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Nursing associate career pathways - not just the ‘top-up'

Updated Monday, 15 April 2024

Read the stories of seven qualified nursing associates who spoke to Dr Gemma Ryan-Blackwell, who was Programme Lead for Foundation Degree in Nursing Associate Practice, and heard their journeys. 

This content is associated with The Open University's Nursing and Healthcare courses and qualifications.

You might be surprised about the different career paths that are emerging for nursing associates (NAs) in the healthcare workforce. In fields such as research and education there are increasing opportunities for band 4 NAs to progress without requiring the degree Transfer to Nursing (top-up) programme to be a registered nurse. You may be interested in Sam’s story below where she chose to pursue a leadership related degree, now working in a band 6 role with potential to progress further. Many people do not wish to complete their registered nurse training and the NA role has a wealth of strengths and opportunities outside of the top-up option. 

Amy’s story

A photo of Amy Amy (pictured right) has been qualified as a NA working in paediatrics for over three years. She had been working as a health care assistant in paediatrics and was interested in progression and wanted to take on more responsibility when her Trust launched a pilot programme for the NA apprenticeship. Initially it was only for those working in adult nursing. However, as the NA programme is not a specific field, she applied and was accepted on the programme in 2019. Amy was the first NA to qualify and work in paediatrics in her Trust. 

Amy recognises that she grew as the role evolved and being a new unknown position, she had to learn to advocate for herself to get the learning experiences that she needed. As a qualified registered NA, she encourages anyone who is interested in a patient facing role to consider the NA programme. Amy has recently started a transfer to nursing programme, again as an apprenticeship.

Caroline’s story

A photo of CarolineCaroline (pictured left) had been working in healthcare in the community and prison service for over 12 years, when she came across the opportunity to undertake the Foundation Degree in Nursing Associate Practice. Like many coming onto the programme, she had not studied for a long time and had a lot of self-doubt. Caroline was determined to make it work. On taking up the training role, Caroline acknowledges that she was fortunate that whilst she couldn’t choose where she went to, the Trust picked up on her interest in vascular medicine and she was able to develop her knowledge through her apprenticeship. 

Now qualified, Caroline works for a Primary Care Network (PCN) in a role similar to a Practice Nurse. She works within surgeries and has undertaken further training in cervical screening, dopplers and a vascular course. Caroline’s favourite day is a Wednesday, when she works in a specialist leg ulcer clinic called the Lindsay Leg Club. This is a social model of care that enables elderly people to get out of their homes to meet others and also get their leg redressed as well. From this service Caroline can refer to the wider PCN such occupational therapists, physiotherapists etc., as required.

Charlotte’s story 

Photo of CharlotteCharlotte (pictured right) qualified as a NA in 2021. Her background had been in chemistry and forensic science, but personal circumstances meant that she had not been able to complete her initial degree and started working in the NHS. Charlotte spent approximately 18 months working in the community with the District Nursing Teams, but when she had a placement in an acute hospital during her NA programme, she knew this was where she wanted to be, although she acknowledges that practically, community work is better for her personal circumstances. Charlotte has not looked back and went straight into a transfer to nursing programme on completing her Foundation Degree in Nursing Associate Practice. Charlotte qualified as a registered nurse in four years and is just about to take up a role as a registered nurse on a renal dialysis unit in the community.

Heidi’s story

Photo of HeidiHeidi (pictured left) joined one of the first pilot groups for the NA programme, so has been a qualified NA for over four years. She admits that when she started her NA training she initially wanted to gain a qualification for the role that she felt she was already doing. She later recognised she got far more than that out of the two year programme, such as enhanced clinical skills, increased knowledge on evidence-based practice, and understanding how important a reflective portfolio is. 

On qualifying as a NA, Heidi returned to working in A&E and found that she enjoyed supervising and supporting learners, although found it difficult at times to juggle the role of practitioner and supervisor. With her passion for the trainee and qualified NA role, Heidi moved to a local university nearly three years ago and now works as a Learning and Development Coach supporting Trainee Nursing Associates on their apprenticeship journey. Heidi is continuing her own professional development by studying for a degree-level qualification to ensure that she will be able to teach at university level in the near future.

Julie’s story 

Initially when Julie’s Trust piloted the NA programme, she wasn’t successful in getting a place. However, after over seven years of healthcare assistant experience with her Trust, Julie’s employer was keen for her to try again. She reapplied and this time was successful. Julie admits without their push, she doesn’t think she would have tried, as she was comfortable where she was. Julie is glad she did though. 

Julie is now a band 4 NA, with a District Nursing team. Having got the ’studying bug’, she went straight onto doing her transfer to nursing programme and hopes to qualify as a registered nurse soon. Julie loves working as a NA in the community and said: “I think a community setting is very different to a ward setting. We're all on a similar level in the community. We all go out with our own workloads and then come back in together and discuss where we've been. And your opinion is always valued. I think that’s grown.” 

Sam’s story

Photo of SamSam (pictured right) qualified as a NA in late 2018. She had initially been looking at Assistant Practitioner training posts, but felt they were too specialised, so she applied to do her Foundation Degree in Nursing Associate Practice. On qualifying, she was successful in securing a post at the university where she had done her NA training to teach others doing the NA and assistant practitioner training programmes. 

Alongside this role, Sam also did her top-up, but not the traditional registered nurse programme, she applied for and completed a BSc (Hons) in Enhanced Integrated Care. Sam knew she enjoyed teaching and university life, so went and completed a teaching qualification. When COVID-19 happened, Sam found that she enjoyed returning to clinical practice as a NA. Sam started to look for less conventional roles where she didn’t need to be a registered nurse. For the last two years, Sam has been working as a Mental Capacity and Deprivation of Liberty Assessor. This is a band 6 role with an Integrated Care Board. Sam loves the challenges that the role brings.

Sarah’s story

Photo of SarahSarah (pictured left) came into nursing after initially having a career in teaching. She commenced her NA training programme in the year following the pilot and hasn’t looked back since. On qualifying as a NA, Sarah originally returned to the clinical area that had supported her to do her NA training as a band 4, however, she was encouraged by colleagues to consider other areas as well as ultimately it was her Trust that had supported her. 

After a placement with the research team, this was something that she was interested in, but there was not any band 4 roles within the team. Keen to move into this field, Sarah kept this in the forefront of her mind as she undertook a top-up programme. Sarah is now a qualified registered nurse and works full time as band 5 in the research team and would encourage anyone to follow their dreams.

The opportunities for NAs to work in a variety of areas is a huge opportunity. For example, there has been discussion of the role of nursing associates in intensive care units. It may well be that a NA provides the essential direct patient care in the days of recovery, when patients are not critically ill on breathing equipment, while registered nurses alongside them could focus on those more critical patients (Bates, 2019). You will see from the NHS jobs website that there are increasingly diverse roles being offered to NAs. 

Looking at some band 5 roles (and beyond) and person specifications outside of the registered nurse role can help identify gaps in skills and experience and strengths NAs have, allowing strategic career plans to be put in place to fill in the gaps and potentially apply for band 5 roles without having to top-up to be a registered nurse (if this is not something NAs wish to pursue). Visiting The Open University's employability hub can help with career planning and development. 

Reference and acknowledgement

Bates, L. (2019) Developing the nursing associate role in a critical care unit. Clinical Practice. 115 (10): 20-24

The research project informing this OpenLearn article was funded and supported by The Open University’s, Praxis Scholarship and Innovation Centre.


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