Saturday, 13 December 2014

Education, certification and employment of assistants in nursing

Roger Watson, Editor-in-Chief

'Assistants in nursing' encompasses a wide range of titles ascribed to an occupational group that works alongside registered nurses to perform a range of duties normally associated with the 'basic' aspects of care. Examples of these aspects of care include washing and feeding patients and performing routine tasks such as bed-making. That is the traditional picture; in fact, assistants in nursing  variously called 'nursing assistants', 'nursing auxiliaries', 'auxiliary nurses', 'nurse aides' and, in the UK, 'healthcare assistants' (HCAs)  often do much more. Assistants in nursing in the UK take vital signs and elsewhere have been reported to take electrocardiograms and to initiate intravenous infusions (Duffield 2014).

It is easy for registered nurses to take exception to various aspects of their traditional domain being encroached on while, at the same time, encroaching on various aspects of medicine and surgery. I doubt those for whom we purport to care  our patients and the general public  care about who does what in clinical practice; often they are not clear who is who in any case. The registered nursing scope of practice is, according to the International Council of Nurses, 'dynamic' but, whatever their scope of practice, registered nurses are registered; their names appear on a register which testifies to their preparation and good standing. Frequently, and in most of the UK, assistants in nursing do not appear on any kind of register. The question arises: does it matter?

It clearly does matter. Following the scandals at the Mid-Staffordshire NHS Foundation Trust in England, the Francis Inquiry specified several points which were relevant to assistants in nursing. Specifically, Francis called for standardised preparation, a code of practice and some form of registration. Specifically, the British government have refused to implement these steps, notwithstanding that a form of education and training for HCAs exists in Scotland and, 'in the wake of the Francis Inquiry' the first recommendations of the The Cavendish Review in England referred to the need for education and certification of healthcare assistants.

The risks and advantages around regulation of assistants in nursing can be weighed as follows:
  • Risks: without regulation an assistant in nursing can be dismissed from one hospital for providing poor care or worse and, provided they have not committed a criminal offence, they can take up employment elsewhere with impunity.
  •  Advantages: the above risk is obviated; preparation can be specified and standardised; and an expected standard of practice can be expected. As some may say: 'what's not to like?'
Naturally, regulation costs money and the issue of who regulates assistants in nursing could occupy our politicians and civil servants for months. Nevertheless, the end in this case must justify whatever means evolve. The issue of payment is surely straightforward; those who are regulated and seek to be recognised as such must pay. Currently the Nursing and Midwifery Council is struggling to regulate the nursing register but, surely, they are the obvious choice and if 'pump-priming' funding is required from central government resources, then surely this would be money well spent. After all, we are dealing with people's lives, safety and physical and psychological comfort. If we really think this is too expensive then we may, consequently, get the kind of healthcare we do not deserve.

Duffield C (2014) How long in forever? 2014 Australian Capital Region Nursing and Midwifery Research Conference Canberra, Australia

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