If you are a nursing associate referred to the NMC, you go through the same Fitness to Practise process as nurses and midwives: screening, investigation, case examiners and, in some cases, a hearing, with the same range of outcomes. Nursing associates are registered with the NMC in England. In 2024–2025, 46 of the NMC's 4,749 new referrals broken down by registration type concerned nursing associates. The NMC's Careline and union support are open to you too.
Key takeaways
- Same process, same standards, same outcomes as nurses and midwives.
- Nursing associates are registered with the NMC to practise in England.
- The Careline is for anyone involved in the FtP process: call 0800 587 7396.
- Contact your union straight away, and check what cover you had when the incident happened.
Nursing associates are a newer part of the register, and many tell us they feel invisible in FtP guidance. Articles talk about nurses and midwives, and it is hard to know whether any of it applies to you. It does. The NMC's guidance on investigations, case examiners, interim orders, hearings and sanctions all refers to the nurse, midwife or nursing associate.
This is general information, not legal advice.
Does the NMC treat nursing associates differently?
No. Anyone who wants to practise as a nursing associate in England must join the NMC register, just as nurses and midwives across the UK must. You are held to the same Code, and concerns about you go through the same Fitness to Practise process. On 31 March 2025 there were 12,782 nursing associates on the register, out of 853,707 professionals in total.
In 2024–2025, the NMC received 46 new referrals about nursing associates, out of 4,749 new referrals broken down by registration type. That is a small number, which is one reason it can feel lonely. But small numbers do not mean a different process.
What happens after a nursing associate is referred?
The NMC will let you know by email that a concern has been raised, with forms to complete. You will have 14 days from the date on the letter to respond. You do not have to respond to the allegations themselves within 14 days, but you do need to complete the personal details form and give your employer's details.
After screening, a case may be closed or investigated. If case examiners decide there is no case to answer, they can close the case, give advice or issue a warning. If they decide there is a case to answer, they can recommend undertakings or refer the case to the Fitness to Practise Committee. If there is a risk that needs managing while the case continues, an interim order may be considered.
For a calm walk-through of the first weeks, read received an NMC referral? Your first five steps and your first letter from the NMC.
Could I be struck off as a nursing associate?
The full range of sanctions applies, from a caution order to conditions of practice, suspension and, in the most serious cases, a striking-off order. If a nursing associate is struck off, they are not allowed to work as a nursing associate in England. Most cases do not get that far: the NMC says a significant majority of the cases it receives conclude without action on a professional's registration.
Striking off also cannot be used in health or lack of competence cases unless the person has already been on a suspension or conditions of practice order for a continuous period of two years.
What should I do first?
- Contact your union or professional body immediately. The NMC's support page lists the RCN, RCM, Unison and Unite.
- Check you were a member at the time of the incident. The RCN, for example, says formal representation depends on having been in the correct membership category when the incident took place.
- Tell your employer, if you have not already: they may be able to support you and help you strengthen your practice.
- Write a private timeline while your memory is fresh.
- Do not contact anyone connected to the case about it.
What if I do not have a union?
You are not on your own. The NMC encourages people without a union to seek advice from regulated legal professionals with experience in regulation as early as possible. Its support page signposts to Citizens Advice, the Law Society's Find a Solicitor service, LawWorks, Advocate and the Queen Mary Legal Advice Centre, a student-led service supervised by lawyers that offers free support to registrants without union representation who cannot afford private legal help.
Our guide to facing an NMC referral without a union goes through these options in more detail.
What helps a nursing associate's case?
The same things that help anyone: engaging with the process, giving context, honest reflection that shows insight, and evidence of strengthened practice linked to the concerns. The NMC says that if you provide information showing you have addressed the concern, decision-makers might decide you are currently fit to practise and that a more detailed investigation is not needed.
Your reflection should be about your role and your scope of practice as a nursing associate. Be specific about what you were responsible for, who you escalate to, and what you do now.
You are not a smaller version of a nurse. You are a registered professional, and the same protections and support apply to you.
Where can I get emotional support?
The NMC's Careline is for anyone involved in the Fitness to Practise process, including nursing associates. It is free, confidential and independent of the NMC, run by a wellbeing provider called CiC, and open 24 hours a day, every day, on 0800 587 7396. It offers emotional support, practical advice, counselling and signposting, and it will not tell the NMC you have used it. You do not need to be in crisis to call. Peer support from people who have been through FtP, such as NMCWatch, can also help.
When to get advice
As soon as you know about a referral, contact your union (RCN, Unison or Unite, or the RCM if relevant), your indemnity provider or a regulatory solicitor. Take advice before sending anything to the NMC. Our Navigating NMC Fitness to Practise course explains each stage in plain English, and 1:1 mentorship offers support from a nurse who has been through it.
Frequently asked questions
Yes. Nursing associates are on the NMC register in England, so anyone can raise a concern about one, including an employer, a patient or the nursing associate themselves through a self-referral.
Yes. The NMC says the Careline is for anyone involved in the fitness to practise process. It is free, confidential, independent and open 24 hours a day on 0800 587 7396.
The NMC's support page lists the RCN, RCM, Unison and Unite. Check each one's membership categories and whether you were covered when the incident happened, as representation usually depends on that.
Not automatically. Many people keep working while a case is investigated. Restrictions only apply if an interim order or a final sanction is made, or if case examiners agree undertakings with you.
