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Healthcare assistants are being asked to undertake increasingly complex interventions, prompting fresh calls for support staff to be regulated.
Respondents to a Nursing Standard survey, conducted as part of our Care campaign, said that some unregistered staff are administering insulin and controlled drugs, as well as managing colleagues and running units.
Some respondents expressed concern that healthcare assistants (HCAs) are under pressure to work beyond their competence and that training standards vary too widely. Registered nurses are also worried that employers see them as interchangeable with HCAs.
The findings, from a survey of 2,554 readers, will put further pressure on peers to support mandatory regulation of support workers when they agree final amendments to the Health and Social Care Bill. More than nine in ten respondents back a system of registration for support workers.
Readers were invited to give examples of 'complex interventions that HCAs or unregistered nursing staff are asked to carry out'.
Responses indicate that monitoring patients' vital signs, carrying out ECGs and venepuncture, and doing wound dressings have all become routine practice for support workers. Some respondents indicated that HCAs had received training, but others said this was lacking.
RCN HCA adviser Tanis Hand said: 'The list of findings reinforces the need for regulation and clear guidance on HCAs' training and education.'
She said the key issue is not what HCAs should or should not be doing, but that registered nurses are responsible for using their clinical judgement to assess whether delegation is appropriate. 'It is important for nurses to understand the principles of delegation and that HCAs are not put into situations that they are not fully prepared for.'
RCN head of policy Howard Catton said: 'These findings make it clear that if we want to maximise patient safety, we need to push forward with mandatory regulation of support workers. There is also a clear need for education and training of support staff to ensure we do not separate tasks from the knowledge required for clinical assessment and decision making.'
But Mr Catton added that there was an important balance to be found between registered nurses 'doing' and 'delegating' work. 'Registered nurses need to carry out clinical tasks to maintain their clinical competence. If their clinical skills deteriorate, they will no longer be able to delegate, support and supervise support workers safely in carrying out clinical tasks,' he said.
Unison head of nursing Gail Adams said: 'This list reaffirms our findings that HCAs are delivering most bedside nursing as well as many extended roles. I question whether some of these roles are appropriate given the lack of consistency and training.'
Nursing and Midwifery Council advice on delegation states: 'A nurse or midwife may only delegate an aspect of care to a person whom they deem competent to perform the task.
A Department of Health spokesperson pointed out that it is developing a code of conduct and minimum training standards for HCAs.
news: january 11 :: vol 26 no 19 :: 2012
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