Deploying registered nursing associates

Before Cheshire and Wirral Partnership Foundation Trust’s first trainee nursing associates qualified, the trust considered the following to determine where to place its registered nursing associates (RNAs):

• where they would be safe and add most value?
• where they would be able to use their range of skills and knowledge to deliver person centred care?
• where there were current gaps and opportunities / skill mix?
• what were the delegation and supervision arrangements?

The trust also completed quality assurance impact assessments (QIA). It consulted the following guidance and legislation while preparing for the deployment:

• NHSI Safer Staffing guidance
• CQC
• NHS Employers

After deciding which teams the RNAs would be placed into, those teams were supported to give them:

• a raised awareness of the role
• an understanding of the role - supporting the NMC Standards of Proficiency for Nursing Associates
• a developed preceptorship programme - a period to support newly qualified nurses to make the transition from student to develop their practice further
• practice education facilitator links

The trust reviewed the QIAs with the RNAs within 3 to 6 months.

Feedback

Initial feedback from team leaders about the impact RNAs are having in their teams:

Heather Dutton, Clinical Facilitator, Chester Adult Mental Health Team, Cherry Bank Resource Centre

“On behalf of the Chester Adult Mental Health Team, I would like to feedback by saying what a valuable asset our band 4 registered nursing associate has proved to be to the team. Not only has her contribution to running the health and wellbeing clinics created increased capacity for our band 5 nurses to further develop in other areas of their roles such as care coordination but she has taken an active lead in promoting the physical health pathway and is working well with her colleagues in clinics to improve efficiency and ensuring that people who access services are receiving their annual physical health checks in a timely manner. She also has a small caseload for whom she is primary worker for, provides feedback in multidisciplinary team meetings and is a keen enthusiastic member of the team.”

Rachel Jarmain, Team Manager, Adult Mental Health Service Ellesmere Port and Neston

“Our registered nursing associate has been qualified in post for 6 months and has been an invaluable asset to the team. She has consolidated the good work that had been started in the wellbeing clinic, by implementing more standardised processes, and structure to the cardio metabolic checks being offered. She has also built upon this by participating in the SPMHPB pathway development for Cardio metabolic screenings and intervention. She has enabled patients to attend physical health appointments, to ensure their physical health needs are being addressed; something we did not have capacity to offer within the team before. She has also been able to provide depot injections for people who require more assertive engagement, and she is carrying a caseload of clients who present with reduced complexity. These latter contributions, in particular, have freed Registered Nurses to have more time to provide initial assessments.”

Adele Barber, Trainee Advanced Practitioner (previously Team Manager) East Cheshire Community Learning Disability Team;

“New roles within the multidisciplinary health team are being developed and includes the role of the registered Nursing Associate that complements and reflects a team with a broad range of clinical skills that will continue to provide person centred care, improve patient health outcomes and patient safety. Although in its infancy, the role of a registered nursing associate is already developing and adding value by working flexibly as part of a multidisciplinary team working across four care pathways that holds a specific physical health remit. Professional registration with the NMC offers professionalism, responsibility and accountability that meet clinical governance standards.”

Jackie Fisher, Community Mental Health Team Manager, Jocelyn Solly Resource Centre, Macclesfield

“Our registered nursing associate is now an integral part of the team, she works autonomously she demonstrates initiative in her day to day practice although is very clear on her boundaries and will seek support from colleagues when needed. She is able to support the band 6 clinic coordinators this clearly makes a difference and adds value and another dimension to overall care. She works closely with the wellbeing clinic to promote the physical health of people who access services, additionally she will complete specific pieces of work with people who access services to promote independence.”

Emma Lea, Broxton Community Care Team Manager, Malpas Surgery

“Our registered nursing associate has added value to the team with her experiences within her mental health placements and using the skills she has learnt to identify mental health issues within patients she is visiting. The RNA is expanding her skills within physical health and learning new skills and enhancing her knowledge. The role has been embraced by the team and we are always looking how we can develop our skill mix in the future.”