Implementation of the Nursing Associate in the NHS: A Rapid Realist Synthesis to Understand Mechanisms of Integration and Workforce Development

TL;DR

This study explores how Nursing Associate roles are being implemented in the NHS and what factors influence their success.

Contribution

The paper introduces a realist synthesis approach to understand the mechanisms behind Nursing Associate integration and workforce development.

Findings

Three theory areas were identified: role scope, model of working, and career progression.

Lack of understanding about Nursing Associate roles can lead to staff friction.

Clear communication about role scope is needed to support successful integration.

Abstract

To develop theories about how Nursing Associate (NA) roles are implemented and working within NHS practice: What works, for whom, in what contexts and how?

Rapid realist synthesis of: (1) empirical and grey literature; (2) realist interviews with stakeholders. Sources were analysed using a realist approach that explored the data for novel or causal insights to generate initial programme theories.

Empirical and grey sources (n = 15) and transcripts from stakeholder interviews (n = 11) were synthesised which identified three theory areas relating to NA implementation: (1) Scope of NA role: Communication and expectations; (2) Variations to the NA model of working; and (3) Career progression: Entry point, stepping stone and career in itself.

The NA holds the potential to improve nursing workforce stability by encouraging locally based, non‐registered healthcare staff to transition to an NA. However, the lack of collective understanding of the NA scope of practice can cause staff friction. It is unknown whether this friction will reduce over time or if staff divisions will lead to further deterioration of the workforce.

Ongoing clear communication regarding NA scope of practice needs to be provided to aid understanding of their supplementary role and its potential contribution to nursing teams.

This work represents a first step to support both researchers and nursing workforce leaders in furthering knowledge of the impact of integrating NAs in diverse healthcare contexts and to unearth the mechanisms underpinning the success or failure of this new role.

Realist and meta‐narrative evidence syntheses: Evolving standards.

Planning of the research design and interpretation of the results was completed with nurse clinicians with experience in the NA role.

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