Background The nursing associate role is relatively new, with the first few registrants qualifying in 2019. Nursing associates contribute to the care of patients under the supervision of a nurse; however, they can often experience challenges in practice associated with variations in the tasks they are permitted to undertake.

Aim To explore the lived experiences of nursing associates and the perspectives of people who work with them to understand what weaknesses and threats are associated with the role.

Method A realist ethnographic approach was used, incorporating semi-structured interviews with nursing associates (n=8) and focus groups with healthcare professionals who had experience of working with nursing associates (n=8).

Results Analysis of the data identified three overarching themes relating to threats to the nursing associate role: incivility and role ambiguity; curriculum and placements; and motivations and career opportunities. The data also revealed five ‘entities’ that influence the nursing associate journey – the individual’s status, the healthcare team, education providers, the employing organisation, and nurses’ professional organisations.

Conclusion A framework addressing the weaknesses and threats to the nursing associate role was produced. This outlines interventions and improvements that can encourage, enable, empower and ennoble nursing associates, while also supporting the implementation of the role into practice.