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.