In England, the nursing associate (NA) is a member of the nursing team who helps bridge the gap between health and care assistants and registered nurses. NAs work with people of all ages, in a range of settings in health and social care and across the fields of nursing, to help build the capacity of the nursing workforce and the delivery of high-quality care.
NAs are practitioners in their own right. The NA part of the Nursing and Midwifery Council (NMC) register opened on 28 January 2019. The NMC must ensure that registrants have the skills that are required to care for people safely, with integrity, expertise, respect and compassion.
Those applying to be admitted to the register must demonstrate that they have met the NMC's standards, have undertaken the required programme hours and have experienced a suitable range of placements. NAs must make a self-declaration that their health and character will enable them to practise safely and effectively, confirm that they have (or will have when they practise) appropriate indemnity arrangements, inform the NMC if they have any pending criminal charges, cautions or convictions, and tell the NMC if another regulator has ever said that their fitness to practise is impaired
If all its requirements are met, the NMC adds the applicant's name to the NA part of the register. NAs in England are also required to pay a £120 registration fee. ‘Nursing associate’ is a protected title and it is an offence to claim to be an NA, or to work as an NA, without registration.
As an NMC registrant, revalidation applies to NAs. NAs are required to uphold the tenets of the NMC Code (NMC, 2018a); they are accountable practitioners and work within a scope of practice.
NAs can expand their knowledge and skills when they are provided with the right training and governance. The NMC's standards (NMC, 2018b; 2018c) set out what a NA should know and what they are able to do when they become registered. The role of the NA is to provide support to registered nurses, not to substitute them.
The Royal College of Nursing (RCN) (2021) has issued a position statement on NAs' training in cervical screening. The RCN recognises that NAs carry out cervical screening in line with national standards. Those who provide and manage services and education providers should be confident that appropriate and relevant training, support and supervision is in place. Developing the skill base of the NA in this way can improve access to screening, reduce the incidence of cervical cancer and reduce the number of women who die from it.
Screening providers are required to ensure that NAs meet the core clinical competencies in the Skills for Health competency framework. To perform cervical screening, registered NAs must undertake initial theory and practical training as required by the NHS Cervical Screening Programme, complete the course and be assessed as competent.
NAs will be required to expand their knowledge and skills so as to undertake additional roles. The RCN publishes position statements on these, such as that on the role of the NA in vaccinations and administration (2019). While undertaking additional education and training, it is the role and responsibility of service providers to ensure that education and training (current and updated/ongoing) are made available and that the NA is provided with support and supervision, and that governance arrangements are in place.
The NA also has a duty to understand the extent as well as the limits of their competence, expertise and experience and to report any deviation from normal to their designated supervisor.