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Introduction to the Nursing Associate Role
The Nursing Associate (NA) was introduced in 2019 to enhance the nursing workforce in England. Nursing Associates are registered with the Nursing and Midwifery Council (NMC). Registered NAs have demonstrated that they meet the required NMC standards having undertaken an educational programme which includes placements in a variety of clinical areas. NAs deliver hands-on, person-centred care as part of a multidisciplinary team in a range of different settings. As registrants NAs need to revalidate every 3-years and are required to uphold the NMC Code (NMC, 2018b). The NMC has set out The Standards of Proficiency Nursing Associates which determines what skills and knowledge Nursing Associates have when they join the register, (NMC, 2018c). As with all registered professionals, Nursing Associates are required to continue to develop their knowledge and skills and undertake additional roles post registration.
To ensure sustainability of the Nursing Associate role it must be seen as a role in its own right. Individuals in the role need to be supported to develop professionally and personally, extending their scope of practice and expertise, as appropriate for the service within a governance structure.
A Note on Supervision Structures for Nursing Associates Working in General Practice (GPNAs)
The line management for General Practice Nursing Associates (GPNAs) must include reporting to a Registered Nurse, who will provide support and guidance around professional issues.
As a registered professional it is the duty of the GPNA to understand the boundaries of their role, including the extent of their competence and expertise and to deliver safe care accordingly. Employers will ensure that education and training is made available to GPNAs, alongside support and supervision. The governance arrangements required to support GPNAs should include clear escalation process for raising concerns.
Scope of Practice
To ensure safe and high-quality care the GPNA must be deemed competent to the national standard in the tasks required of them. A governance plan detailing the standard, supervision required, and an escalation plan, will support the expansion of the GPNA.
This is a list of activities the GPNA cannot currently undertake:
The competency framework illustrates the need for GPNAs to work closely with Registered Nurses, Advanced Clinical Practitioners (Nursing) and General Practitioners to ensure that primary nursing assessments, care planning as well as diagnosis are undertaken safely for the patient and within scope of practice by the GPNA and wider nursing team.
General Practice Nursing Associate Role Development
A key component of the GPNAs development will come from their professional relations with their supervisor, who will be a role model, provide clinical advice, ad hoc learning opportunities and planned supervision sessions. These planned regular supervision sessions provide an opportunity for case reviews, clinical discussions, and reflection contributing towards the GPNAs revalidation. GPNs working alongside GPNAs will provide the clinical supervision and education of GPNAs. It is advisable to include this responsibility in job descriptions.
The GPNA Competency Framework
The competency framework for General Practice Nursing Associates (GPNAs) relies on career long attention to NMC standards. The framework includes a self-assessment of practice against the NMC Standards of Proficiency for Registered Nursing Associates. This requires self-assessment and supervisor sign off. It is intended as a first and important step for all nurses stepping into a General Practice Nursing Associate career. It will assist GPNAs to continue to operate as reflective practitioners. The reflective practice templates and professional development plan templates, included in the framework will support revalidation and appraisal.
The section on Statutory and Mandatory Training enables both the employer and the GPNA to chart their progress on attaining all the required training, which supports both professional practice and employer HR processes.
The framework is structured to provide a route map to support GPNAs new to General Practice Nursing on a career long journey. It will assist GPNAs to establish high level competence and expertise in a field of nursing which requires knowledge across a wide range of clinical situations. It provides an elaboration of the most common clinical areas of practice which are delivered by nurses who are providing general practice services. The framework will support GPNAs to develop clinical skills in context, and understand their role in the wider nursing and professional team.
The framework will support General Practice Nursing Associates education and training. It is not a defined academic curriculum as the scope of the competencies in the framework will take time (years) to develop. The nature of the nursing associate role in general practice means that the requirements of individual roles will be influenced by individual and employer interests, the supporting team members and the health care needs of the practice population. There is no expectation that all the competencies will be achieved in their entirety by every General Practice Nurse Associate.
The framework provides a structure which supports self-assessment, clinical supervision, observed practice and competency sign off. GPNAs using this framework will be able to demonstrate they have achieved a specific and measurable standard of practice in each area of practice included in the framework.
Competency assessment is not a substitute for accessing relevant post-graduate academic education or other training or for high quality role induction. It offers a structured format so that along with your employer, assessor and supervisor you will be able to state your competence in these areas as a registered practitioner. It will also act to identify any gaps in knowledge and competence and enable you to request appropriate training or carry out self-directed learning to fulfil this requirement. It will support you to offer clinical care appropriately to the full extent of the Nursing Associate scope of practice.
It is reasonable to expect that the depth of knowledge and clinical expertise that is demonstrated by an individual nurse associate will vary for a number of reasons. To address this the competencies themselves have been assigned tiers which demonstrate the level of expertise that has been gained in a particular field. There is no hierarchy assigned to the competencies included in the framework, as this will emerge from the specific needs of the patient population and requirements of the employer.
It is the intention of the framework that GPNAs will be able to come back to it and use it to assess their practice against the competencies, at whatever stage they are in their career. It is intended to support the (often unsung) work of clinical supervisors/educators, assessors.
Competence definition is an evolving process, we have attempted to define and describe the common areas of GPNA care. The absence of a defined competence should not be interpreted as an area where competence should not be considered by the GPNA, GPN or employer.
The framework will maintain its relevance by being updated with the latest evidence and guidelines. It will change as new areas of practice become mainstream. It will serve employers as a tool to understand and appreciate the clinical expertise that GPNAs bring with them in any environment they are working as a GPNA, be that a general practice, a prison, a mental health trust environment or elsewhere
Introduction to the Nursing Associate Role
The Nursing Associate (NA) was introduced in 2019 to enhance the nursing workforce in England. Nursing Associates are registered with the Nursing and Midwifery Council (NMC). Registered NAs have demonstrated that they meet the required NMC standards having undertaken an educational programme which includes placements in a variety of clinical areas. NAs deliver hands-on, person-centred care as part of a multidisciplinary team in a range of different settings. As registrants NAs need to revalidate every 3-years and are required to uphold the NMC Code (NMC, 2018b). The NMC has set out The Standards of Proficiency Nursing Associates which determines what skills and knowledge Nursing Associates have when they join the register, (NMC, 2018c). As with all registered professionals, Nursing Associates are required to continue to develop their knowledge and skills and undertake additional roles post registration.
To ensure sustainability of the Nursing Associate role it must be seen as a role in its own right. Individuals in the role need to be supported to develop professionally and personally, extending their scope of practice and expertise, as appropriate for the service within a governance structure.
A Note on Supervision Structures for Nursing Associates Working in General Practice (GPNAs)
The line management for General Practice Nursing Associates (GPNAs) must include reporting to a Registered Nurse, who will provide support and guidance around professional issues.
As a registered professional it is the duty of the GPNA to understand the boundaries of their role, including the extent of their competence and expertise and to deliver safe care accordingly. Employers will ensure that education and training is made available to GPNAs, alongside support and supervision. The governance arrangements required to support GPNAs should include clear escalation process for raising concerns.
Scope of Practice
To ensure safe and high-quality care the GPNA must be deemed competent to the national standard in the tasks required of them. A governance plan detailing the standard, supervision required, and an escalation plan, will support the expansion of the GPNA.
This is a list of activities the GPNA cannot currently undertake:
The competency framework illustrates the need for GPNAs to work closely with Registered Nurses, Advanced Clinical Practitioners (Nursing) and General Practitioners to ensure that primary nursing assessments, care planning as well as diagnosis are undertaken safely for the patient and within scope of practice by the GPNA and wider nursing team.
General Practice Nursing Associate Role Development
A key component of the GPNAs development will come from their professional relations with their supervisor, who will be a role model, provide clinical advice, ad hoc learning opportunities and planned supervision sessions. These planned regular supervision sessions provide an opportunity for case reviews, clinical discussions, and reflection contributing towards the GPNAs revalidation. GPNs working alongside GPNAs will provide the clinical supervision and education of GPNAs. It is advisable to include this responsibility in job descriptions.
The GPNA Competency Framework
The competency framework for General Practice Nursing Associates (GPNAs) relies on career long attention to NMC standards. The framework includes a self-assessment of practice against the NMC Standards of Proficiency for Registered Nursing Associates. This requires self-assessment and supervisor sign off. It is intended as a first and important step for all nurses stepping into a General Practice Nursing Associate career. It will assist GPNAs to continue to operate as reflective practitioners. The reflective practice templates and professional development plan templates, included in the framework will support revalidation and appraisal.
The section on Statutory and Mandatory Training enables both the employer and the GPNA to chart their progress on attaining all the required training, which supports both professional practice and employer HR processes.
The framework is structured to provide a route map to support GPNAs new to General Practice Nursing on a career long journey. It will assist GPNAs to establish high level competence and expertise in a field of nursing which requires knowledge across a wide range of clinical situations. It provides an elaboration of the most common clinical areas of practice which are delivered by nurses who are providing general practice services. The framework will support GPNAs to develop clinical skills in context, and understand their role in the wider nursing and professional team.
The framework will support General Practice Nursing Associates education and training. It is not a defined academic curriculum as the scope of the competencies in the framework will take time (years) to develop. The nature of the nursing associate role in general practice means that the requirements of individual roles will be influenced by individual and employer interests, the supporting team members and the health care needs of the practice population. There is no expectation that all the competencies will be achieved in their entirety by every General Practice Nurse Associate.
The framework provides a structure which supports self-assessment, clinical supervision, observed practice and competency sign off. GPNAs using this framework will be able to demonstrate they have achieved a specific and measurable standard of practice in each area of practice included in the framework.
Competency assessment is not a substitute for accessing relevant post-graduate academic education or other training or for high quality role induction. It offers a structured format so that along with your employer, assessor and supervisor you will be able to state your competence in these areas as a registered practitioner. It will also act to identify any gaps in knowledge and competence and enable you to request appropriate training or carry out self-directed learning to fulfil this requirement. It will support you to offer clinical care appropriately to the full extent of the Nursing Associate scope of practice.
It is reasonable to expect that the depth of knowledge and clinical expertise that is demonstrated by an individual nurse associate will vary for a number of reasons. To address this the competencies themselves have been assigned tiers which demonstrate the level of expertise that has been gained in a particular field. There is no hierarchy assigned to the competencies included in the framework, as this will emerge from the specific needs of the patient population and requirements of the employer.
It is the intention of the framework that GPNAs will be able to come back to it and use it to assess their practice against the competencies, at whatever stage they are in their career. It is intended to support the (often unsung) work of clinical supervisors/educators, assessors.
Competence definition is an evolving process, we have attempted to define and describe the common areas of GPNA care. The absence of a defined competence should not be interpreted as an area where competence should not be considered by the GPNA, GPN or employer.
The framework will maintain its relevance by being updated with the latest evidence and guidelines. It will change as new areas of practice become mainstream. It will serve employers as a tool to understand and appreciate the clinical expertise that GPNAs bring with them in any environment they are working as a GPNA, be that a general practice, a prison, a mental health trust environment or elsewhere