' views of a new second-level nursing associate role: a qualitative study exploring early implementation in an acute setting. J Clin Nurs. 2021; 30:(9-10)1312-1324 https://doi.org/10.1111/jocn.15675

National Quality Board. Supporting NHS providers to deliver the right staff, with the right skills, in the right place at the right time. Safe sustainable and productive staffing. 2016. https://tinyurl.com/tps7bnz2 (accessed 9 March 2023)

Nursing and Midwifery Council. The code: professional standards of practice and behaviour for nurses, midwives and nursing associates. 2018a. https://tinyurl.com/2s3h464b (accessed 9 March 2023)

Nursing and Midwifery Council. Standards of proficiency for nursing associates. 2018b. https://tinyurl.com/hv958bej (accessed 9 March 2023)

Nursing and Midwifery Council. Future nurse: standards of proficiency for registered nurses. 2018c. https://tinyurl.com/j3zkktzj (accessed 9 March 2023)

Nursing and Midwifery Council. Standards for student supervision and assessment. 2018d. https://tinyurl.com/4kmzn8j3 (accessed 9 March 2023)

Nursing and Midwifery Council. Annual report and accounts 2018–2019 and strategic plan 2019–2020. 2019. https://tinyurl.com/32w7tv2y (accessed 9 March 2023)

Nursing and Midwifery Council. Annual report and accounts 2019–2020 and strategic plan 2020–2025. 2020. https://tinyurl.com/yck44wb7 (accessed 9 March 2023)

Nursing and Midwifery Council. Annual report and accounts 2020–2021 and strategic plan 2021–2022. 2021. https://tinyurl.com/mry5324d (accessed 9 March 2023)

Nursing and Midwifery Council. Annual report and accounts 2021–2022 and strategic plan 2022–2025. 2022. https://tinyurl.com/3nz489s6 (accessed 9 March 2023)

Raising the bar. The shape of caring—a review of the future education and training of registered nurses and care assistants. 2015. https://tinyurl.com/mryxwf6b (accessed 9 March 2023)

The registered nursing associate: an overview

Editor in Chief, British Journal of Nursing

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Registered nursing associates have obtained a nursing associate foundation degree that has been endorsed by the Nursing and Midwifery Council (NMC) through an approved educational institution. This usually involves 2 years of higher-level study, enabling the registered nursing associate to undertake more complex and significant tasks than a healthcare assistant would, but without the scope of a registered nurse. It is not the intention to replace the registered nurse with a registered nursing associate. The role is used and regulated in England, with the aim of addressing a skills gap between healthcare assistants/support workers and registered nurses – it can also provide a progression route into graduate-level nursing. This article, the first in a series, provides an overview of the registered nursing associate role.

In 2017 Health Education England (HEE) launched a pilot programme consisting of 2000 trainee nursing associates. Since 2017 there has been a year-on-year increase in the number of trainee nursing associates who are undertaking their training to become registered nursing associates. Registered nursing associates were admitted to the Nursing and Midwifery Council (NMC) register in January 2019, becoming eligible to join the workforce in England. Registered nursing associates are working in the NHS, in social care, hospices and GP practices, in increasing numbers.

The registered nursing associate offers hands-on, person-centred care working as a part of the nursing team, and a valued member of the wider multidisciplinary team, working with people of all ages in a number of health and social care settings. Registered nursing associates make valuable contributions to the promotion of health, health protection and the prevention of ill health. They are skilled at empowering people and communities to make choices and assume control of their own health decisions and behaviours; where possible, they support people in managing their own care. Registered nursing associates interact on a daily basis with a number of service users, families and carers, as well as with an extensive range of health and care professionals and other agencies, including social services, police and justice systems, probation, prisons, housing, education, language interpreters and third sector/voluntary agencies. They undertake various shift patterns, enabling care to be offered 24 hours a day, 7 days a week for 365 days of the year. The registered nursing associate has become a key part of the team, meeting the integrated health and care needs of patients and service users.

‘Nursing associate’ is a protected title in law. In England, it is an offence for anyone to practice as a registered nursing associate without being registered with the NMC, or to incorrectly claim to be qualified or registered.

Shape of Caring review

The role of registered nursing associate was introduced in response to the Shape of Caring review (https://tinyurl.com/bdcfv5tm), to help build the capacity of the nursing workforce and support the delivery of high-quality care. The registered nursing associate role has been developed to meet the specific needs of the English nursing workforce.

The Shape of Caring review, chaired by Lord Willis, made a number of recommendations to strengthen the capacity and skills of the nursing and caring workforce in England. The review, which reported findings to HEE, identified a skills and knowledge gap between healthcare assistants and registered nurses and the registered nursing associate role was developed to bridge that gap. One of the main recommendations in the review was to explore the need for a defined care role to act as a bridge between the unregulated healthcare assistant workforce and the registered nursing workforce ( Willis, 2015 ).

In December 2015, the Government announced a plan to create a new nursing support role for England ( Department of Health and Gummer, 2015 ). A 6-week consultation on this new role was undertaken by HEE. The NMC was approached to become the regulator for the registered nursing associate and agreed to take on the role, and there was a further consultation regarding changes to the legislation that would allow this to happen ( Department of Health and Social Care, 2018 ).

Nursing and Midwifery Council

The NMC's key function is to regulate. It has a statutory responsibility to maintain the register of nurses and midwives who have demonstrated that they have met the requirements for registration in the UK, and in England, registered nursing associates who have met the conditions for registration. The NMC has set the standards for the professional education that is provided to support those people who have to develop the knowledge, skills and behaviours needed for entry to, or annotation on, the professional register. The NMC influences the practice of those professionals on the register through the development and promotion of standards. The Code ( NMC, 2018a ) provides the professional standards that all registrants must uphold so as to be registered to practise in the UK. The Code is structured around four themes:

• Prioritise people
• Practise effectively
• Preserve safety
• Promote professionalism and trust.

Lifelong learning is promoted through revalidation. The aim of revalidation is to improve public protection, ensuring that registrants remain fit to practise throughout their career as they develop and reflect on their practice. Registrants are required to revalidate every 3 years.

The NMC will investigate and, if required, will act where there are serious concerns that have been raised regarding a nurse, midwife or nursing associate's fitness to practise. Concerns that may put patients at risk or that could undermine professional standards or public confidence will be investigated. Investigation as part of fitness to practise is vital if the NMC aims to achieve its key objective, which is the protection of the public. The NMC, through its various processes, determines whether a registrant's skills, knowledge, education or behaviour has been deemed to have fallen below the standards necessary to deliver safe, effective and kind care. If those standards have not been maintained, steps are then taken by the NMC to keep the public safe and to prevent something from going wrong again. A range of sanctions can be used to protect the public, this may include, in the most serious of cases, removing people from the register.

The professional register

The number of nurses, midwives and nursing associates on the permanent register on 31 March 2022 was 758 303. This is an increase of 3.6% (26 403 professionals) since March 2021 and makes this the highest number of professionals ever seen on the NMC register ( NMC, 2022 ). There are 6874 registered nursing associates on the register. Table 1 provides an overview of the number of registrants since 2019 when registered nursing associates joined the register.

Registered nursing associates, nurses and midwives pay their registration fee annually. The fee payable is the same for all registrants, currently this is £120. The annual registration fee allows registered nursing associates to remain on the register. In addition, once in every 3 years they must also demonstrate that they are competent to provide safe and effective practice and this is undertaken through revalidation. Both processes are compulsory in order to maintain registration. In the full year 2021–2022, a total of 205 044 professionals successfully revalidated, included in this number, for the first time since their entry to the register in 2019, were 370 registered nursing associates.

Programme delivery and standards of proficiency for nursing associates

The Standards of Proficiency for Nursing Associates ( NMC, 2018b ) are the standards that a trainee nursing associate is assessed against. There are six platforms set out with these standards, whereas the Standards of Proficiency for Registered Nurses have seven platforms ( NMC, 2018c ) ( Table 2 ).

Trainee nursing associate programmes are mostly delivered through an apprenticeship model – this is a work-based programme where a student was an employee (existing or new). During the training period the student is working as an apprentice nursing associate. There are compulsory learning days and placements occurring in different areas to meet programme requirements including mandatory protected learning time along with a minimum 460 hours of external practice placements.

Trainee nursing associate programmes are designed to meet local needs and depend on effective partnership working. An alternative full-time pathway is offered by approved education institutions, similar to how pre-registration nursing is delivered. It is important to note that on this kind of pathway the trainee nursing associate is counted as a student of the university, they are not an employee. Being an employee means, for example, that if the trainee nursing associate's ward or unit is short staffed they can be pulled from attending university and have to return to work, or they may be asked to forfeit protected study time and go back to work; service needs come first when employed as opposed to enjoying student status.

The workplace must be conducive to learning as well as having registered staff who are prepared and able to act as supervisors and assessors, in order to effectively support the trainee nursing associate. The NMC's Standards for Student Supervision and Assessment apply ( NMC, 2018d ).

Scope of practice

Registered nursing associates must be able to care for people in their own home, in the community or hospital or in any care settings where a person requires their services; they work as part of a team, they may be required to work alone when caring for people in their own homes or in the community. The context of care in which they work is in a continual state of flux, involving challenging environments, diverse models of care delivery, and older and more diverse populations, as well as the use of innovation and rapidly evolving technologies. As there is an increasing integration of health and social care services, they are required to negotiate boundaries and play a crucial role in multidisciplinary teams.

The Standards ( NMC, 2018b ) are the starting point, the baseline, for a registered nursing associate with regard to competency expectations. Registered nursing associates have a range of skills, knowledge and abilities. Their skills and proficiencies should be used to the fullest degree. The registered nursing associate will develop additional skills and competencies that will complement their working environment as they grow into their scope of practice as well as being a part of their career pathway. It is the responsibility of individual organisations to formulate additional competency standards for the registered nursing associate role.

Scope of practice can be defined as the range of roles, functions, responsibilities and activities that the registered nursing associate is educated and authorised to perform. The vision of the scope of practice for the registered nursing associate role should be reflective of workforce development and clinical need, included as a part of the workforce that provides support to the registered nurse in the delivery of care.

The scope of practice should be agreed as part of the workforce plan, there will also be a need to include governance measures, education and training, ensuring that the skill/task is reflected in the person's job description. Processes must be put in place for any concerns or issues to be raised where a registered nursing associate is alleged to be working outside of their scope of practice. There is also a need to have a robust appraisal system.

As registered professionals, including registered nursing associates, are individually accountable for their own professional conduct and practice, they are required to uphold the principles of the NMC Code ( NMC, 2018a ) and to work within their scope of practice, raising concerns where needed.

Supporting the registered nursing associate in practice

It should be acknowledged that the developing role and scope of practice related to the registered nursing associate is new and, as such, there may not be any local or national definitive list to draw on to guide employers and employees. Effective governance processes must be established and implemented. The overall aim must be to ensure consistency as well as providing the necessary underpinning theory and competence for practice to be safe and for the registered nursing associate to fulfil their role in supporting the registered nurse while acknowledging the role is that of a registered professional in their own right.

As is the case with registered nurses and other health professionals, registered nursing associates can expand their scope of practice through further education, experience and support. Usually, expanding scope of practice takes place after a period of consolidation and preceptorship that supports the transition from trainee nursing associate to registered professional. Proficiencies and skills will require further education as well as competency assessment and to be supported through the individual's job description, policies and guidelines.

Moving forward

As the evidence base develops around the role of the registered nursing associate, it could be that they will be undertaking other activities, these activities should be monitored and where needed changes made to standards and education provision (pre and post registration). It is essential that data are gathered, collated and examined as the evidence underpinning the role increases and the role itself matures and gathers momentum.

The expectation is that the role of registered nursing associate, regardless of care setting, is clearly related to the needs of patients, aligning patient needs with the skills and competencies of the practitioner – this would be the case with any healthcare practitioner. See Table 3 for an overview of the expectations for safe, sustainable and productive staffing.

Lucas et al (2021) conducted a qualitative study in order to explore the views of a number of stakeholders regarding their experiences concerning (what was then) the newly implemented nursing associate role in England as well as the potential the role had to contribute to the care of patients. Their results suggested that the role was ‘broadly adaptable to different healthcare settings and provided a positive professional development mechanism for healthcare support workers’. There were limitations noted with the role, especially when it came to medicines and intravenous medicine management. Some of the respondents commented on the speed at which the role was implemented, suggesting that poor communication and insufficient time for planning could have been factors resulting in role misunderstanding.

Lucas et al's (2021) work was undertaken in an acute care setting, limitations associated with the role in this care setting were noted. The results discussed in this study should not be generalised to other care settings. As the numbers of registered nursing associates increase and deployment to various health and care areas increases, further and ongoing evaluation is required to explore how the role is embedding.

It was noted by Lucas et al (2021) that the registered nursing associate role has to be communicated clearly, ‘championed and supervised and its scope demarcated to build a clear identity within healthcare organisations’. They added a further caution: the role should not be seen as a stepping stone only into registered nursing positions, it needs to be valued in its own right. Reflecting these views, British Journal of Nursing is starting a series of articles that are directed primarily at the registered nursing associate.

The needs of the patient must always dominate when determining what level of practitioner is required to care for them. The registered nursing associate provides care to people in health and social care settings, this role has only been implemented in England. The role has been developed to bridge the skills gap between care assistants and registered nurses, contributing to the core work of nursing, and as such can enable the registered nurse to work at the upper limits of their registration as they focus on more complex care needs and leadership.

The registered nursing associate is educated to foundation degree level. When the trainee nursing associate has successfully completed their programme of study they may apply to the NMC for entry to the professional register thus becoming an accountable practitioner. All registered nursing associates must undertake continuous professional development and demonstrate through revalidation that their practice is up to date.

• The role and function of the registered nursing associate is dynamic and subject to change
• There has been a year-on-year increase in the number of trainee nursing associates undertaking training to become registered nursing associates
• The Nursing and Midwifery Council is the regulator for the registered nursing associate (in England)
• Trainee nursing associate programmes are mainly delivered through an apprenticeship model
• Registered nursing associates are accountable for their actions or omissions

CPD reflective questions

• Consider the role of the registered nurse and the registered nursing associate. What are the differences and similarities between these two roles?
• How does the Nursing and Midwifery Council hold the registered nursing associate to account?
• What do you understand by the term ‘appropriate delegation’?
• Describe the preparation of the trainee nursing associate in order to achieve registered nursing associate status

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Evidence and practice    

Open access exploring the implementation of the nursing associate role in general practice, annie topping director of nursing, nursing and quality directorate, north east and north cumbria integrated care board, england.

• To refresh your knowledge of the nursing associate role and the reasons why it was introduced

• To recognise the barriers and challenges in implementing the nursing associate role in general practice

• To consider how the nursing associate role could be better supported and more widely accepted in general practice

Background The nursing associate role was introduced to help reduce staff shortages in the NHS by bridging the gap between healthcare assistants and nurses. However, there is evidence that its implementation in general practice has been limited.

Aim To understand why, how and to what extent the nursing associate role has been implemented in general practice and what the barriers and enablers have been.

Method Semi-structured interviews and focus group discussions were conducted with a purposive sample of general practice staff in north east England. Template analysis based on a priori themes drawn from the literature was used to analyse the data.

Findings A total of 17 interviews and three focus group discussions were conducted with 29 GPs, managers, nurses, nursing associates, trainee nursing associates and healthcare assistants from five general practices. The barriers to the implementation of the new role included a lack of clarity about the place and purpose of nursing associates, a mismatch between nursing associate training and practices’ needs, tensions around professional boundaries, and challenges in developing a professional identity.

Conclusion In general practice settings, the role of nursing associate is not yet fulfilling its original purpose and it needs to be better supported, accepted and implemented.

Primary Health Care . doi: 10.7748/phc.2023.e1817

This article has been subject to external double-blind peer review and checked for plagiarism using automated software

@nursetopping

[email protected]

None declared

Topping A (2023) Exploring the implementation of the nursing associate role in general practice. Primary Health Care. doi: 10.7748/phc.2023.e1817

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (see https://creativecommons.org/licenses/by-nc/4.0/ ) which permits others to copy and redistribute in any medium or format, remix, transform and build on this work non-commercially, provided appropriate credit is given and any changes made indicated.

Published online: 29 November 2023

career pathways - community - general practice - nursing associates - primary care - professional - skill mix - support staff - workforce - workforce planning

Workforce shortages in the NHS are frequently under the spotlight, often due to their negative effects on service delivery and patient safety ( Buchan et al 2020 , Rolewicz et al 2022 ). The coronavirus disease 2019 (COVID-19) pandemic has increased the demand on healthcare services and the pressures on the NHS ( Shembavnekar et al 2022 ) but the underlying chronic workforce shortages remain and are an area of concern for policymakers and healthcare service managers.

Despite medical and technological advances, delivering healthcare services remains highly labour-intensive. The government has committed to an expansion of the NHS workforce with more GPs and additional resources for professionals including nurses, physician associates, pharmacists and mental health workers, together with an increase in funding ( NHS 2019 , NHS England 2014 , 2016 ).

The workforce continues to be a significant component of the NHS budget and one of the main factors in the increase of healthcare costs ( Addicott et al 2015 ). In 2019/2020, the total expenditure on NHS staff was £56.1 billion, almost 47% of the NHS budget ( King’s Fund 2023 ). Making the most effective use of this resource is critical.

In recent years, acute workforce issues in nursing and general practice have been reported, and continuing staff shortages and high workloads have caused significant strain ( Buchan et al 2019 , Shembavnekar et al 2022 , King’s Fund 2022 ). These issues have been exacerbated by the COVID-19 pandemic and by the subsequent period of recovery ( King’s Fund 2022 ). A Health Foundation report predicted persistent shortages of practice nurses and GPs amid wider workforce concerns ( Shembavnekar et al 2022 ). To help address GP shortages, a change in skill mix in primary care has emerged as one practical response ( Nelson et al 2018 ).

In 2019, as part of the introduction of primary care networks, it was announced that 26,000 additional non-medical clinical staff would be recruited in primary care by 2023/2024 through the Additional Roles Reimbursement Scheme (ARRS) ( Baird et al 2022 ). The nursing associate role is one of 13 roles eligible for that financial support ( Baird et al 2022 , Francetic et al 2022 ). While some primary care networks have been quick to take up the offer of financial support and recruit new staff, there is evidence of ineffective implementation of the ARRS ( Baird et al 2022 ).

The role of nursing associate was created in response to the Shape of Caring review ( Willis 2015 ), with the intention of bridging the gap between healthcare assistants and nurses ( Nursing and Midwifery Council (NMC) 2023a ). Nursing associates are regulated by the NMC (2023a) and the role only exists in England.

This article describes a study conducted to explore the implementation of the role of nursing associate in general practice. To the author’s knowledge it is the first of its kind. It is intended to inform the future planning and implementation of the nursing associate role and other non-medical roles in primary care and beyond.

Implications for practice

• Skill-mix changes in general practice need to be underpinned by robust workforce planning

• Preceptorship and peer support are needed to facilitate the integration of newly registered nursing associates in general practices

• Integrated care boards, primary care networks and general practices need to work together to clarify the role of nursing associate

• The possibility for nursing associates to administer medicines under a patient group directive needs to be explored

• The structure and contents of nursing associate training programmes must better reflect the needs of general practice

• Public and professional awareness of the nursing associate role could be raised through a media campaign

To understand why, how and to what extent the nursing associate role has been implemented in general practice and what the barriers and enablers have been.

The associated research questions were:

• In establishing (or institutionalising) the nursing associate role, what processes are followed?

• What effect does professional role identity have on the legitimisation process?

• What are the early effects of implementing the nursing associate role?

A qualitative multiple case study design with an interpretive approach was used. According to Yin (2017) , such an approach enables researchers to investigate ‘how’ and ‘why’ questions in situations where participants’ behaviours are not under their control. A multiple case study design is generally more compelling and robust than a single case study design ( Yin 2017 ).

Participants

Purposive sampling was used to recruit general practices in north east England. Because there are few nursing associates in primary care, all practices in the region who employed nursing associates were invited to take part. Recruitment was carried out through the nursing directors of the seven local clinical commissioning groups (CCGs) and supported by the Health Education England senior nursing workforce regional lead and research engagement leads. Five general practices in five out of the seven CCGs were recruited. Table 1 shows the demographics of the participating general practices.

Table 1.

Demographics of the participating general practices, data collection.

Data were collected between October 2021 and October 2022, at least six months after the nursing associates employed by the practices had registered, so that they would have had time to settle in their new role. NHS England (2022) recommends a minimum length for preceptorship programmes of four months, so six months was considered a reasonable time period.

Semi-structured interviews were used. Different members of staff were interviewed in each practice: GPs, managers (nurse managers or practice managers), nurses and nursing associates. A different semi-structured interview schedule was used for each participant group, with questions covering three broad areas:

• General views on the nursing associate role.

• Use of the nursing associate role in daily practice.

• Effects of the implementation of the new role.

Nursing associates were also asked about their relationships with members of the practice team and patients.

In three of the five practices, focus group discussions were held with various members of the nursing team – nurses, trainee nursing associates and/or healthcare assistants.

All interviews and focus groups discussions were audio-recorded and transcribed verbatim. The transcripts were anonymised and the data transferred to NVivo (version 12) software.

Data analysis

Template analysis, a form of thematic analysis ( King and Brooks 2017 ), was used to identify and organise themes from the interviews and focus group discussions. A priori themes generated by a review of the literature on the implementation of new work roles were used as the basis for template analysis – in particular Kessler et al’s (2017) work on the institutionalisation of new support roles in healthcare, which had expanded the model proposed by Reay et al (2006) . The focus was on identifying overarching organisational and operational factors affecting the implementation of the nursing associate role and the early effects of its implementation. Data were first analysed at the level of each practice and then across practices.

Ethical considerations

Ethical approval had been obtained from Northumbria University, Newcastle upon Tyne, and from the Health Research Authority. Informed consent was obtained from the GP practices and all the participants. Pseudonymisation of personal data was carried out to ensure the confidentiality of personal data.

In total, 17 interviews and three focus group discussions were conducted with 29 members of staff. Table 2 shows participants’ role and the data collection methods used. All nursing associates had previously been employed by their respective practice as healthcare assistants.

Table 2.

Participants’ role and the data collection methods used.

Five themes emerged from the analysis of the data:

• Motivations for introducing the new role.

• Role purpose, scope and remit.

• Professional identity.

• Barriers to implementing the new role.

• Early effects of the new role.

Motivations for introducing the new role

Initially the author had hypothesised that the COVID-19 pandemic and its effects on staff numbers and service needs would have been one of the main factors motivating general practices to introduce the nursing associate role. However, this hypothesis was not borne out by the study.

In all five practices, workforce-related factors were identified as the first motivation for introducing the new role. Reasons for introducing the role included the shortage of nurses, an ageing workforce, the difficulty attracting younger people to general practice, issues with retaining staff, succession planning and workforce development. In all practices there was a strong desire to develop the experienced healthcare assistant workforce.

The second motivation for introducing the new role was service needs, both short-term and longer-term, articulated at strategic and operational levels. In practice 2, a multidisciplinary model had been envisaged to address the shortages of GPs and nurses.

Participants in practices 2, 3 and 4 mentioned cost savings as a motivation for introducing the new role. Those in practice 3 also recognised and welcomed cost savings as a secondary benefit of the change. Participants in practice 4 thought that the initial cost of introducing the role would be set offset by long-term gains. In practices 2 and 3, the additional funding via the ARRS was explicitly discussed as an incentive:

‘So it wasn’t really something that we had to consider as strongly as we would have done for other roles, because of the fact that it wasn’t coming out of our core funding.’ (GP, practice 2)

In practice 2, one nurse expressed scepticism regarding the official reason given for introducing the role, believing the change to be financially driven:

‘They’re going to be doing [a practice nurse’s] job for a fraction of the price, really.’ (Nurse, practice 2, focus group discussion)

Role purpose, scope and remit

For the most part, the nursing associates had continued to carry out the tasks they had been undertaking as healthcare assistants. The number of enhanced or additional duties allocated to them was limited. One registered nurse interviewed in practice 1 explained that there were not enough tasks in the week to fill a full-time nursing associate post.

Table 3 outlines the tasks carried out by nursing associates in the five participating practices.

Table 3.

Tasks carried out by nursing associates in the five participating practices.

Despite having similar job descriptions, the nursing associates had taken on varying responsibilities ( Table 3 ). Their role was described in all practices as being on a continuum from healthcare assistant to nurse. The manager in practice 1 described the duties of a nursing associate as:

‘The higher level of healthcare assistant work… coming from a different mindset because of the training.’ (Manager, practice 1)

In practice 2, participants highlighted the overlapping of the roles between healthcare assistant and nursing associate. In practice 3 it was considered that involvement in clinical decision-making was an important difference between nursing associates and healthcare assistants. Members of the nursing team in practice 5 considered that the nursing associate would stand out from their previous healthcare assistant role by gaining new skills.

In practices 1, 2 and 3 some participants expressed the view that nursing associates and newly registered practice nurses had comparable responsibilities and that this should be reflected by pay equity:

‘The only issue I have with this is, I think, the need to be banded in a band 5 across the board instead of a 4. I really do because [nursing associates are] actually doing band 5 work.’ (Nurse, practice 1, interview)

In all practices except practice 4, participants compared the role of nursing associate to the role of state enrolled nurse, which was abolished in the 1990s. In practices 2 and 4, members of the nursing team considered that the nursing associate role was of less use than that of healthcare assistant and was not needed in general practice.

A lack of clarity about the role of nursing associate was highlighted in all practices and participants had expected more guidance from the NMC on that aspect. Scope, remit, accountability, boundaries and professional identity were all cited as areas that lacked clarity. At times the practices appeared to struggle to determine the place and purpose of nursing associates and to decide what responsibilities could be allocated to them. Nurses in particular were unsure where accountability for some delegated tasks would lie. The nurse interviewed in practice 4 described ‘huge grey areas’ in that respect.

Accountability is integral to delegation and crucial when developing a new professional role. There was a perception that although NMC registration instilled confidence it could not automatically be interpreted as enabling delegation. Participants in practices 3 and 4 considered that having confidence in the person was more important than the fact that they were registered. Participants’ views on the role of nursing associate and their perceptions of the individuals taking up the new role in their practice appeared intertwined.

Based on the author’s professional experience and knowledge, the introduction of the nursing associate role was further complicated by a lack of robust service and workforce planning and the higher skill set of healthcare assistants working in general practices compared with healthcare assistants working in the hospital setting. This was confirmed by the findings of this study, for example one trainee nursing associate from practice 2 indicated that she could already carry out some of the duties of the nursing associate role as a healthcare assistant. As a result, the practices proceeded cautiously, with the contents of the role being a matter for local interpretation and its development slower than expected.

Future development opportunities envisaged for nursing associates included practical ‘treatment room’ duties such as ear syringing, dressings, vaccinations and blood pressure monitoring. Some practices envisaged that nursing associates would replace practice nurses over time.

Professional identity

Developing a professional identity was something all nursing associates found challenging, with one of them stating:

‘It’s been very hard to shake the fact that I’m no longer a healthcare assistant with other members of staff… and I do feel like I have struggled to get out of the [healthcare assistant] box since I’ve qualified. It is an ongoing thing.’ (Nursing associate, practice 5)

In practice 5, the new role created tensions in the nursing team. According to the nursing associate in that practice, their promotion to a higher role and their alignment with other registered healthcare professionals had caused ‘a bit of a backlash’ from the team. The nurse interviewed in practice 4 explained that some healthcare assistants had ‘difficulties in sort of accepting [the nursing associate’s] new role and also for the team in general [it’s] taken a little bit of getting used to’.

All nursing associates had continued their previous duties and, overall, practices had maintained their old ways of working. This compounded the challenges for nursing associates to establish a distinctive professional identity. Furthermore, nursing associates described a severe lack of support from the university for trainee nursing associates in primary care, with one of them describing their experience as:

‘Like hitting a brick wall every single step of the way.’ (Nursing associate, practice 5)

In some cases, the new role had been – or was going to be – advertised on the practice’s website. In practices 1, 2, 3 and 5, participants thought that patients had shown little or no awareness of the new role; however, according to participants, some patients had noted the change in uniform or the different tasks taken on by nursing associates and some patients had compared it to the role of state enrolled nurse.

Barriers to implementing the new role

Table 4 summarises the barriers to implementing the new role identified by participants.

Table 4.

One barrier mentioned by participants was that practices have to organise aspects of the training programme beyond the time trainee nursing associates spend at the practice. For example, according to participants, practices have to contact relevant organisations to arrange external placements for trainees, secure honorary contracts and negotiate access to clinical areas, particularly in hospital settings.

Another barrier was that the contents of the education provided by universities was not always relevant to general practice. Some participants questioned whether the training programme was fit for purpose for primary care settings. In practices 4 and 5, participants criticised the level of support from the university for trainees and for the practice. In practice 4, participants wondered whether their nursing associate might have stayed if better support had been available during training and after registration. At the time of the study, there was no peer support network for nursing associates in primary care nor any preceptorship programme for newly registered nursing associates working in general practice.

In line with the NMC (2023b) standards for student supervision and assessment, trainee nursing associates must be supported by a practice supervisor, who has to be a nurse and undergo specific training for their supervisor role. Practices found it challenging to provide supervision, notably because of limited physical space. The capacity of practices to train and supervise trainees was further hampered by nurses’ workload and the shortage of nurses, in general and especially during the COVID-19 pandemic. Some practices also lacked the physical space to set up additional clinics that nursing associates could take on once they had registered.

Additional subject-based training was considered necessary before newly registered nursing associates could take on certain responsibilities, for example cervical screening, which practices would have to pay for. Another barrier cited by participants was that nursing associates were not allowed to administer medicines under a patient group directive.

Early effects of the new role

Participants in practices 1, 2, 3 and 5 reported an increase in the capacity for patient appointments. In practices 1, 3 and 5, nurses had more time to focus on patients with complex long-term conditions. Releasing GPs’ time was mentioned in practice 3, while in practice 5 the early effects of the new role were described as ‘keeping services running’. Early effects included a higher quality of service resulting from the nursing associate’s enhanced knowledge (practice 1), continuity of care (practice 5), resilience of the nursing team (practices 3 and 5), additional skills leading to better patient access and choice (practice 2) and having more time with patients (practice 2). Other staff had benefited from the presence and support of a nursing associate: in practice 1 the nursing associate had mentored a phlebotomist; in practice 2 the nursing associate had supported trainee nursing associates; and in practice 5 the nursing associate had supported a new practice nurse.

Studies on the implementation of new roles in healthcare are scarce ( Kessler et al 2017 ) and evidence regarding primary care is generally lacking ( Nelson et al 2018 , Spooner et al 2022 ). This study adds to the evidence in these under-researched areas and to the emerging evidence on the implementation of the nursing associate role in settings other than general practice ( Kessler et al 2020 , 2022 ).

Contrary to the findings of Gibson et al (2023) , the primary reason to implement the role of nursing associate was to address workforce issues, not to increase appointments. In that respect the findings of the present study reflect the rationale given by chief nurses for introducing the role ( Kessler et al 2020 ) and other evidence on introducing new roles in healthcare ( Bungay et al 2013 , Drennan et al 2014 , 2019 , Evans et al 2020 ).

Payment systems can enable skill-mix changes ( Sibbald et al 2004 ) and are used often to encourage the uptake of new roles ( Drennan et al 2019 , Gibson et al 2023 ). However, in the present study financial incentives did not appear to be one of the main motivating factors, which reflects the findings of Gibson et al (2023) . Data from NHS Digital (2022) showed that despite a 41.7% increase in direct patient care staff employed in England under ARRS between March 2019 and March 2022, the numbers of nursing associates and trainee nursing associates remained low overall in March 2022. The actual increase between this period was 0.07% for nursing associates and 0.88% for trainee nursing associates. Furthermore, the author of this article has access to evidence to confirm that many practices have not been taking advantage of the ARRS to introduce trainee nursing associates and nursing associates. This suggests that the financial support may need to be more targeted at specific staff groups to be effective.

Skill mix can be changed in many ways. The findings of the present study support previous research that emphasised the importance of paying attention to the process of implementing skill-mix changes ( Sibbald et al 2004 , Nelson et al 2019 , Maier et al 2022 , Spooner et al 2022 ). They also illustrate how important it is to clarify the scope of new roles, as emphasised by various authors ( Drennan et al 2014 , van der Biezen et al 2017 , Halse et al 2018 , Nelson et al 2018 , Drennan et al 2019 , Maier et al 2022 ).

Professional identity has been described as highly resistant to change ( Chreim et al 2007 ). The relationship between role and professional identity needs to be recognised so that the development of a new role is accompanied by the construction of a professional identity ( Chreim et al 2007 , Goretzki et al 2013 ). In the present study, challenges in the construction of a professional identity included the existence of the well-established role of healthcare assistant, recollections of the defunct role of state enrolled nurse and the absence of a strong narrative for the new role of nursing associate. The lack of peer support networks and preceptorship programmes and the absence of role models for nursing associates in primary care at this early stage compounded the challenges.

A major revision of people’s skills and competencies is necessary before they can adopt a new role ( Sibbald et al 2004 ) and various authors have highlighted that this requires adequate resources ( Halse et al 2018 , Drennan et al 2019 , Kilpatrick et al 2019 , Greenhalgh et al 2020 ). The findings of the present study suggest that current nursing associate training programmes do not meet all the needs of general practices nor those of nursing associates working in general practice. Some participants felt that nursing associates were not ‘practice ready’ on registration and it is possible that nursing associate training programmes are more targeted at the hospital setting. If the nursing associate role is to be expanded in general practice, it is essential that training programmes are tailored to that setting. For example, all nursing associates appear to need additional subject-based training after registration, such as cervical screening, so this needs to be included in their preregistration training.

Some practices seemed unconvinced of the benefits of the nursing associate role, considering the efforts and investment required. The main factor that will determine the scale and pace of any future roll-out of this role in general practice is the presence of demonstrable benefits and added value. Kessler et al (2017 , 2021) similarly concluded that the decision to implement the role would depend on there being evidence of a distinct contribution and improved quality of care.

Limitations

The number of participants was relatively small, which was partly due to the fact that the study took place during the COVID-19 pandemic. The findings would have had further weight with a larger sample size, wider regional coverage, the inclusion of other sources of evidence and a mixed-method study design.

There is limited evidence regarding the implementation of the nursing associate role, particularly in general practice settings. This study, believed to be the first of its kind, provides insights into why, how and to what extent the nursing associate role has been implemented in general practice. Barriers to its implementation appear to include a lack of clarity about the role, a mismatch between nursing associates’ training and the needs of general practices, the lack of a strong narrative for the role, and the challenges encountered by nursing associates in developing a professional identity.

The author suggests that in general practice the nursing associate role is not yet fulfilling its original policy purpose, and that it needs to be better supported and more widely accepted and implemented.

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By Philip T. Beckwith, School of Healthcare Practice, University of Bedfordshire

Contact: [email protected]

Concerns were raised at the 2017 National Trainee Nurse Associate Conference. The Associate Nurse Work-based Learning Signature Pedagogy creates constructive alignment to the work based learning units of the nurse associate programme and aims to address these concerns. However, attempts to locate a pedagogic approach for high quality learning and skills development have proved unsuccessful. Further exploration of Bloom’s (1956) taxonomy and Anderson & Karthwohl’s (2001) adaption of Bloom’s taxonomy have failed to align with Biggs’ (1999) model of constructive alignment and have led to the creation of the Higher Order Thinking and the Skills of Higher Order Thinking (HOTSHOT) taxonomy which redefines Higher Order Thinking Skills (HOTS). Additionally, a move away from Socratic dialogue to reflection enabled the evolution of the signature pedagogy framework into a reflective signature pedagogy framework. The Associate Nurse Work-based Learning Signature Pedagogy offers a solution to the concerns raised, based upon robust pedagogical theory.

Introduction

The Secretary of State for Health announced an expansion in the numbers of Nursing Associates on 3 October 2017. Plans will see 5,000 Nursing Associates trained through the apprentice route in 2018 and 7,500 in 2019.

Details of the expansion will be confirmed by HEE in the forthcoming weeks for employers, Higher Education Institutes and prospective Nursing Associate applicants.

The expansion builds on Health Education England’s (HEE) current pilot project which has 35 test sites training 2,000 Nursing Associates. Early feedback from the ongoing evaluation is very positive, with employers reporting enthusiasm for the role and its potential for adding value to the work of their multidisciplinary teams.

Health Education England (2017, p. 1)

Jones (2017, p. 109) declared that ‘we are now at a point where the test sites for associate nurses have been identified, Skills for Health are working with Health Education England but as yet, no educational framework has been published’. This new way of training and learning within the clinical setting presents a variety of challenges that require a new pedagogical approach. The accepted conventions were visited and where necessary challenged, allowing the emergence of new pedagogical thought.

In a recent exploration of Bloom’s (1956) taxonomy and Anderson & Karthwohl (2001)’s adaption of Bloom’s taxonomy, it was concluded that it is Bloom’s use of nouns and Anderson & Karthwohl’s insistent use of verbs that creates a dichotomy (Lewis and Smith, 1993) between higher order thinking skills and critical thinking (Beckwith, 2018). Lewis and Smith (1993) determined that scientific problem solving was the domain of higher order thinking skills and therefore posited that critical thinking was the domain of the social studies. Furthermore, Lewis and Smith (1993) endeavoured to define higher order thinking as ‘reasoning, critical thought and problem solving’ but their review of the literature available at the time contradicted this definition. They concluded that higher order thinking was a ‘conceptual swamp’ (Lewis & Smith,1993).

As part of a mixed method study, a systematic literature review was undertaken with the purpose of defining Higher Order Thinking Skills (HOTS) (Beckwith, 2018). This review produced a mixture of noun and verb keywords, much like the ‘conceptual swamp’ found by Lewis & Smith (1993), but closer analysis revealed not two keyword themes, but three keyword themes: activity nouns, synthesis verbs and implementation nouns (Beckwith, 2018) (Figure 1).

This revelation then led to mapping of the three themes to the Pyramid of Lower and Higher Order Thinking (Beckwith, 2018) (Figure 2). Mapping the specific types of nouns and verbs revealed that activity nouns are lower order thinking activators, synthesis verbs are Higher Order Thinking, and implementation nouns are Skills of Higher Order Thinking (Figure 2).

Figure 2: Pyramid of Lower and Higher Order Thinking

This means that Bloom’s nouns and Anderson & Karthwohl’s verbs can be replaced by the nouns and verbs indicated in Figure 1 (Beckwith, 2018). These nouns and verbs do not authenticate HOTS, but confirm Higher Order Thinking and the Skills of Higher Order Thinking (HOTSHOT) (Beckwith, 2018). The HOTSHOT taxonomy is compared to Bloom’s original taxonomy and Anderson & Karthwohl’s adaptation in Figure 3.

Having defined the components of the HOTSHOT taxonomy, the HOTSHOT taxonomy was mapped to Biggs’ (1999) constructive alignment model (Beckwith, 2018). This creates the Signature Pedagogy framework that was not possible using Bloom’s or Anderson & Karthwohl’s taxonomies alone (figure 4). This framework provides a structure that ensures quality, reliability, and consistency to the Nurse Associate Programme. With this strong structure in place, further needs of the programme can be addressed.

Figure 4: Associate Nurse Signature Pedagogy Framework

The Signature Pedagogy and the Nurse Associate Trainee

The Associate Nurse Programme requires trainees to move from novice toward expert practice in line with Benner’s (1984) transformation continuum, which asserts that nurses move from detached observers to involved performers as part of the novice-to-expert model. This is a well-established nurse education theory. Benner’s use of the ‘formation’ is described as something that ‘points to being constituted by the meanings, content, intent and practice of nursing rather than merely learning or being socialized into a nursing role in an external way’ (Benner et al., 2010, pp. 86-87).

This programme also requires trainees to demonstrate preparedness for registration with the Nurse and Midwifery Council (NMC) by meeting ‘The Code: Professional standards of practice and behaviour for nurses and midwives’ (NMC, 2015) to which the qualified Associate Nurse will be held accountable.

An assessment for the Associate Nurse programme requires trainees to:

‘Write an essay that offers an evidence based reflective style rationale as to why the work based skills (no more then 2) chosen for development in the second year of the course are relevant to the Nursing Associate’s area of practice and to the advancement of the work based role’.

‘The essay will reflect on the role of the Nursing Associate in their practice area providing care. Please include the two (2) selected skills in an appendix, added at the end of the essay, after the references’

(University of Bedfordshire, 2016)

All of these requirements demonstrate the enhancement of the Associate Nurse Signature Pedagogy Framework with the Reflection for Learning model (Beckwith, 2016). This reflective model will assist the trainee in reflecting upon clinical experience, develop self-awareness, and engage in critical thinking in order to move from novice towards expert, prepare for professional registration, meet the assessment requirements, and encourage lifelong learning via continuing professional development. Combining the Reflection for Learning model with the Associate Nurse Signature Pedagogy Framework requires an understanding of each phase of the Reflection for Learning model (Figure 5) (Beckwith, 2016).

Reflection for Learning

Reflection for Learning begins with the event (RfL step 1) where the student is asked to remember an experience and attempt to understand the actions and processes that led to the event (Beckwith, 2016). This is adapted for the Nurse Associate Trainee, who defines the event as the skills that have been selected for him or her to develop.

For the influence point (RfL step 2) in the reflective cycle, the student is asked to identify the reason for selecting this particular event. This leads the student to create a reflective question based upon their own experience (Beckwith, 2016). In step 2 the Nurse Associate Trainee, having identified the skills they wish to cultivate, will develop a reflective rationale, outlining his or her individual developmental needs as well as the potential to enhance the patient experience and service delivery.

The overview (RfL step 3) of the reflective cycle is where the student undertakes an analysis and is asked to research the event with the aim of expanding upon previous knowledge and developing in an evidence-based manner (Beckwith, 2016).

In step 3, the Nurse Associate Trainee is asked to analyse and research the desired skills with the aim to determine achievability and applicability to the band 4 Nurse Associate roles.

For the synthesis section (RfL step 4) of this model, the student is asked to take the evidence discovered or reviewed and apply this to his or her identified event demonstrating new evidence-based thinking and perhaps a different approach that will affect future practice (Beckwith, 2016). The Nurse Associate Trainee will undertake the development required to attain the defined new skills and apply these skills to his or her practice. Each trainee must evaluate whether local policy will need to be altered to reflect the Nurse Associate Trainee as the named person to practice this particular skill and address any accountability concerns.

The personal development plan (RfL step 5)of this reflective model asks the student to formalise synthesis achieved in the previous step by creating a plan to continue to employ this new learning and identify resources needed in order to re-encounter the identified event once again (Beckwith, 2016). For the Nurse Associate Trainee this step is modified to encompass the reflective essay outlined in the trainee’s assessment brief, exploring and analysing their journey, and outline how they will maintain currency and competency in these skills up to and beyond registration.

The signature pedagogy framework (Figure 4) can now be populated with the five steps of the modified Reflection for Learning model, giving rise to the Associate Nurse Work-based Learning Signature Pedagogy (Figure 6).

Figure 6: The Associate Nurse Work-based Learning Reflective Signature Pedagogy

Some educators advocate the use of Socratic dialogue as an effective way to guide trainees in the transfer of analytical thinking to professional skills (Coughlin, McElroy and Patrick, 2009). However, as the Trainee Nurse Associate programme is uniquely individualised to each student, this delivery style would be limiting.

Another traditional training technique in a wide variety of health professional programmes is ‘see one, do one, teach one’. Coughlin, McElroy and Patrick (2009, p.379) cite the Best Practice report whereas ‘in addition to experience, students can more rapidly develop problem-solving expertise by… observing how experts solve problems’. These authors also assert that students must observe experts many times in order to improve performance.

This accepted cognitive apprenticeship concept of ‘observing how experts solve problems’ for optimal learning is addressed in the Associate Nurse Work-based Learning Signature Pedagogy (figure 6) as this concept is synonymous with lower order thinking: activity nouns ‘critical thought’ and ‘reflective thinking’. When the trainees observe the expert, critical thought occurs at the time of the observation and continues with reflective thinking of the event observed. This then leads the trainee to move from lower order thinking to the Higher order thinking through the synthesis verbs ‘elucidating’ and ‘problem solving’ (Figure 6). In this way the student is able to use this experience to begin to move from novice to competent trainee through the ability to problem solve around this event.

Coughlin, McElroy and Patrick (2009) counter that this is merely the trainee mimicking the expert and may learn just enough to pass the related assessment without actually gaining the understanding required to practice in a safe manner. However, the implementation verbs of the HOTSHOT taxonomy ‘production’ and ‘justification’ require the student to justify through his or her assessment and therefore demonstrate understanding giving both robustness and credibility to the signature pedagogy.

Recently Anna Beckett (2017) delivered a presentation entitled ‘Evaluating the Impact of Nursing Associates: Emergent Findings’ . A concern highlighted in this presentation was the need for quality assurance between programmes due to the variety of structures that have emerged. The Associate Nurse Work-based Learning Signature Pedagogy (Figure 6), with its constructive alignment and reflective structure offers a robust, defined and consistent, yet flexible, structure to the work-based learning component of the programme. This would offer the quality assurance expected of a pre-professional programme.

Beckett (2017) also indicated three areas of nursing associate training that requires further improvement that includes streamlining the workload associated with the programme, promoting awareness and understanding of the new role and training programme, and addressing unwarranted variation in the trainees’ work based learning. The Associate Nurse Work-based Learning reflective Signature Pedagogy (figure 6) addresses all three considerations.

Streamlining the trainee workload associated with the programme is addressed by providing a structure for the trainee to utilise to organise skill development. Promoting awareness and understanding of the new role and training programme is addressed by the trainee’s creation of his or her personal development plan to aid in maintaining competence and currency in skills attained. Addressing unwarranted variation in the trainees’ work based learning can be achieved by following the established structure, despite personalisation for each trainee, and provides consistency throughout the programmes.

Recently concerns were raised at the 2017 National Trainee Nurse Associate Conference regarding the streamlining of the workload within the programme, promoting awareness and understanding of this new role, addressing variation in the trainees’ work based learning and the need for quality assurance between programmes due to the variety of structures. The Associate Nurse Work-based Learning Signature Pedagogy creates constructive alignment to the work based learning units of the nurse associate programme and addresses these concerns.

Attempts to locate a pedagogic approach for high quality learning and skill development proved unsuccessful because Bloom’s (1956) taxonomy and Phol’s (2000) adaption of Bloom’s taxonomy failed to align with Bigg’s (1999) model of constructive alignment. Further exploration of these highly regarded taxonomies lead to the creation of the Higher Order Thinking and the Skills of Higher Order Thinking (HOTSHOT) taxonomy which redefines Higher Order Thinking Skills (HOTS). Additionally, a move away from Socratic dialogue to reflection enabled the evolution of the signature pedagogy framework into a reflective signature pedagogy framework.

The Associate Nurse Work-based Learning Signature Pedagogy offers a solution to the concerns raised based upon robust pedagogical theory at the midway point of the current pilot programmes with recommendations for re-evaluation of the work-based learning component when appropriate.

Anderson, L., Krathwohol, D. eds. (2001) A taxonomy for learning, teaching, and assessing: A revision of Bloom's taxonomy of educational objectives. Allyn and Bacon.

Beckett, A. (2017). 'Evaluating the impact of Nursing Associates Emergent Findings', National Trainee Nurse Associate Conference. De Vere Grand Connaught Rooms, 61 - 65 Great Queen Street, London, England 22nd November 2017. Lomdon: Health Education England, pp 1-9.

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Coughlin, C., McElroy, L. and Patrick, S. (2009) 'See One, Do One, Teach One: Dissecting the Use of Medical Education's Signature Pedagogy in the Law School Curriculum', Georgia State University aw Review, 26 (2), pp.361-416.

Health Education England (2017) Nursing Associate - shared narrative. Available at [ https://www.hee.nhs.uk/sites/default/files/documents/nURSING%20Associate%20narrative.pdf] accessed 10/01/2018

Nursing & Midwifery Council (2015) The Code: Professional standards of practice and behaviour for nurses and midwives. London: Nursing  & Midwifery Council.

Jones, T. (2017) 'How will the nursing associate role fit within the neonatal workforce?' Journal of Neonatal Nursing (23), pp 109-111.

Lewis, A. and Smitrh, D. (1993) 'Defining higher order thinking', Theory in to Practice, 32 (3), pp 131-137.

University of Bedfordshire (2016) ASP008-2 Unit Information Form, Luton: University of Bedfordshire. pp.1.

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Primary care trainee nursing associates in England: a qualitative study of higher education institution perspectives

Steve robertson.

1 RCN Strategic Research Alliance, Division of Nursing & Midwifery, Health Sciences School, Barber House Annexe, 3a Clarkehouse Road, Sheffield S10 2LA, UK

2 Leeds Beckett University, Leeds, UK

3 Waterford Institute of Technology, Waterford, Ireland

Rachel King

Bethany taylor.

4 Department of Nursing, Winona State University, Winona, MN, USA

Michaela Senek

To explore higher education institution (HEI) perspectives on the development and implementation of trainee nursing associates (NAs) in the primary care workforce in England.

Background:

Current shortages of primary health care staff have led to innovative skill mix approaches in attempts to maintain safe and effective care. In England, a new level of nursing practice, NAs, was introduced and joined the workforce in 2019. This role was envisaged as a way of bridging the skills gap between health care assistants and registered nurses and as an alternative route into registered nursing. However, there is limited evidence on programme development and implementation of trainee NAs within primary care settings and HEI perspectives on this.

This paper draws from a larger qualitative study of HEI perspectives on the trainee NA programme. Twenty-seven staff involved in training NAs, from five HEIs across England, were interviewed from June to September 2021. The interview schedule specifically included questions relating to primary care. Data relating to primary care were extracted and analysed using a combined framework and thematic analysis approach.

Three themes were developed: ‘Understanding the trainee role and requirements’, ‘Trainee support in primary care’ and ‘Skills and scope of practice’. It is apparent that a more limited understanding of the NA programme requirements can lead to difficulties in accessing the right support for trainees in primary care. This can create challenges for trainees in gaining the required competencies and uncertainty in understanding what constitutes a safe scope of practice within the role for both employers and trainees. It might be anticipated that as this new programme becomes more embedded in primary care, a greater understanding will develop, support will improve and the nature and scope of this new level of practice will become clearer.

Introduction

The current shortage of medical and nursing staff within the United Kingdom (UK) health care workforce has been well documented (Buchan et al. , 2020 ; British Medical Association, 2021 ). This issue has been specifically highlighted in the UK primary care sector where the chronic shortage of general practitioners (GPs) has been associated with difficulties in accessing GP appointments (Royal College of General Practitioners, 2021 ). Similarly, concerns about the shortage of nurses within the UK community, nursing home and primary care sector have also been recognised and are predicted to become worse in the coming years partly due to an ageing workforce and the difficulties of recruiting internationally for posts that often require additional post-basic qualifications (Buchan et al. , 2020 ).

In England, one solution to help address the staffing shortage across the health and social care system was to introduce a new second-level nursing qualification – the nursing associate (NA). This level of practice is similar to that of ‘Licensed Practical Nurses’ in North America and ‘Enrolled Nurses’ in Australia and New Zealand. The suggestion for developing a new role was first recommended in the Shape of Caring review (Health Education England, 2015 ) which explored the future education and training needs of health care assistants (HCAs) and registered nurses (RNs). HCAs are non-registered members of the team who work alongside health professionals. In December 2015, the then Secretary of State for Health announced a plan to create a new nursing support role with the provisional title ‘nursing associate’ (Department of Health and Social Care, 2015 ) and in October 2016 Health Education England (HEE) was mandated to lead the piloting and development of the training for this role (Department of Health, 2016 ). Several drivers underpinned these decisions including the wish to facilitate career development for HCAs, the need to fill an identified clinical skills and knowledge gap between HCAs and RNs, and a desire to create an alternative route to becoming an RN.

The NA training is completed over two years at Foundation Degree level. The first two pilot groups of trainee NAs, based at 11 centres across England, commenced in 2017 and began joining the workforce in early 2019. While this pilot was funded directly by HEE, subsequent cohorts have mainly been funded through an apprenticeship model. As a consequence, trainees are primarily employees, many of whom are already been working as a HCA, who are expected to have time release for study leave (equivalent to one day a week) and for alternative placements (away from their employment base), rather than being students needing to gain experience in health and social care settings. In this sense, NA learning differs from that of traditional RNs in the UK and from second-level nurse educational status in North America and Australasia where learners are students not employees.

The requirement to undertake alternative placements, in a range of settings, links to a further important aspect of NA training. It was recognised from the outset that NAs should provide a flexible addition to the nursing workforce, able to work across any and all parts of the health and social care system. This would be achieved by ensuring trainees gain experiences across the four UK recognised fields of nursing (Adult, Child, Learning Disabilities and Mental Health) and that they develop experience of providing care ‘in hospital’, ‘close to home’ and ‘at home’ (Nursing and Midwifery Council, 2018 ). The ability of NAs to provide care in primary care contexts was therefore seen as crucial and linked to helping manage the increasing long-term conditions agenda, an important part of the National Health Service Long Term Plan (NHS, 2019 ).

Implicit in this requirement for NAs to be a flexible member of the nursing workforce is that trainees need to either be based with a primary care employer or be able to gain sufficient alternative experience within community and primary care settings. In England, community services within the NHS are provided through Community Trusts (these are sometimes part of a larger Trust that also includes hospital sector services) and consist of a range of services, such as district nursing, specialist long-term conditions care, preventative services like sexual health, child health services and others. Primary care on the other hand is delivered by general practices (GPs) that are independent, small- to medium-sized businesses contracted by the NHS to deliver services within a geographical or population area. Survey work commissioned by the National Institute for Health Research (NIHR) Policy Research Programme shows that Community Trusts tend to have smaller numbers of trainee NAs than Acute Trusts (Kessler et al. , 2021 a). While this work provides no data on the employment of trainee NAs or qualified NAs in primary care (in GP), early nationally commissioned evaluations of the NA pilot programme noted that only 2% of trainees came from primary care (Traverse, 2019 ). However, following changes in the funding mechanisms for these trainees (ESFA, 2020 ), the numbers employed by the primary care sector are now increasing rapidly (Robertson et al. , 2022 b).

An overview of the limited research that has been undertaken on the NA role in community and primary care settings (Robertson et al. , 2022 b) highlights several issues of importance. First, it provides some evidence of the benefits that trainee and qualified NAs might bring to these sectors, such as trainees becoming more person-centred (less task focused), having increased skills in helping patients self-manage and freeing up RN time to engage in more complex care. Second, it notes that trainees in these sectors experience lower levels of support than their hospital-based peers. Third, it suggests that trainee NAs in community and primary care had a less clear sense of their professional identity, and of their future career direction, than their hospital-based peers. Finally, it flagged emerging concerns from the higher education institution (HEI) sector around the organisation and availability of placements, opportunities for peer support, and having adequate access to practice-based assessors (which is a requirement of the training in all clinical settings) for trainees employed in the primary care sector.

This paper adds to the limited evidence on the programme development and implementation of trainee NAs within primary care settings. Specifically, it explores the perspectives from the HEI (university) sector on the development and implementation of trainee NAs within primary care.

This paper stems from a larger programme of research looking at the motivations, experiences and career aspirations for trainee NAs. Specifically, it is developed from a strand of this research programme that sought the perspectives of staff from HEIs. The design and methods of this HEI element of the research, and the specific aspects focusing on the primary care trainee NAs, are reported here using components from an abridged version of the Consolidated Criteria for Reporting Qualitative Research proposed by Tong et al. ( 2007 ).

Study design

A descriptive and exploratory qualitative design within an interpretive framework was used to explore HEI perspectives on the development and implementation of the trainee NA programme. This paper focuses specifically on data relating to HEI perspectives on developing and implementing the programme in primary care settings.

Participant selection

After ethics approval for the study was confirmed by the University of (blinded – Ref: 026 355), staff from five HEIs across England were recruited using a combined purposive and convenience sampling technique. Following initial contact with a senior academic in each of the five HEIs, invitations to participate were distributed to staff involved with the trainee NA programme. The research team then provided the study information sheet to those staff who expressed interest. This resulted in 27 staff agreeing to participate (Table  1 ) from two Universities in the North East, one in the North West, one in the Midlands and one in the South East. Written informed consent was obtained from all participants prior to data collection commencing. Participants were subsequently identified by a code to aid anonymity.

Sample for England-wide HEI stakeholder interviews

Data collection

A semi-structured interview schedule for the wider HEI study was developed by drawing on existing NA literature and the team’s previous experience of research with trainee NAs (King et al., 2020 , 2022 ; Robertson et al., 2021 , 2022 b). This schedule specifically included three questions, noted below, relating to trainee NAs from the private, independent and voluntary sector (which includes primary care) as previous research suggested there were particular concerns within this sector:

• What are the main motivations for commencing NA training in the Private, Independent and Voluntary Organisation sector?
• What are the main training concerns or challenges for trainee NAs from this sector?
• How has the HEI had to adapt to meet the needs of trainee NAs from this sector?

Due to the ongoing impact of COVID-19, interviews were conducted online by three members of the research team (two female and one male) between June and September 2021. Interviews lasted from 28 to 66 min (mean 48 min) and were audio-recorded and subsequently fully transcribed. The final part of the interview incorporated the three questions above. Data from these three questions, and other points in the interviews where primary care was specifically mentioned, form the basis for this paper. Malterud et al. ’s ( 2016 ) concept of ‘information power’, rather than an attempt at data saturation, was used to make a judgement about the sufficiency of the sample and the data collected.

Data analysis

Data analysis utilised a reflexive and iterative approach that combined aspects of framework analysis (Ritchie and Lewis, 2003 ) and thematic analysis (Braun and Clarke, 2006 ). All data relating to comments about the NA training programme in primary care were extracted into Quirkos © software by one researcher [XX]. Through a process of iterative reading, key finding areas were initially identified by [XX], and these formed a frame that consisted of four parts: support; placements; understanding of the role and business planning; skills and scope. Data were then coded/categorised into each of these four elements using notes and signifying the interviews that linked to these codes/categories. An example of this early coding/categorising within one key area is provided in Table  2 .

Example of frame code/category development

This initial frame and associated coding and categorisation were then considered by another team member [YY]. Following two rounds of iterative discussion, some re-categorisations were made; that is, some codes and categories were collapsed, or reassigned to different parts of the frame, and key areas refined and retitled as codes and categories were aligned to develop clear subthemes and themes to best present the data. Final subthemes and themes were agreed between XX and YY. These were sense-checked with the wider research team. Further critical interpretations of the data were then made during the development of this paper as findings were linked and integrated to previous research and policy, and authors discussed draft versions of the paper and specifically the interpretation of the findings in the discussion section.

Three themes were developed from the analysis: understanding the trainee NA role and requirements, trainee support in primary care, and skills and scope of practice (Table  3 ).

Theme and subtheme outline

Understanding the trainee NA role and requirements

Participants generally agreed that there was limited understanding about NAs in primary care when compared to the hospital sector. In particular, participants mentioned the additional work involved in helping primary care employers understand what the requirements and expectations were when hosting a trainee NA. However, participants also recognised that fulfilling these requirements could be difficult for primary care employers, especially in the context of high service demand and limited staffing:

‘The main challenge is that they [primary care] don’t quite understand the role as much as the big Trusts do, and it takes a lot more work and building of partnerships to create that understanding’. [HEI2_S3]

‘There’s been teething problems in terms of making sure the ‘off-the-job’ elements are understood. Making sure trainees aren’t constantly in clinics all day. Realising they’re not your HCA anymore, they’re a trainee NA now. It’s realising that, to meet the requirements for this programme, they have to have that element of 20% ‘off-the-job’ learning, they need supervised practice, they need supernumerary time. I think that’s been challenging for the GP surgeries’. [HEI3_S3]

Implicit in these accounts were concerns that the requirements, especially the need to have time release and for trainees to have access to a suitably qualified practice assessor in the workplace (a requirement for trainees in all clinical settings), were often not fully understood in advance by primary care employers, creating challenges for both the HEI and the employer:

‘There’s been increased interest from primary care. But there are huge challenges there because they don’t always fully appreciate that they’re going to lose their trainee when they complete their alternative placement hours. We’ve seen quite a lot of people being put forward and then an awful lot of backtracking when the penny drops. Which is a real shame’. [HEI1_S4]

‘One difficulty we’ve had with primary care is that whilst they want to send somebody on this [NA] programme, they don’t necessarily realise the things they have to have in place to support that trainee. And it’s not until we’re contacting them that you’re finding they’ve not got a practice assessor, they’ve not got a lot of things in place and we then have to train-up to get those things in place’. [HEI5_S2]

However, there was also recognition that some primary care employers were understanding and acknowledging the potential benefits NAs could bring and planning accordingly. This was often linked by participants to employers being able to take a longer term view, particularly in relation to how NAs might help with medium or longer-term staffing concerns within primary care:

‘Some of the smaller employers have said, “We just can’t get qualified staff, registered nurses, to come and work in the practice”. So they’re wanting to train up the HCAs they’ve got to fill those posts. Long-term planning really. So two or three years down the line, “We’ve got a qualified nurse”’. [HEI2_S1]

‘Especially in GP surgeries, where this may be someone who’s worked with them for many years as a HCA or whatever. They see them blossoming and developing and I think they feel they can really shape them into fulfilling the role that they want their NA to be’. [HEI5_S4]

Several participants felt strongly that it was therefore part of their role to promote the benefits that training NAs might bring to primary care employers. It seemed especially important to be able to help primary care employers see the link between promoting career development for their staff and ensuring their workforce for the future in a way that limited the cost to the practice and improved service delivery:

‘I think what’s really important is sell the role, that actually you’re investing in your staff and you’re growing your own staff and you’re equipping them with better skills for them to come back to the surgery with and implement within the workplace’. [HEI4_S1]

‘It’s more palatable to say to a GP, “We’re going to take your HCA and we’re going to transform them into a nurse. It’s going to be over two years and it can be an apprenticeship and we’ll sort out the levy, so you don’t have to pay. You’ll still get some of their time.” Rather than saying, “We’re going to take them away for three years and you’re hardly going to see them at all.” It’s a business thing’. [HEI4_S4]

Although promoting the NA role to GP employers was clearly seen as important, some quotes here might suggest that NAs would provide an alternative, or even an equivalent role, to RNs within the primary care context. While NAs may take on some tasks previously undertaken by RN-qualified practice nurses, the role is not intended to be one of substitution. As such, enthusiastic HEI promotion of the role should take care not to give the impression that releasing staff to complete NA training will provide the equivalent of an RN. Rather, it should focus on how NAs would fit within modern primary care skill mix and emphasise role boundaries. These challenges around the scope of the NA role are considered further in a later theme.

A fuller understanding of the NA role and purpose, and the training commitments and requirements, leads to a necessary consideration of what the support needs might be for trainees within primary care.

Trainee support in primary care

Participants highlighted that the support provided to trainee NAs by primary care employers varied. As mentioned earlier, this mainly related to the support provided by practices to ensure the required opportunities for protected learning time or alternative placement release were met. Again though, the specific reasons for struggling to meet these support challenges in the primary care context were noted by some participants:

‘The GP surgeries are really inconsistent. It’s the first time that we’ve had primary care trainees with us and there’s two practices that are brilliant and their students are supernumerary the entire time of the course. Whereas the other two practices, they’re booking their trainees into doing clinics three full days a week so they’ve no leeway to go and spend a day with a district nurse or anything like that because they’re not being flexible with their clinics. We’ve had a lot of conversations with them and it’s just down to the practice managers saying that they can’t release them’. [HEI3_S4]

‘If it’s a GP surgery, the GP and the practice manager don’t want to send the member of staff [trainee NA] off. I think that’s because in small practices they just don’t have the staff around that are easily replaced. In a hospital, it’s quite easy to send trainee NA off when you’ve got eight other HCAs on the same ward’. [HEI4_S1]

As well as difficulties in obtaining time release, the nature of primary care workplaces, particularly the size of the team, also limited the supervisory and peer support available from nursing colleagues. This could leave NA trainees in primary care somewhat isolated and unsupported:

‘I think what we tend to find with our independent organisations, like primary care, is that they maybe don’t have that many registered nurses that can support the trainees’. [HEI3_S3]

‘They [large Trusts] already work with a lot of student nurses as well. Whereas trainees are quite isolated in the GP practices’. [HEI3_S4]

Beyond the support offered, or not, by employers, there were wider issues noted by participants relating to how the system itself can restrict available support for trainees within primary care contexts. The size and existing educational structures in larger hospital Trusts were seen to provide a support framework for trainees that was not readily available to primary care trainees; although the development of Primary Care Networks (PCNs, groups of GP practices working collaboratively) could help ameliorate this issue:

‘We’ve had a lot more GP practices in the last few cohorts. That brings its own challenges, because they don’t have the infrastructure wrapped around them that big [hospital] organisations have. Normally, we would just assume that mandatory training and everything like that would be done for [hospital Trust] because they’ve got a training department. But that’s not the case for GP practices’. [HEI5_S4]

‘I think they’ve [primary care] just not got the safety net. They don’t have the clinical educators who work side-by-side with you if you’ve got particular problems. They don’t have the capacity to impact as much as the big Trusts that have a separate clinical educator who can come in and make an action plan if something goes wrong, who is more linked to the university and more linked to the education side of things and knows what they’re looking out for’. [HEI2_S3]

‘What’s good is that within primary care, because there’s the Primary Care Networks, they [trainees] can be placed at different surgeries. It might not necessarily be the surgery the trainee comes from. The nurse education lead can liaise with other surgeries within that PCN and place trainees within that PCN rather than just one surgery’. [HEI4_S1]

Most participants noted their HEI had established support meetings, some required by the training body, such as the tripartite meetings between employer, HEI and trainee, and some additional to help organise placements or address queries that might have arisen. Again, these were familiar educational structures in larger Trusts and hospital contexts but less so in primary care which could lead to reduced involvement:

‘We have these drop-in meetings every month where if any employers or mentors or assessors have got any questions about the [NA] course, they can just drop in and ask us, but the GPs never attend any of them. But they’re the ones where we’re having the issues with!’ [HEI3_S4]

Adequate understanding and appropriate support is important for several reasons one of which links to trainees being able to gain the required skills and knowledge competencies to operate safely within a well-defined scope of practice.

Skills and scope of practice

Some participants noted that primary care trainees had a limited basic nursing tasks skill set relative to hospital trainees. Conversely, there was recognition that some already have advanced competencies:

‘I tend to forget that some might not have really basic nursing skills. For instance, coming from a GP practice, you don’t routinely bed bath someone. […] I have to keep reminding myself, it’s about all those proficiencies and skills. If you work in a GP practice, you’re not really doing it’. [HEI1_S2]

‘In the GP surgery they [trainees] have phlebotomy skills, are able to run diabetes clinics and those sorts of clinics. And they can already do things like give injections, take ECGs, take bloods’. [HEI2_S3]

A more pressing issue than the level of skills that trainees from primary care commenced with was the restricted opportunities available to develop the required skills and knowledge competencies. This was related to both the breadth of experience that could be gained within a small primary care employer and having to gain many competencies in a short period of time during alternative, hospital-based, placements. In addition, learning skills that would likely never be used in primary care also seemed to be a concern:

‘When we’ve got trainees working in primary care they’re not going to be exposed to the opportunities that somebody in an acute setting would be […] Trainees working in primary care, in GP surgeries, they rely on that three-week block [alternative placement] to try and get everything done’. [HEI4_S3]

‘Some skills they have to learn, trainees in a GP practice will never, ever have to do that. Like there’s a section on caring for dying patients and last rites; well, a NA in a GP practice, would never see that in their day-to-day work […] So, there were certain things, which they’ll never, ever use, which makes it a bit crazy that we’re training them to do that’. [HEI2_S1]

Finally, there were interesting points raised about the possibility of role substitution for trainees in primary care once they have qualified. This was seen not only to be about taking on roles previously undertaken by RNs but also related to accountability in primary care where, as an independent business, lines of accountability could be more ambiguous:

‘For example, in GP practices, they say “I did this course, the smear test course” or “we did this course.” It’s absolutely great that they’re moving onwards and upwards but my fear is that they’re just becoming RNs […] I think there’s an issue with the expansion of the HCA role within those smaller areas. I suppose they have more power or more ability to increase those roles because the accountability is different where the GPs or the practice holder take accountability for what members of staff do’. [HEI2_S3]

‘I think the social care sector want a cheap alternative to nurses. I think GPs are the same. They want someone who can do a clinic, be accountable for it, but not have to be necessarily overseen by a more expensive RN’. [HEI3_S5]

The pre-existing skill set of trainees can vary widely between those based in primary care and those from hospital settings. Furthermore, opportunities to gain certain required proficiencies during training were limited in primary care settings. Concerns around the scope of this new level of practice, boundary blurring and accountability were also noted.

Early work on the introduction of the trainee NA programme highlighted the difficulties that a limited understanding of the trainee requirements, and the role itself, created for employers (Vanson and Bidey, 2019 ; Kessler et al. , 2020 ) and for trainees (Coghill, 2018 ; Vanson and Bidey, 2019 ; King et al. , 2020 ). More recent work suggests that this understanding has improved, that some of the early problems are beginning to resolve, and that many employers plan to continue embedding the NA role (Kessler et al. , 2021 a; Robertson et al. , 2022 a). However, findings here suggest that concerns remain about the level of understanding regarding requirements and expectations for trainee NAs among many primary care employers. The most likely reason for this is that uptake of the NA programme has taken place later in primary care than in hospital and combined hospital and Community trust contexts. The complexity of introducing new roles into primary care, and the need for better recognition of the factors affecting the assimilation of these roles, has been previously noted (Nelson et al. , 2019 ). Yet, there are precedents for managing such skill mix assimilation. The development of advanced nurse practitioners initially created challenges, concerns and even resistance, but they are now an accepted, understood and mainly appreciated part of the primary care workforce (Greenwood, 2019 ). Similarly, the introduction and assimilation of Physician Associates in primary care has proved to be a complex but clinically and cost-effective approach to skill mix in the UK primary care context (Drennan et al. , 2015 ). Findings here demonstrate that HEIs can help promote understanding of the requirements and advantages that these new trainee NAs might bring to the primary care team. However, care should be taken to ensure that any promotion of the role does not give the impression that releasing staff for NA training will provide the GP practice with the equivalent of a RN-qualified practice nurse on training completion. Future research might look in more detail at the specific factors influencing the understanding and assimilation of trainee and qualified NAs in primary care.

While supporting trainee NAs may begin by promoting an understanding of the requirements and scope of role, this alone is not enough. Kessler et al. ( 2021 b) note that the ability of trainee NAs to acquire required competencies is dependent on their status within clinical teams and on workforce pressures. Evidence here suggests that the limited size, and independent business nature, of many primary care workplaces and teams can mean that opportunities for appropriate supervision and adequate protected learning time for trainees are constrained. Trainee NAs are in a different situation to student nurses in that they are primarily employees, and this has implications in the practice setting, particularly when service demand is high and clinical need takes precedence over learning experiences (Kessler et al. , 2021 b; Robertson et al. , 2022 a). Trainee NAs in hospital Trust settings work in larger teams and often have access to wider systems of organisational support, such as clinical educators, whom they can turn to if problems arise. These systems serve as a bridge between the clinical setting and the HEI providing front-line support for trainee NAs (Robertson et al. , 2022 a). Within primary care, such wider systems of nursing educational support are not always well established. However, although not a directly intended objective, the establishment of collaborative PCNs in England (Fisher et al. , 2019 ) could provide an excellent framework for expanding this wider system support for trainee NAs as they link primary care with other community health and nursing services. Further work exploring current educational support practices among PCNs in order to disseminate and extend best practice would be helpful.

While difficulties in gaining required competencies is generally recognised among trainee NAs (Kessler et al. , 2021 b), findings here suggest this can be compounded in primary care as assessors might be less available and certain competencies can only be gained in hospital settings where placement time is limited. The value of attaining competencies that do not relate to the primary care context was also noted. This raises questions about how the purpose of NA training is perceived by different stakeholders. While envisaged in policy terms as being about the production of a generic worker within the health care system, primary care employers might be more interested in the development of a trainee specifically skilled to perform effectively in the GP setting. This is especially the case if GPs are developing HCAs as part of a long-term staffing plan in the context of nursing shortages in primary care as some were noted to be doing. HEIs were often left managing the tensions that occurred when a shared sense of purpose in relation to NA training was absent, and future work could be undertaken to consider how best to develop a shared sense of purpose between policy implementers and primary care employers.

As a new role, there was uncertainty noted about the scope of this level of practice. In blurring the boundaries between HCAs and RNs, it was recognised that some trainees were undertaking similar roles to RNs in primary care, with potential implications for ensuring lines of accountability and adherence to regulatory standards. Previous work has identified that GP managers recognise the importance of new roles in primary care, and that this is strongly motivated by a desire to increase appointment availability, release GP time and therefore increase business efficiency (Gibson et al. , 2020 ). However, this requires those undertaking new roles to work more autonomously. Nelson et al. ( 2019 ) suggest the risks around this increased autonomy can be daunting for those in new primary care roles, particularly where there is ambiguity over role definition and purpose and a level of role substitution. It was apparent that there were concerns from HEI participants that the level of autonomous and independent working for trainee (and subsequently qualified) NAs in primary care was not always clear. Future research could help establish what constitutes the current scope of practice boundaries, what are the expected and actual levels of independent working, and where and how clear the lines of responsibility are for both trainee and qualified NAs in primary care. This research should incorporate the perspective of primary care trainee NAs themselves, a voice that is currently largely absent in the literature.

Limitations

There are limitations to the current study. Data collection was limited to five HEIs so may not reflect all the issues occurring when developing and implementing the NA programme in primary care. In addition, the primary care focus only formed one aspect of the larger study with limited emphasis placed on this in the interview topic guide. Nevertheless, the multisite nature of the study, and having some specific emphasis on HEI perspectives of implementing the NA programme in primary care, moves beyond most previous research that has focused generically on trainee NAs or on single-site HEI studies.

It is apparent that the limited understanding of NA programme requirements can lead to difficulties in getting or accessing the right support for NA trainees in primary care. In turn, this can create challenges in gaining required competencies and uncertainty in understanding what constitutes a safe scope of practice within the role for both employers and trainees.

It can be anticipated that as the NA programme becomes more embedded in primary care that greater understanding will develop, support will improve and the nature and scope of this new level of practice will become clearer. However, such progress does not happen by chance. While HEI participants were mainly passionate about promoting an understanding of the NA programme and training requirements, putting this understanding into action requires wider change. Recognition of the staffing and the service and business demand needs in primary care is required if a better balance is to be made between immediate service provision expectations and longer-term learning requirements for trainee NAs. In addition, system-level support, perhaps through the PCNs, could ensure the effective use of resources to help trainees access appropriate and timely clinical support and the learning opportunities to develop required competencies. Finally, as the number of trainees (and therefore future NAs) in primary care is increasing, it would seem timely to attempt to bring clarity to the scope of this level of practice in primary care in order to ensure that their place within the team is well understood, that they are not operating as a form of cheap substitution, and that their practice is safe and effective.

Financial support

The project was funded by the Royal College of Nursing (RCN) as part of the Strategic Research Alliance between the RCN and the University of Sheffield. The views expressed are those of the authors and not necessarily those of the RCN or University of Sheffield.

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An Interview With a Registered Nurse Essay

Introduction, client-centered care, interprofessional teams, evidence-based practice, unwanted variations, national safety guidelines, electronic medical records.

In the modern context, nursing has become increasingly patient-focused, collaborative, and research-based. Nurses are responsible for ensuring that patients and their families receive care consistent with their values, preferences, and requirements. It is, therefore, important to analyze how nurses support interdisciplinary teams, electronic medical records, and evidence-based practice. This essay provides a synopsis of an interview with a registered nurse (RN) in a hospital’s medical-surgical unit. The interview focused on the level of support for client-centered care in the unit, the challenges encountered, and strategies for overcoming them. Additionally, the interview covered the nursing and interprofessional teams in the unit, how nursing has evolved in response to new evidence, and how unexpected variances have led to positive changes in care and better patient outcomes. Insight into the obstacles and possibilities for enhancing nursing practice on a medical-surgical unit is expected to be gained from this conversation.

In nursing practice, client-centered care is an important approach that focuses on the patient and their unique values, beliefs, and preferences. During an interview with a unit’s RN, it was discussed how the nurses in the unit facilitate client-centered care for patients and their families whose beliefs may be at odds with their own. The nurse explained how the entire ward tries to learn about and accommodate the patient’s values, beliefs, and preferences. For instance, if a patient desires a loved one to be present during medical procedures, the nursing staff will strive to make that happen (Murray et al., 2019). The nursing staff communicates with patients and their loved ones culturally and linguistically appropriate.

However, the RN mentioned that some obstacles hinder the full implementation of patient- and family-centered care. Tailored treatment for each client can be challenging due to time constraints, a lack of resources, and competing objectives. Additionally, tension or confusion may arise when a patient’s views or preferences contradict accepted medical or ethical practices (Murray et al., 2019). To improve patient-centered treatment, the RN proposed enhancing interdisciplinary communication and collaboration. Consulting with other healthcare team members, such as social workers, chaplains, and interpreters, can help the nursing staff better understand and accommodate patients’ preferences and requirements. Regular team meetings and debriefings facilitate honest dialogue and a common appreciation for the clients’ care priorities and needs.

Clients receive better, more all-encompassing care when provided by interprofessional teams. The RN emphasized the multidisciplinary nature of care in the medical-surgical unit, including the involvement of physicians, pharmacists, respiratory therapists, physical therapists, occupational therapists, and social workers. The nurse elaborated on the role of interdisciplinary teams in patient care. The teams frequently gather to deliberate on client care and make joint choices. If a patient has trouble breathing, the nursing team will coordinate with the respiratory therapist to provide the best care possible. If a patient needs PT or OT, the nursing team will collaborate with the therapist to create a treatment plan tailored to the patient’s specific requirements. The RN stressed the value of open lines of communication and teamwork between specialists. For patients to receive appropriate, coordinated care, the nursing staff must successfully interact with other healthcare team members. The RN noted that to exchange information and work with other healthcare experts, the nursing team used a variety of ways of communication, including in-person meetings, phone conversations, and electronic communication.

The RN further remarked that interdisciplinary groups were crucial when dealing with complicated patient situations. Having a group of healthcare specialists working together to build a holistic care plan when a client has various health conditions is crucial. Suppose a patient has many health issues, such as diabetes, heart disease, and renal disease. In that case, the nursing staff will collaborate with the patient’s doctor, pharmacist, and dietician to create a comprehensive treatment plan. The RN elaborated on the importance of interprofessional teams in quality improvement programs. Teams work together to pinpoint opportunities for enhancing patient care and create plans. Client education, staff training, and environmental improvements are all part of the fall prevention protocol that the interprofessional team will create if the unit has a high rate of client falls.

The RN gave an example of an updated nursing procedure implemented within the past year in light of new research findings. The team has begun following a new procedure for preventing pressure ulcers, which involves more regular repositioning, skin examinations, and pressure-relieving beds. The evidence-based guidelines for pressure ulcer prevention that informed the development of the procedure highlight the significance of early identification and intervention in preventing the development of pressure ulcers. The RN reported that pressure ulcer rates had decreased due to the implementation of the regimen. The use of pressure ulcer prevention methods such as repositioning, skin assessments, and specific support surfaces is congruent with the current data supporting their effectiveness in preventing pressure ulcers. This exemplifies the value of evidence-based practice in nursing by demonstrating how it can boost patient outcomes and reduce avoidable problems.

The RN also gave a specific instance of how an unexpected shift in the unit’s routine led to better care for patients. Patients with permanent urinary catheters were likelier to develop urinary tract infections (UTIs). The unit instituted a new strategy emphasizing the importance of timely removal, practicing good hygiene, and utilizing catheter-associated UTI prevention bundles. Due to the strategy, the number of catheter-associated UTIs on the unit has dropped significantly, and the RN said.

The RN explained how the unit followed federal safety regulations. Hand hygiene, isolation procedures, and the proper use of personal protective equipment are just a few of the CDC’s recommendations implemented throughout the unit (PPE). The RN added that the unit was subject to frequent audits and quality improvement activities to guarantee meeting all applicable national safety criteria. To protect patients and reduce the spread of healthcare-associated infections, it is essential to follow national safety criteria. The RN highlighted that all the floor nurses were fully committed to following these standards. The nursing staff and interprofessional team work together to ensure the clients receive safe and effective care through continuous education, training, and quality improvement initiatives.

The nurse said there were two major problems with the unit’s EMR system. One problem is that using the system and entering data takes time away from providing direct treatment to patients. The second problem is that if nurses are not well taught or the system isn’t intuitive, they may make mistakes or leave out important information when documenting patient care. The RN indicated that these problems could be resolved by frequently updating the EMR system and giving further training and support to nurses.

The talk with the RN about nursing on the medical-surgical floor was very educational. Notwithstanding difficulties, the nursing and interprofessional teams are dedicated to enhancing patient care through evidence-based practice, quality improvement programs, and adherence to national safety criteria to provide patients with the best possible outcomes. The unit’s nursing team can provide better care for their patients and see better results with their patients when they use evidence-based methods. The nurse mentioned that the unit used evidence-based techniques such as the pressure ulcer prevention strategy to better care for patients.

Murray, M., Sundin, D., & Cope, V. (2019). Benner’s model and Duchscher’s theory: Providing the framework for understanding new graduate nurses’ transition to practice . Nurse Education in Practice , 34 , 199-203. Web.

• Certified Medical-Surgical Registered Nurses' Competency
• Shared Governance in Medical-Surgical Unit
• Importance of Patient-Centered Collaborative Relations
• Critical Thinking Applied to Patient's Health History
• Seven Dimensions of Wellness Model in Practice
• Individual Nurse Practitioner and Telehealth
• Bowel Diversion: Nursing Role in the Procedure
• A Reflective Journey in Psychiatric Nursing
• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2024, May 24). An Interview With a Registered Nurse. https://ivypanda.com/essays/an-interview-with-a-registered-nurse/

"An Interview With a Registered Nurse." IvyPanda , 24 May 2024, ivypanda.com/essays/an-interview-with-a-registered-nurse/.

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IvyPanda . 2024. "An Interview With a Registered Nurse." May 24, 2024. https://ivypanda.com/essays/an-interview-with-a-registered-nurse/.

1. IvyPanda . "An Interview With a Registered Nurse." May 24, 2024. https://ivypanda.com/essays/an-interview-with-a-registered-nurse/.

Bibliography

IvyPanda . "An Interview With a Registered Nurse." May 24, 2024. https://ivypanda.com/essays/an-interview-with-a-registered-nurse/.

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Nurse Resume Examples & Writing Guide

Crafting a resume as a nurse involves showcasing your clinical skills, patient care expertise, and dedication to the health profession. This guide will assist you in highlighting these key qualities and experiences. 

It is tailored to define the role of a nurse and provide guidance on creating a resume that effectively communicates your ability to excel in nursing roles, enhancing your prospects in this compassionate and challenging field.

What does a Nurse do?

Nurses are integral to the healthcare system, providing direct patient care, administering treatments, and supporting patients and their families. They must be adept at assessing patient needs, implementing care plans, and working collaboratively with other healthcare professionals. 

An effective nurse resume should emphasize clinical skills, empathy, and the ability to handle stressful and emotionally charged situations.

Skills to Highlight on a Nurse Resume

• Patient care and assessment
• Medication administration
• Empathy and compassion
• Strong communication skills
• Ability to work in high-pressure environments
• Knowledge of healthcare protocols
• Team collaboration and leadership
• Wound care expertise
• Patient education and advocacy
• Time management and organization

How to Write a Nurse Resume?

A nurse's resume should be clear, concise, and well-organized, fitting onto a single page. It must include sections for contact details, a professional summary, work experience, education, certifications, and additional skills.

Focus on those sections that best reflect your strengths. For instance, a new graduate might emphasize education and clinical rotations, while an experienced nurse would highlight specific areas of expertise and professional achievements.

Choose a Nurse Resume Format

The format of your resume is key in presenting your nursing career effectively. There are three primary formats: chronological, functional, and combination. 

For most nurses, the reverse chronological format is recommended as it clearly outlines your professional history. However, if you're new to the field or shifting specializations, other formats may be more appropriate. 

Rezi can help create a perfectly formatted resume, and you can choose a suitable template from the options provided.

Start with Your Contact Information and Name

Begin your resume with your name and contact details, including your phone number, email address, and possibly your LinkedIn profile URL and location. This ensures recruiters can easily identify and contact you. Clear presentation of this information at the top of your resume is vital.

Write a Strong Professional Summary

The summary section should concisely capture your nursing expertise and key strengths. It's important to highlight your experience in patient care, clinical skills, and any specialized areas of nursing.

Example Summary : "Compassionate Registered Nurse with 5 years of experience in pediatric care. Proficient in patient assessment, treatment administration, and providing emotional support to patients and families. Dedicated to delivering high-quality care and promoting patient well-being."

This summary effectively communicates the candidate's experience, specialty area, and core nursing values.

Consider Optimizing Your Resume for ATS Keywords

To ensure your resume is noticed by employers, include keywords relevant to nursing. Rezi can help identify important keywords from job descriptions, ensuring your resume aligns with what employers are seeking.

List Your Relevant Work Experience

The work experience section should detail your nursing roles and responsibilities, emphasizing patient care, treatments administered, and any specialized experience. For a nurse, standing out means highlighting specific achievements or initiatives in patient care or teamwork.

Example : “Registered Nurse at City Hospital, 2018-2023. Provided comprehensive pediatric care to an average of 15 patients daily. Implemented a new patient education program that improved patient satisfaction scores by 20%.”

This section shows specific duties and quantifiable achievements, making the candidate's experience and impact clear.

Tips for the Work Experience Section of Your Resume

Focus on experiences that demonstrate your nursing skills and achievements. Start with your most recent position and describe your roles using active verbs. Including specific achievements or improvements you contributed to can help your resume stand out.

List Your Projects

If applicable, include any projects or additional work that highlights your nursing skills, such as volunteer work, research, or involvement in health campaigns or initiatives.

Example Project : “Volunteer Nurse at Health Fair, 2022. Conducted health screenings and provided health education to over 100 community members.”

This example demonstrates the candidate’s commitment to healthcare beyond their formal role, showcasing additional skills and community involvement.

List Your Education

The education section of a resume provides critical information about your nursing training and qualifications.

• Nursing degree and any specializations
• University or nursing school name
• Graduation year
• Relevant coursework
• Academic honors or distinctions

Example Education Section : “BSc in Nursing, XYZ University, 2017. Specialized in Pediatric Nursing. Dean’s List 2016 and 2017.”

This section highlights the candidate's nursing education and any special achievements, adding credibility to their professional qualifications.

List Any Relevant Skills

The final section of your resume should highlight additional skills that enhance your nursing qualifications. This can include specific nursing techniques, languages spoken, technical skills, or soft skills like empathy and patient advocacy.

Final Tips for Writing a Nurse Resume

Ensure accuracy and clarity.

Your resume should be error-free and clearly formatted. This reflects your attention to detail, a crucial skill in nursing.

Tailor to the Position

Customize your resume for each job application, highlighting experiences and skills that align with the job's requirements. This shows your suitability for the specific nursing role.

Highlight Patient-Centric Achievements

Focus on achievements that demonstrate your patient care skills and contributions to patient outcomes. This approach showcases your dedication and impact as a nurse.

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What Is an Anaesthesia Associate? And How to Become One

Read this guide to discover more about anaesthesia associates’ schooling requirements and necessary qualifications. Additionally, learn about the role, typical tasks, salary information, and how to become one.

Elsewhere in the world, nurse anaesthetists play a pivotal role in the operating theatre. In the United Kingdom, anaesthesia associates administer anaesthesia to patients before, during, and after surgical procedures. 

Anaesthesia associates are part of a multidisciplinary theatre team in various health care environments, such as NHS hospitals, private hospitals, and clinics. In addition to working under a supervising consultant anaesthetist, you can expect to work alongside nurses, surgeons, and physicians to ensure their patients receive the best care possible.

To succeed in this position, you must remain calm under pressure and empathise with the patients you’ll work with. Explore what anaesthesia associates do, how much they earn, and their job outlook in the coming years. 

Anaesthesia associates explained

Anaesthesia associates administer anaesthesia to patients, monitor their vital signs, and help them manage pain and post-surgery recovery. With advanced training in administering anaesthesia, anaesthesia associates must possess a postgraduate degree such as the MSc in Anaesthesia and Perioperative Science or the Anaesthesia Associate Postgraduate Diploma, a two-year program followed by three months of supervised practice. As a result, anaesthesia associates are highly-skilled medical professionals with many important responsibilities in high demand within the medical field. 

What does an anaesthesia associate do?

An anaesthesia associate performs their duties in three stages: preoperative, intraoperative, and postoperative. Before surgery, you'll need to assess the patient's medical history and current condition to determine if any factors may pose complications with the anaesthesia. Throughout the surgical process and after, you’ll also be responsible for:

Undertaking a physical assessment

Taking part in preoperative teaching

Choosing the correct type of anaesthesia for each patient

Determining the proper amount of anaesthesia 

Monitoring the patient's vital signs and adjusting the amount of anaesthesia as necessary

Delivering anaesthesia via gas and intravenously to keep the patient pain-free 

Maintaining anaesthesia intraoperatively

Administering medications that help block pain 

Preparing for anaesthetic management

Responding appropriately if complications arise

Supervising recovery from anaesthesia

Proving post-surgical pain management to help ensure a controlled recovery

Anaesthesia associate skills

As an anaesthesia associate, you must be professional, think critically, communicate well, and possess technical nursing skills. During your schooling and career, you’ll develop an advanced skill set to use specialised equipment and make complex decisions that critically impact a patient's health. Here are some of the core competencies you'll need as an anaesthesia associate:

Critical thinking: You need to be able to make quick decisions based on patient observations and test results.

Attention to detail: You need to interpret data, such as a patient's vital signs, and adjust accordingly. You also need good technical knowledge when administering precise doses of anaesthesia and other medicines.

Interpersonal skills: You must work well with others on the health care team, including doctors, nurses, and other medical professionals.

Communication skills: You need to be able to explain what you're doing as you administer anaesthesia and provide updates about your patient's condition after surgery.

Clinical skills: To offer safe, high-quality care as an anaesthesia associate, you must have excellent clinical skills, including physical assessment skills. You also need to keep up-to-date with best practices in anaesthesia and new developments in pain management.

How much does an anaesthesia associate make?

NHS compensation uses a banding system. Anaesthesia associates are nationally banded at band 7, but roughly half get paid at band 8a. Higher payment comes with experience and increased responsibilities [ 1 ]. That means you can expect to earn between £28,407 and £30,639 when you’re starting but can eventually earn up to £99,891 as you progress in your career [ 2 ].

Anaesthesia associate job outlook

Anaesthesia associates are in high demand. The UK anticipates that by 2040, it will have a tremendous shortage of anaesthesia professionals as many are set to retire, with less training than is needed to fill the gap. Experts predict a shortage of 11,000 anaesthesia professionals by 2040, which could prevent eight million or more surgeries from taking place [ 3 ].

Health Education England recently announced efforts to support anaesthesia associate workforce expansion. These efforts include establishing additional training programs, funding 120 students annually, and an apprenticeship training route [ 4 ]. 

Is being an anaesthesia associate a good career choice?

Some benefits of being an anaesthesia associate include higher compensation within the nursing field, a positive job outlook, and both personal and professional satisfaction. While many professionals within the health field dedicate themselves to helping patients get better, you’ll have the opportunity to help them feel better as they face some of their most trying health scares. 

Your job as an anaesthesia associate is to ensure that patients do not feel pain throughout the surgical care cycle. While this may seem simple enough, it can be quite complicated because each person feels pain differently and has different drug tolerances. You must also know how to handle problems if they arise before, during, or after surgery.

When deciding if being an anaesthesia associate is the right career choice, remember that it entails working in high-stress environments with critically ill people who require life-saving care. You’ll be able to make a difference in people’s lives every day.

Some of the benefits of becoming an anaesthesia associate include the following:

Collaboration: As an anaesthesia associate, you’ll practice in collaboration with other health care team members.

Compensation: In a band 7 role, anaesthesia associates earn more than many nursing professionals.

Demand: The demand for anaesthesia associates is rising, and efforts are underway to expand the workforce.

Intellectually challenging: Your work as an anaesthesia associate requires considerable insight and critical thinking.

Professional satisfaction: As an anaesthesia associate, you can typically get great professional satisfaction from providing quality care to patients in pain.

Depending on your work type and environment, you may work nights, weekends, and holidays, especially in a facility that provides around-the-clock emergency treatment. 

How to become an anaesthesia associate

To become an anaesthesia associate, you must have experience in acute medical or theatre settings, earn the right qualifications, become licensed, and maintain your licence with continuing education and revalidating efforts. Here's what you can expect to do on the path to joining this critical profession: 

1. Obtain the right credentials.

To become an anaesthesia associate, you need to complete a postgraduate degree. To be admitted into an anaesthesia associate program, you must have an undergraduate degree in biomedical science or a related field or three years of theatre practice as a clinical NHS staff member. 

The University of Birmingham and University College London offer postgraduate degrees, and additional programmes were launched in March 2023. Most of your coursework will be in a clinical environment, giving you the hands-on experience to prepare for your career.

2. Join the Anaesthesia Associates Register.

After graduation, you will receive an invitation to join the Anaesthesia Associates Register and become an affiliate of the Royal College of Anaesthetists (RCoA). The RCoA offers opportunities for continued learning, professional development, and access to advisors and tutors.

3. Register with the General Medical Council.

All anaesthesia associates must be registered with the General Medical Council and maintain good standing through revalidation. Revalidation involves continuing professional development, quality improvement activities, and reviewing your patient feedback, compliments, and complaints.

Getting started 

Becoming an anaesthesia associate involves years of education and clinical training. Rather than put off the process, consider exploring critical concepts related to the field by taking a cost-effective online course through Coursera today. 

To deepen your understanding of how vital signs and pain correlate within the body, consider taking the University of Pennsylvania's Vital Signs: Understanding What the Body Is Telling Us course. Meanwhile, the University of Michigan's Anatomy Specialisation will introduce you to the major organ systems, their functions, and how they relate to one another within the body.

Article sources

Association of Anaesthesia Associates. “ FAQs , https://anaesthesiaassociates.org/general-info/faqs/.” Accessed May 22, 2024.

Nurses.co. “ A Nurse’s Guide to NHS Pay bands in 2022 , https://www.nurses.co.uk/blog/a-nurses-guide-to-nhs-pay-bands-in-2022/.” Accessed May 22, 2024.

Association of Anaesthetists. “ Action Must Be Taken to Help Retain Older Anaesthetists to Prevent Staff Shortage of 11,000 by 2040, Preventing More Than 8 Million Operations , https://anaesthetists.org/Home/News-opinion/News/Action-must-be-taken-to-help-retain-older-anaesthetists-to-prevent-staff-shortage-of-11-000-by-2040-preventing-more-than-8-million-operations.” Accessed May 22, 2024. 

Health Education England. “ Anaesthesia Associates , https://www.hee.nhs.uk/our-work/anaesthesia-associates.” Accessed May 22, 2024.

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