Implementation of Nursing Associate roles in the NHS: What works for whom, how and why? A rapid realist review.

 Summary

Nursing Associates (NAs), registered to the Nursing and Midwifery Council, are a new role, in healthcare that were first introduced in 2017. The first NAs qualified in 2018/19, and by 2022 there were approximately 7000 registered NAs.

The NA role was proposed to bridge the gap between Health Care Assistants (HCAs) and Registered Nurses (RNs). NAs begin as Trainee Nursing Associates (TNAs) and embark on a two-year apprenticeship where they undertake a mixture of education and work placements to qualify as an NA. Once qualified, NAs work in a variety of NHS settings under the support and direction of RNs to carry out clinical and care duties that are intended to reduce the workload of RNs and enhance patient care.

Very little is known about how this new role fits in to existing workforce skill mix or what the benefits and disadvantages of the role are for patients and NHS services. We propose to undertake a rapid realist review of the NA role to understand how it is intended to operate; in which circumstances the role might benefit staff and patients and why. The rapid realist review will inform a grant proposal for a large-scale realist evaluation of the NA role. The future evaluation would involve collecting and analysing qualitative and quantitative data to explain how the role operates and how it can be best implemented according to different circumstances. The findings will be used to inform policy and commissioning and plan clinically- and cost-effective service provision.