The information in this blog was correct at the point of publication.

From time to time people ask me questions about the role of the Nursing Associate.  They forward tweets to me, or screenshots of Facebook pages, generally demonstrating confusion, or inaccuracies, or ambiguity about the role and they ask if I can comment.  I usually engage and try to be accurate, but I am also aware that there is confusing information out there, sometimes contradictory information even from authoritative sources, and it is not easy to get at the most up-to-date and accurate position.  I thought there was scope for a blog that sets out the current position – as far as I can ascertain it – so I’ve been in conversation with the Chief Executive of the Nursing and Midwifery Council (NMC) and this blog is a result of that conversation.

1 Nursing Associate education

Most current trainees preparing to be Nursing Associates are undertaking a two-year Foundation Degree (or equivalent).  These are pilot test programmes at academic level 5.  Whilst on these programmes trainees could accurately be described as Trainee Nursing Associates (TNAs).

The pilot programmes were developed using Health Education England’s (HEE) curriculum framework.  HEE established a two-year Nursing Associate training programme in January 2017 and these have not been approved by the NMC as they started before the regulation of the role.  The NMC has shared an early draft of Nursing Associate standards of proficiency, and it will consult on a further version later in the Spring of 2018, but the regulatory standards cannot be formally agreed until the new legislation is in place (see below).  Therefore the pilot programmes cannot be assessed for approval until after the legislation is in place.  The new legislation is expected to be in place around July 2018.

HEE is engaging with the NMC to support its pilot cohorts to meet the NMC’s required standards.  However, according to the Department of Health’s Nursing Associate consultation, the NMC will, where necessary, still have the power to insist on further education and training and a test of competence, if required, in order to protect the public.  Ensuring qualifications meet the required standards will provide assurance that all registered Nursing Associates are appropriately qualified and capable of safe and effective practice.

2  Nursing Associate Registration

There are two  main part to the NMC Register – Registered Nurse and Midwife.  In terms of Nursing, the existing Register is for Registered Nurses who have completed an NMC (or its predecessor bodies) approved three-year preparation programme (I know there are shortened programmes/pre-registration Masters etc, but for simplicity’s sake I am citing the usual route here).  Since 2013 entry onto the nursing part of the Register requires a Bachelor’s Degree from a University which has been approved by the NMC.  A Bachelor’s degree is at academic level 6 and normally takes 3 years of full-time study combined with a standard number of practice hours.  Entry on to the Register allows the use of the title ‘Registered Nurse’.  This title is protected in law.  It is an ‘offence’ to use the title Registered Nurse if an appropriate programme leading to registration has not been undertaken successfully, and it is an ‘offence’ to use the title Registered Nurse if one is  not on the appropriate part of the NMC Register.  More detailed information on the Register for Nurses can be found on the NMC’s website.

A part of the Register for Nursing Associates does not currently exist.  The NMC has to be the regulator in law before that new part of the Register can be created.  As stated previously, that legislation is not expected until July 2018.  Nursing Associates will apply to join the new Nursing Associate part of the Register when they qualify and can demonstrate that they have met the NMC’s standards and wider registration requirements.  They will not enter the Registered Nurse part of the Register.

The date of the required legislation is crucial.  I understand from the NMC that if the legislation is delayed, the Nursing Associate part of the Register may not open in January 2019 when the first 1,000 Nursing Associates qualify.  If the legislation is not in place, there will be no requirement for Nursing Associates to be registered in order to practise and they will be practising unregulated.  The title ‘Nursing Associate’ will only be protected when the new Nursing Associate part of the register opens.  I understand that there is constant dialogue with the Department of Health relating to this crucial timing.  Some information on potential transition arrangements can be found in the Department of Health’s Consultation document on the Regulation of Nursing Associates. Pages 18 and 19  specifically.

There is also some confusion over the title to be protected for the new role.  The title ‘Registered Nursing Associate’ with the post nominal ‘RNA’ is felt to be too close to the already protected title of ‘Registered Nurse Adult’ with the same post nominal of ‘RNA’.  The Department of Health has consulted on protecting the title ‘Nursing Associate (NA)’.  This will help to avoid confusion with Registered Nurse Adult.  However, this will not be known for certain until the Department of Health publishes the responses to its consultation in February 2018.

In the same way as for Registered Nurses, the Department of Health will create an ‘offence’ – anyone calling themselves a ‘Nursing Associate’ who is not registered on the appropriate part of the register with the NMC will be committing an offence. This is an important point for individuals, and equally important for employers to recognise that they cannot use the job title ‘Nursing Associate’ for workers who are not on the appropriate part of the NMC register.  Further information on this can be found in the Department of Health’s consultation document on the Regulation of Nursing Associates. Pages 25 and 26 respectively.

The purpose of regulation is to protect the public.  It does this by approving standards of education and only allowing those who successfully undertake such education to be entered on to a register and to be able to use the appropriate title. Where titles are protected in law e.g. Registered Nurse, they cannot legally be used by someone who has not undergone such education, or someone who is not on the register – neither by an individual nor as a job title by an employer.  As a result, the public can feel confident that anyone caring for them who uses a protected title has undergone a specified period of education and continue to meet certain standards.

3 Additional information

A Batchelor’s Degree leading to registration as a Registered Nurse and a Foundation Degree (or equivalent) leading to registration as a Nursing Associate are different programmes, at different academic levels, leading to different roles.  A qualified and Registered Nursing Associate is not a qualified and Registered Nurse.  The Nursing Associate is a support role and the key areas of delegation and supervision are still being actively considered.  These areas will need to be clear by the time the NMC’s Council agrees the standards for Nursing Associates.  See the NMC’s draft standards of proficiency for Nursing Associates for some description of the major differences between the functions of the Nursing Associate and the role of the Registered Nurse. Page 5 specifically.

It may be possible for Registered Nursing Associates to progress to undertake a shortened Bachelor’s degree leading to registration as a Registered Nurse, but until the Nursing Associate standards of proficiency are published it isn’t possible to say how much of the Bachelor’s degree they would need to complete.  Entry onto a shortened Bachelor’s programme is normally at the discretion of an awarding higher education institution (University), following the assessment and mapping of the content of the completed FD (or equivalent) against the content of the Bachelor’s degree, bearing in mind that the two programmes are at different academic levels  i.e. they will differ in terms of breadth and depth of study as well as content.  Given that the Nursing Associate role is meant to be a ‘bridge’ between the Health Care Assistant and the Registered Nurse, it seems likely that there  will be some firm guidance on this in due course.

So, there you have it.  Some facts from an authoritative source that I hope will be helpful.  Please note that this blog is not my personal view, my opinion or a reflection of my own thoughts.  It is an attempt to set down some factual information.

I would like to thank Jackie Smith, Chief Executive of the Nursing and Midwifery Council for a frank conversation and for checking the information in this text prior to publishing.

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