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Nursing associates: A new route to nursing?

When the idea of a new nursing associate role was first mooted in 2015, it was met with divided opinion.

Although it was agreed that nursing associates could help the nursing workforce, concerns were raised that the role might be incorrectly used to cheaply substitute nurses instead of filling the gap between them and healthcare assistants as intended.

But one year on since nursing associates joined the Nursing and Midwifery Council (NMC) register, there is no denying that demand for the role is there – with 1,500 on the register and the number set to grow.

What is a nursing associate?

  • The nursing associate is designed to help bridge the gap between health and care assistants and registered nurses.
  • The main route is a two-year apprenticeship, where trainees are employed by a specific health or social care organisation, alongside studying towards a foundation degree programme and completing placements across health and social care settings.
  • 1,500 nursing associates are on the NMC register as of January 2020.

However, skepticism still remains around the Government’s true intentions for the role.

Dan Davies, a community nurse specialist in London, thinks the role is ‘wonderful’ but believes it was introduced to ‘fight the huge deficit in the registered nurse workforce’.

‘I think [nursing associates] working their way up the ladder to nursing would have accessed nursing directly if it was financially viable,’ he explained to Nursing in Practice.

‘So why not reintroduce better financial support [for student nurses] or push the apprenticeship route?’

Dr Elaine Maxwell, a nurse and former associate professor specialising in patient safety at London South Bank University, is also doubtful about the role now being considered as a way into registered nursing.

‘If the role is an alternate route to registered nurses, it is the longest, most expensive way of doing it,' she said.

‘Far cheaper would have been to promote and fund more access to nursing courses which have been very successful in the past.’

Different starting points

This January, the University of Hertfordshire was one of the institutions welcoming its first cohort of nursing associates who will join existing students set to qualify as nurses next summer.

'It’s opening up opportunities where perhaps people couldn’t see them before,’ head of nursing at the University of Hertfordshire and qualified nurse Dr Julie Vuolo told Nursing in Practice.

The starting points for traditional second year student nurses and nursing associates are different, as nursing associates join halfway through the course at the University of Hertfordshire – meaning they complete half of second year and the entirety of third year. 

They already have two years’ experience from their nursing associate course and must have had at least one year before that in healthcare.

‘The nervousness is whether nursing associates will have had the same experiences,’ said Dr Vuolo.‘I know what a three-year student will go through to come out with a qualification as, say, a mental health nurse. But if someone joins mid-point, they won't have had that same experience.’

Either employers can pay for nursing associates to join the nursing degree apprenticeship through the apprenticeship levy or, less commonly, nursing associates can self-fund.

As nursing associates usually remain at the institution local to their employer for both degree apprenticeships, universities can match the two programmes.

If nursing associates are joining the nursing course from a different institution, the programme team checks ‘they have the same understanding of the same core content’.

‘It’s not a completely seamless transition because we have to make sure they’re orientated to a new programme of study,’ said Dr Vuolo.

The team use a ‘mapping exercise’ to determine the content a student must have caught up with by certain points on the course.

Bespoke sessions and transitional mentors also help nursing associates integrate into the programme, she added.

‘I think there is understandably a 'wait and see' element’ around [the impact of the nursing associate route to nursing],’ Dr Vuolo concluded.

‘A million miles in front’

Ian Costello, a student nurse on the University of Hertfordshire‘s degree apprenticeship, told Nursing in Practice his background as a nursing associate prepared him well for study.

'Some student nurses come straight from school but I’ve already had years of learning everything people are doing day-to-day working on the NHS,’ he explained.

‘The downside is the ones that go straight from class to university have got academic experience. But we were given academic support to help us as adult learners, so our university was very responsible.’

Before the nursing associate role became an option for him, Mr Costello had hit a ‘career block’ as a healthcare assistant in a forensic learning disability unit – where he still works now.

‘I couldn’t afford to go to university,’ he said. ‘But I knew the nursing associate role would get me on the ladder to the career path I wanted, which is to be a registered nurse.’

Laura Briers, who started her two-year shortened nursing degree at the University of Derby in March 2019, agreed the nursing associate course gave her a ‘big insight’ into the nursing role.

‘Compared to nursing students, I feel a million miles in front of them,’ she told Nursing in Practice. ‘Students in my cohort do not feel ready to qualify. They don’t feel they know enough, whereas I feel ready and can’t wait...

‘I’ve worked in healthcare for 20 years. Without this, I never would have had the opportunity to become a nurse as I didn’t have the qualifications.’

A new route to nursing

Commenting on last week’s anniversary of nursing associates joining the NMC register, health minister Edward Argar said the role would form part of the pledge for 50,000 more nurses by 2025.

‘This fantastic role provides a new route into a rewarding career in the NHS by making it easier to climb the ladder for those who want to become registered nurses,’ he explained.

The new route is expected to result in around 4,600 extra nurses by 2022, according to government estimations.

However, HEE and the University and Colleges Admissions Service were not able to provide exact figures of nursing associates who have joined nursing courses so far.

 

 

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