King's College London

Ian Kessler, Professor of Public Policy and Management at King’s Business School, has led research on the new NHS nursing associate role in health and social care. He undertook the study in his role as Deputy Director of the King’s College London Health and Social Care Workforce Research Unit, which is funded by the government’s National Institute for Health Research.

The nursing associate role was introduced to act as a ‘bridge’ between the care assistant and the registered nurse, freeing registered nurses to work in more clinically complex ways and providing a more accessible route into registered nurse training.

Pilot Nursing Associate training programmes started in 2017, and by October 2020 (the latest figures available) there were around 3,000 registered Nursing Associates, with some of the initial recruits dropping out or choosing to continue direct into nursing preregistration training.

Through a survey of Chief Nurses from over 100 Trusts, two detailed case studies and around forty expert interviews with policymaker, practitioners and commentators across health and social care, Professor Kessler and his colleagues were able to gain a picture of how the role is being used, some of the benefits to the role and some of the challenges care providers have faced in making best use of it.

He found that while Trusts were employing Nursing Associates with multiple objectives in mind, one of the most prominent was a desire to ‘grow their own nurses’, especially through the development of talented existing staff, such as healthcare assistants, not in a position to access nursing training via the existing academic routes.

The study also found that many trusts were finding benefits from the role, though with Nursing Associates generally only employed in small numbers, it was not possible to identify as yet an immediate impact on the quality of care. The part played by Nursing Associates was often specific to the context. For instance, one community healthcare Trust had found a niche for the role in helping to administer insulin to people living with diabetes in their homes.

Without an exhaustive list of readily defined tasks and responsibilities suitable for Nursing Associates, some concerns were raised about how the role would be integrated into and accepted by wider clinical teams. While Professor Kessler found signs that Nursing Associates were broadening the scope of their roles, for instance taking on responsibility for less complex cases, administering a greater range of medicines or mentoring and supervising Health Care Assistants, some Nursing Associates reported that their colleagues were still unsure what to expect from them in terms of technical skills. The research revealed the development of the NA role was an iterative process, with its scope of practice emerging gradually as postholders and colleagues adjusted, shaped and engaged with it.

Professor Kessler will conduct further research to identify further how NHS Trusts are making best use of the new role and negotiating some of challenges of integrating it into the workforce structure.

These initial study findings were presented and discussed at a Webinar held on 23rd November 2020.  The Webinar was opened by Lord Willis, whose 2015 report ‘The Shape of Caring’ originally recommended the introduction of the Nursing Associate role.  The webinar was attended by around 160 policy makers and practitioners.