Trainee nursing associates in England: A multisite qualitative study of higher education institution perspectives.

AIM: To explore the experiences of university employees on the development and implementation of the nursing associate programme. BACKGROUND: As part of wider policy initiatives to address workforce shortages, provide progression for healthcare assistants and offer alternative routes into nursing, England recently introduced the nursing associate level of practice. Little research has yet considered university perspectives on this new programme. METHODS: An exploratory qualitative study reported following COREQ criteria. Twenty-seven university staff working with trainee nursing associates in five universities across England were recruited. Data, collected via semi-structured interviews from June to September 2021, were analysed through a combined framework and thematic analysis. RESULTS: Three themes developed: 'Centrality of partnerships' considered partnerships between employers and universities and changing power dynamics. 'Adapting for support' included responding to new requirements and changing pedagogical approaches. 'Negotiating identity' highlighted the university's role in advocacy and helping trainees develop a student identity. CONCLUSIONS: Nursing associate training in England has changed the dynamics between universities and healthcare employers, shifting learners' identity more to 'employee' rather than 'student'. Universities have adapted to support trainees in meeting academic and professional standards whilst also meeting employer expectations. While challenges remain, the ability of nurse educators to make adjustments, alongside their commitment to quality educational delivery, is helping establish this new training programme and thereby meet government policy initiatives. IMPLICATIONS FOR NURSING POLICY: The international movement of apprenticeship models in universities has the potential to change the status of the learner in nursing educational contexts. National policies that encourage this model should ensure that the implications and challenges this change of status brings to learners, employers and education institutions are fully considered prior to their implementation.

Enhancing the quality of oral nutrition support for hospitalized patients: a mixed methods knowledge translation study (The EQONS study).

AIM: The aim of this study was to report a multifaceted knowledge translation intervention to facilitate use of the Malnutrition Universal Screening Tool and innovation in nutritional care for patients at risk of malnutrition. BACKGROUND: Malnutrition among hospitalized patients is a widespread problem leading to adverse health outcomes. Despite evidence of the benefits of malnutrition screening and recommendations for achieving good nutrition, shortfalls in practice continue. DESIGN: A mixed method integrated knowledge translation study. METHODS: The knowledge translation intervention comprised nutrition champions supported by knowledge translation facilitators and an action planning process. Data collection was undertaken over 18 months between 2011-2012 in a hospital in England. Data comprised observation of mealtimes, audit of patient records, survey of nurses and semi-structured interviews with nutrition champions, knowledge translation facilitators, senior ward nurses and nurse managers. FINDINGS: Statistically significant relationships (Chi Square) were observed between self-reported confidence of nurses (a) to assess patients using the Malnutrition Universal Screening Tool, (b) to teach colleagues how to use the Malnutrition Universal Screening Tool and (c) to ensure that patients were assessed within 24 hours of admission. Ward-based nutrition champions facilitated successful innovation in nutrition support. Contextual factors operating at micro (ward), meso (organization) and macro (healthcare system) levels acted as barriers and enablers for change. CONCLUSION: Nutrition champions were successful in increasing the timely assessment of patients at risk of malnutrition and promoting innovation in nutritional care. Support from knowledge translation facilitators helped nutrition champions develop their role and work collaboratively with senior ward nurses to implement action plans for improving nutrition.

Development of the nursing associate professional identity: A longitudinal qualitative study.

AIM: The aim of this study was to understand the factors that contribute to the development of the nursing associate professional identity. DESIGN: A 3-year longitudinal qualitative study of trainee nursing associates. METHODS: Trainee nursing associates in England were interviewed remotely annually in February 2020, March 2021 and March 2022. They also provided diary entries. Data were anonymised, transcribed and analysed thematically. RESULTS: Nursing associate professional identity was developed through: increased knowledge, skills and responsibility; and self-perceptions of identity alongside responses to the role by colleagues. Tensions arose when the scope of practice expected by organisations differed from that expected by the nursing associates. Frustrations occurred when nursing associates were perceived as substitutes for Registered Nurses in the context of nursing workforce shortages. CONCLUSION: Nursing associates in this study clearly valued their new knowledge, skills and responsibility, enabling them to provide enhanced patient care. Increased clarity of role boundaries is necessary in enhancing the professional identity of nursing associates and reducing inter-professional tensions arising from role ambiguity within health and social care organisations. IMPLICATIONS FOR THE PROFESSION: National guidance and employers should provide clarity on the boundaries of the nursing associate role which will strengthen their professional identity and mitigate role ambiguity within health and social care organisations. REPORTING METHOD: The Consolidated Criteria for Reporting Qualitative Research has been used to guide reporting. PATIENT OF PUBLIC CONTRIBUTION: A patient and public involvement group was consulted during the initial study design stage. IMPACT: This study aimed to understand the factors which contribute to the development of a nursing associate professional identity. Nursing associate professional identity is developed through increased knowledge, skills and responsibility, and the perceptions of identity by participants themselves and their colleagues. The findings should inform the implementation of initiatives to clarify nursing associate role boundaries and the development of similar roles internationally.

Primary care trainee nursing associates in England: a qualitative study of higher education institution perspectives.

AIM: To explore higher education institution (HEI) perspectives on the development and implementation of trainee nursing associates (NAs) in the primary care workforce in England. BACKGROUND: Current shortages of primary health care staff have led to innovative skill mix approaches in attempts to maintain safe and effective care. In England, a new level of nursing practice, NAs, was introduced and joined the workforce in 2019. This role was envisaged as a way of bridging the skills gap between health care assistants and registered nurses and as an alternative route into registered nursing. However, there is limited evidence on programme development and implementation of trainee NAs within primary care settings and HEI perspectives on this. METHODS: This paper draws from a larger qualitative study of HEI perspectives on the trainee NA programme. Twenty-seven staff involved in training NAs, from five HEIs across England, were interviewed from June to September 2021. The interview schedule specifically included questions relating to primary care. Data relating to primary care were extracted and analysed using a combined framework and thematic analysis approach. FINDINGS: Three themes were developed: 'Understanding the trainee role and requirements', 'Trainee support in primary care' and 'Skills and scope of practice'. It is apparent that a more limited understanding of the NA programme requirements can lead to difficulties in accessing the right support for trainees in primary care. This can create challenges for trainees in gaining the required competencies and uncertainty in understanding what constitutes a safe scope of practice within the role for both employers and trainees. It might be anticipated that as this new programme becomes more embedded in primary care, a greater understanding will develop, support will improve and the nature and scope of this new level of practice will become clearer.

Training and development experiences of nursing associate trainees based in primary care across England: a qualitative study.

BACKGROUND: The nursing associate role was first deployed in England in 2019 to fill a perceived skills gap in the nursing workforce between healthcare assistants and registered nurses and to offer an alternative route into registered nursing. Initially, trainee nursing associates were predominantly based in hospital settings; however, more recently, there has been an increase in trainees based in primary care settings. Early research has focussed on experiences of the role across a range of settings, particularly secondary care; therefore, little is known about the experiences and unique support needs of trainees based in primary care. AIM: To explore the experiences and career development opportunities for trainee nursing associates based in primary care. METHODS: This study used a qualitative exploratory design. Semi-structured interviews were undertaken with 11 trainee nursing associates based in primary care from across England. Data were collected between October and November 2021, transcribed and analysed thematically. FINDINGS: Four key themes relating to primary care trainee experiences of training and development were identified. Firstly, nursing associate training provided a 'valuable opportunity for career progression'. Trainees were frustrated by the 'emphasis on secondary care' in both academic content and placement portfolio requirements. They also experienced 'inconsistency in support' from their managers and assessors and noted a number of 'constraints to their learning opportunities', including the opportunity to progress to become registered nurses. CONCLUSION: This study raises important issues for trainee nursing associates, which may influence the recruitment and retention of the nursing associate workforce in primary care. Educators should consider adjustments to how the curriculum is delivered, including primary care skills and relevant assessments. Employers need to recognise the resource requirements for the programme, in relation to time and support, to avoid undue stress for trainees. Protected learning time should enable trainees to meet the required proficiencies.

A tale of two bridges: Factors influencing career choices of trainee nursing associates in England: A longitudinal qualitative study.

AIM: The nursing associate role has created a new second-level nursing role and provided an alternative route into registered nursing. For some, this provides a previously inaccessible opportunity for career progression. The aim of the study was to understand the factors that influence career choices of trainee nursing associates. DESIGN: A longitudinal qualitative study of trainee nursing associate motivations, experiences and career aspirations. METHODS: Semi-structured interviews with trainee nursing associates from across England, UK, in February 2020 (N = 14) and March 2021 (N = 13). Diary data were also collected. Interview and diary data were analysed thematically. Reporting has followed COREQ guidelines. RESULTS: Nursing associate training was viewed by some as a bridge into registered nursing. Role ambiguity led several to seek perceived security offered by the Registered Nurse profession. Those preferring to remain as nursing associates were keen to embed the bridging role between healthcare assistants and Registered Nurses, valuing a positive workplace culture.

Improving clinical experiences for nursing students in nursing homes: An integrative literature review.

Well-organized clinical placements in older adult care settings will prepare nursing students to provide care for this growing population and may influence career choices. The purpose of this integrative review is to identify strategies that can be used to provide student nurses with effective clinical education experiences in residential aged care facilities offering skilled nursing (RACF-SNs). Twenty-three studies evaluating teaching and learning models and experiences were reviewed. Four themes were identified related to effective strategies for providing gerontological clinical education to students in residential aged care environments, principally nursing homes. These were: developing a partnership, comprehensive orientation, effective supervision for students, and supporting staff. Eight different models were described for enhancing clinical learning experiences in these environments. These models reflect the themes highlighted in the review. Relevance of the findings to a conceptual framework for evaluating gerontological clinical placements, the Senses Framework, is considered. Strong partnerships between schools of nursing and residential aged care environments can provide well-organized clinical education to undergraduate nursing students. To be sustainable, these partnerships must be developed in ways that do not require significant additional resources. A guideline for this process based on findings of the review has been developed.

Medicines reablement in intermediate health and social care services.

Aim To evaluate a medicines reablement initiative involving health and social care, to include consideration of the training package, proportion of patients reabled successfully, and patient and staff perspectives of the service. BACKGROUND: Intermediate care services provide short-term intervention to support patients with chronic conditions transition from hospital to community-based services and involves maximising patients' independence through reablement. The term 'medicines reablement' describes the process of rehabilitating patients to be independent with their medication. METHODS: Pharmacy technicians led the medicines reablement initiative. They delivered a competency-based training programme for frontline health and social care staff. They assessed and set goals with patients to facilitate independence in self-administration of their medication. The pharmacy technicians provided on-going support to staff helping patients to reable. They reassessed patients after six weeks to determine if medicines reablement had been successful or whether further input was needed. Data were collected by means of a questionnaire and semi-structured interviews with pharmacy technicians, frontline staff, managers, and patients. Findings Twenty per cent of patients discharged from hospital to intermediate care were assessed to be suitable for medicines reablement. Of these patients, 44% were successfully reabled and a further 25% benefited from the input of a pharmacy technician. Patients and staff were positive about medicines reablement, emphasising the importance of patients attaining independence for self-administration of medication. Although following training, health and social care staff felt confident in facilitating medicines reablement they valued on-going access to pharmacy technicians for timely support, help with problem solving, and advice throughout the reablement process. CONCLUSION: Medicines reablement can lead to patients becoming independent with taking medication and contribute to staff satisfaction. Pharmacy technicians can play an important part in delivering medicines reablement training to frontline staff and overseeing the reablement process. Further research examining medicines reablement is needed to develop a stronger evidence base.