Registered nurses’ experiences of working with trainee nursing associates in acute hospital settings: a generic qualitative study

Abstract

Launching new roles in healthcare settings can be controversial; potentially threatening the status of existing professionals. The introduction of the Trainee/Nursing Associate (TNA/NA) role occurred in response to a governmental mandate to bridge the gap between unregulated generic healthcare support workers and Registered Nurses (RNs) in 2016. Nursing associates support RNs in the provision of quality patient care. Within a growing body of literature exploring the impact of the introduction of TNAs/NAs, there is a clear research gap addressing what it is like to work with TNAs, exclusively from the RN perspective. I adopted a Generic Qualitative Research Approach (GQRA) to explore RN experiences. This overarching GQRA approach provided a method of exploring the discipline of nursing. My study is aligned to the constructivist branch of interpretivism with a narrative inquiry lens. Phenomenology and hermeneutics are integral to my study design, focusing on the lived experience of participants. Purposive criterion sampling recruited five RN participants who took part in an individual face to face semi-structured interview during 2018. Reflexive Thematic Analysis generated five themes and seventeen subthemes. The five themes were, Apprehension, TNAs alleviate pressure and provide support, Conflict and tension, Professional accountability and Harmony and reciprocal learning. Findings revealed that RNs journeyed from an initial position of apprehension and uncertainty as they worked with TNAs, to a later position of accepting and welcoming TNAs to the role across a variety of acute clinical settings. An unexpected finding was the existence of conflict, tension, jealousy and animosity from healthcare support worker colleagues toward TNAs. The introduction of new healthcare support roles can be contentious. A myriad of dynamics impact on the acceptance and successful embedding of new roles into existing teams. The exclusive RN perspective within a generic qualitative research approach, with both a narrative inquiry and hermeneutic interpretative lens makes this study unique. My study is timely and adds to the developing body of knowledge where an in-depth understanding of the RN experience of working with TNAs and NAs is not evident. Various recommendations have been proposed for three different audiences: the nursing profession and nursing practice, workforce planners and managers, and educationalists in academic settings.