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The nursing support workforce plays a vital role in delivering safe and effective care. Here at the RCN, we are offering greater clarity on these roles by outlining two distinct levels:

• Supportive level – includes health care assistants, healthcare support workers and equivalent roles.
• Assistive level – includes registered nursing associates, assistant practitioners and equivalent roles.

These definitions have been developed as a collaboration between the RCN Professional Nursing Committee and the Nursing Support Workers Committee, facilitated by a Joint Partnership Board and with support from the RCN Professional Forums and Fellows.

Health and social care support workers 

This definition relates solely to the support workforce that is supervised by a registered nurse. We acknowledge that a broader group of support workers exists across health and social care settings, often referred to as health and social care support workers, but they fall outside the scope of this definition.

Due to workforce shortages, in practice, there are cases where staff are expected to work beyond their defined roles (substitution). We do not consider this to be acceptable. Therefore, this definition reflects what we believe should be happening in practice.

What is a nursing support worker?

Nursing support workers are collaborative members of nursing and multidisciplinary teams, providing person-centred nursing care across health, social care and education settings.

While they are responsible for their own actions, all nursing care they deliver is delegated and supervised by a registered nurse. Their role supports and assists registered nurses in delivering safe and effective care for individuals and populations. 

Note: Supervision does not necessarily mean direct supervision. More guidance is available on the accountability and delegation section of the RCN website.

Level descriptors for nursing support workers

Expert consensus has identified two key levels within the nursing support workforce. To further clarify the roles and levels of nursing support workers (particularly in relation to education and employment) the RCN Professional Nursing Committee and the Nursing Support Workers Committee are developing additional resources to complement this definition. These will provide further clarity on education, employment and career progression.

Supportive: Includes health care assistants, health care support workers and equivalent roles in all settings.

They will work within the team under the supervision of a registered nurse, delivering delegated task orientated care consisting of routine, high-volume activities with little variance. They have knowledge and understanding within the nursing support worker context, developed by education and training to the standard set for this level by the country of employment within the UK. They are responsible for recording their activity promptly and accurately, with any matters of concern escalated promptly to the registered nurse. 

Assistive: Includes registered nursing associates, assistant practitioners and equivalent in all settings.

In addition to the supportive level descriptors, staff at this level have a deeper level of knowledge, skills and training, meeting the standards set for this role by each country in the UK. For nursing associates, this includes the NMC standards. This enables them to carry out a broader range of activities, use their initiative and apply problem-solving skills within their agreed scope of practice, particularly in familiar, low-risk and predictable situations. Where appropriate, they can be delegated to guide the supportive level nursing support workforce, while remaining under the supervision of the registered nurse.

For more information on accountability and delegation, visit the RCN Professional Development page.

Further information

England

• Nursing and Midwifery Council (NMC): 
• Skills for Care:

Northern Ireland

• Department of Health:

Scotland

• NHS Education for Scotland (NES): 
• NES: 
• NHS Scotland: 

Wales

• NHS Wales: 
• Welsh Assembly Government: