Motivations, experiences and aspirations of Trainee Nursing Associates in England. A qualitative study

Abstract

Background The nursing associate role was developed in England in response to the ‘Shape of Caring’ review. It has been implemented to fulfil two aims; to bridge the gap between registered nurses and healthcare assistants, and to provide an alternative route into registered nursing in light of workforce shortages. Other high income countries deploy second level nurses within their healthcare systems, however the UK has a turbulent history with such roles. The previous state enrolled nurse was phased out in the 1990s, and more recently the assistant practitioner (AP) role has faced wide variation in titles, scope and pay. Little is known about those who have embarked on the new nursing associate training course and their experiences of the role. Methods An exploratory qualitative study was undertaken using focus groups of trainee nursing associates to generate in-depth discussion about their motivations, experiences of training, and career aspirations.Three focus groups (n=15) took place in December 2018 using a purposive sample of trainee nursing associates registered at a University in the North of England. Two researchers facilitated each group discussion at a time and place convenient for participants. The discussions were audio recorded, transcribed and data was analysed thematically.Results This study found that trainee nursing associates are motivated by affordable, local, career development. During training they face challenges relating to clinical support, academic workload and uncertainty about future career opportunities. They experience role ambiguity both individually and across the wider organisation. Trainee nursing associates rely on broad support networks to build their occupational identity.Conclusions The barriers and facilitators of trainee nursing associate personal development have implications for policy and practice relating to recruitment and retention. The findings increase our understanding of this emerging role, and have informed the development of a larger longitudinal cohort study. Further research is required to evaluate the impact of this new role.

Employment Inequalities Among British Minority Ethnic Workers in Health and Social Care at the Time of Covid-19: A Rapid Review of the Literature

“…The literature identified through this review links the over-representation of ME workers in low paid jobs, including health and social care, to historical segmentation and selection practice into specific sectors and occupations (Hudson et al, 2017). Furthermore, income reliance due to socio-economic disadvantages and having families and caring responsibilities act as push factors to accept low-paid, local jobs in social care among minority ethnic workers (King et al, 2020). These 'sorting' processes of particular groups into lower-paid occupations exacerbate racialised and gendered stereotypes of caring jobs, particularly those involving domiciliary and live-in care (Atkinson and Crozier, 2020;Farris, 2020).…”

“…These and other interventions call for organisational level changes, such as introducing procedures to raise awareness of bullying and provide a bullying reporting mechanism, as well as individual-level interventions such as the provision of training and education to change behaviours or perceptions in a way that ensures responsibilities are placed on the perpetrators of bullying rather than the victims (Gillen et al, 2017). Support structures also need to be put in place, such as creating 'communities of practice' (King et al, 2020) and 'safe spaces' (Ross et al, 2020) to facilitate career progression and empower workers' voices.…”

The impact of COVID‐19 on work, training and well‐being experiences of nursing associates in England: A cross‐sectional survey

“…Second, previous work has shown that during the development and implementation of this new, second level, nursing associate qualification, students and staff often feel in a liminal space with role and task boundaries often being unclear (Davey, 2019; King et al., 2020). Findings here suggest that COVID‐19 accentuated this.…”

“…Decreases in patient contact, discontinuation of clinical placements, reduced supervision and redeployment were all reported. TNAs already face challenges in their training relating to clinical support and career development opportunities (King et al., 2020) and in relation to “worker” versus “learner” perceptions (Coghill, 2018). These have been compounded by COVID‐19.…”

Healthcare professionals' views of a new second‐level nursing associate role: A qualitative study exploring early implementation in an acute setting

“…Initial research into nursing associate trainees' experiences largely focused on the training model. In these studies, role ambiguity and the need for role clarity (Coghill, 2018) (King et al, 2019), as well as the need for education and communication about the scope of practice of the role has been reported (Health Education England, 2019). An evaluation of the nursing associate role including expert interviews, a survey with chief nurses in England and case studies of two NHS organisations providing community and mental health care has also been conducted (Kessler et al, 2020).…”