Denise Baker, Head of Pre-Qualifying Healthcare at the University of Derby
The University of Derby is one of the first eleven cohorts of nursing associates in the UK. Later cohorts have been termed fast followers and now we have in the region of 2,000 trainee nursing associates in England, 125 of whom are at Derby. As part of a wider review of development of the nursing workforce, the associate role was proposed as one which would free up registered nurses to concentrate on more complex cases. The associate role is also seen as a route into nursing, allowing experienced support workers access to the registered nurse role if that’s appropriate.
Our students have been sponsored by Health Education England and are supported by their employers to attend university one day per week for two years to undertake a foundation degree. Work-based learning is nothing new – we have been seeing assistant practitioners educated this way for years – but the scale and pace of this development is unprecedented.
Students had a break in their studies over August, but there is no let-up in their development. Many are undertaking placements in a completely different environment to their usual workplace. This has been one of the challenges for employers – sourcing an adequate number of appropriate placements, often with different employers. A large employer hosting a small number of social or primary care students is not impossible, but it becomes much harder when you want to place 30 hospital based Nursing Associates in GP practices or nursing homes. Is the hard work worth it? Our students tell us it is. Their practice is enriched and enhanced by seeing how care is delivered in different sectors and they have a much better understanding of the journey patients need to undertake to receive care. Not surprising perhaps, but the thought of allowing employees to visit other employers to see how it all works is quite unique.
There are many who still do not quite know what the nursing associate role is. Indeed, the Nursing and Midwifery Council (NMC) are still drawing up the standards which will tell universities and employers exactly what the role will look like. This is a challenge for education providers and nursing associates alike. Are we sure that we are teaching the right topics and giving them the correct workplace experiences? We believe so, but we have also learned so much already. The support that the trainees receive in practice is critical. Each trainee has an experienced nurse as their supervisor whose role is to mentor the future nursing associate into the nursing profession. However, not knowing what the ‘finished’ role looks like is hard for everyone. Of course, this brings many opportunities to shape the role and make it fit for purpose, but we run the risk of introducing variations in the role in different parts of the country or even region.
Funding received from Health Education England has allowed employers to provide clinical educators in our region. This role has been key in offering support to nursing associates and supervisors and enabled easier communication between employer and education provider. But this is a short lived role, only possible because of the additional funding. Further cohorts of nursing associates are planned and an apprenticeship is in development, but unless employers agree to continue funding the educator role themselves, they will finish at the end of the pilot project. The clinical educators have already proved their worth, so their removal will be a risk.
In spite of the challenges, working with this group of learners is a joy. Experience with our assistant practitioners has shown us how much talent is already in the support workforce, and given the opportunity, they blossom. What they bring with them is experience of delivering care – sometimes years and years of it. Foundation degrees offer trainees the opportunity to organise, supplement and develop their existing knowledge, and we know that what we do in the classroom today can be put into practice tomorrow. Writing assignments is a challenge – many haven’t studied for a number of years and they have full time jobs and full time lives to fit in too. But don’t be tricked into thinking that foundation degrees are the easy option or that support workers aren’t academic. University may have felt like an impossible dream to many of our trainees, but they absolutely deserve to be there and consistently impress us with their hard work, knowledge and compassionate approach which comes through in the classroom.
At a time when we hear a lot about the challenges faced in the healthcare workforce – the impact of Brexit, the public sector pay cap, removal of bursaries or the numbers of vacancies employers are currently carrying, we have to think differently about the workforce of the future. Nursing associates are part of that future. Lack of clarity about the role, time to develop new skills and logistics of arranging placements in other organisations are challenging, yes, but we are already starting to see benefits in practice. We look forward to welcoming more trainees early in 2018 and are proud to be part of a wider team of employers and education providers in the East Midlands.