The Rise of Nursing Associates in Social Care


With roles in healthcare being relatively stagnant for some time, recent years has seen the rise of some new roles within the sector to bridge gaps, increase accessibility and reduce strain on NHS services. A decade ago we saw the introduction of the Physician Associate (PA) role in the UK, inspired by the US model to help ease the workload of doctors, PA’s work across primary and secondary care and play a vital role in providing continuity of care for patients with around 600 qualified PA’s as of 2018 and numbers enrolling to study continuing to increase year on year.

Last year we saw the first group of qualified Nursing Associates join the NMC register in January. By September 2019 nearly 1000 more had joined bringing the total number up to 1488. This made up just over 12% of the increase of professionals on the register in 2019, a record year for the NMC with over 706,000 registrants able to practice in the UK. 

But just how much of an impact will the newly established Nursing Associates have on the UK social care sector?

The qualification was originally developed in 2015 by Health Education England as a way to bridge the gap of knowledge between care assistants and registered nurses. For the first batch of students in January 2017, 11 NHS trust test sites were chosen to lead the 2 year training programmes with a further 24 sites joining later that year and even more now incorporating the programme. A range of settings are covered across these sites to represent the variety of work places that students could move into once qualified including hospices, community, care homes, acute care and mental health trusts. 

Although accountable for their own practice and conduct, it’s important to remember nursing associates won’t be a substitute for registered nurses and instead will act as a support for them within the workplace. The list of skills that nursing associates will have includes;

–         taking and interpreting vital signs such as pulse, blood pressure and pulse oximetry

–         collect and observe sputum, urine stool and vomit samples

–         undertake neurological observations

–         maintenance of skin integrity

–         assisting with personal care

–         manage wounds and undertake wound care

–         support with hydration and nutritional needs

–         make suggestions about appropriate hygienic care

–         recognise bowel and bladder patterns to identify problems

–         recognise and manage the risk of falls

–         administer oxygen, injections and medications through various routes

–         support at end of life care 

Although the number of active nurses on the NMC register has hit a record high, so have nursing vacancies – there are currently estimated to be approximately 12% of nursing posts empty which means a shortage of over 43,000 members of staff in the sector! As the nursing associate programme is much more accessible; needing to obtain level 9 to 4 (A-C) in English and Maths at GSCE level to meet entry requirements, hopefully this pathway will gain more traction later offering those qualified to undertake a nursing degree of approximately 18 months compared to the usual 3 years. Will this help to increase the number of active registered nurses? With nursing associates being able to take on some clinical duties, this will in turn free up nurses time to deal with more complex cases which should if nothing else reduce some of the pressures nurses are currently facing every day.

The nursing associate programme has also coincided with a massive change in the UK – the hot topic of Brexit! Although overall figures on the NMC register have grown by over 8000 nurses, midwifes and nursing associates throughout 2019, figures of EU/EEA qualified staff registered in the UK has hit a worrying low figure, falling by over 1000. What will this mean for the future of our diverse work force in the NHS? Whilst this fact is definitely concerning, it is worth noting that those overseas registering from outside of the EU/EEA to work in the UK has actually grown dramatically by 4065 (a 5.5% increase).

As we enter 2020, there are many questions and debates around the current situations within healthcare.

Will the new nursing associate pathway lead to more qualified nurses in the long run? Will they be used to substitute nurses rather than supplement them as intended? There is definitely still skepticism about how it will all pan out but in teams that have integrated nursing associates so far, feedback has been extremely positive so it’s definitely an exciting time to watch the changes coming in the future and hopefully make a dent in improving an overworked (and often unappreciated!) workforce.

Most of this information has come from the NHS, so I’d love to hear from managers within social care with your thoughts on the nursing associate pathway, particular in nursing homes.  

Have you adopted workers with this qualification in to your services or look to do so in the future?

What impact do you think this will have on the sector? Is it going to help?