Are nurses sunbathing while HCAs do the work?

Readers' comments (76)

• mike | 1-Jul-2010 7:03 pm

  Ooh now there's a title to get people pulling the boxing gloves on! But you are right, a similar discussion on this topic did end up with heated opinions on each side.
  
  We have to remember the difference between direct basic care, and direct clinical or specialist care.

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• jjjez@hotmail.com | 2-Jul-2010 5:45 pm

  I agree, healthcare assistants are only and have ever only performed the most basic aspects of healthcare, though we are lucky to have those with the skills they do. Compare the situation in Ireland where they don't even take BP's or BM's!!
  
  Then he have this assistant practitioner guff coming along and paying them more to do less than they do now.
  I certainly have noticed that the NA's on Band 2 do more work than the few Band 3's and 4's i know.
  
  What is needed is for NHS trusts to ensure that things like observations etc have a clear parameter of warnings e.g. what is high and low, what needs to be brought to the nurses attention etc. but NHS trusts like mine give their NA's almost no real practical education, assuming that people can learn on the job.
  
  Well they can't in the same way that nurses couldn't learn on the job because of the theory and study involved that can't simply drip down informally.
  
  A good NA can be your eyes and ears and ought to be considered an extension and tool of the nurse, rather than an autonomously functionning being.
  I refer to them as my assistants because they are by design, default and decree and they do not practise independent of my supervision.
  
  Having said that many are already toe, ankle or thigh deep in the profession anyway and have picked up a great deal of knowledge and interpersonal skills that myself, being a bit cold sometimes, lack but they have the time and the inclement to do that.
  
  My job is to prioritize what care is delivered where and to ensure their health improves vis-a-vos other MDT members.
  
  Where i work nobody works harder than anybody else because we are all in it together, but with the various types of work i have to do, trust me, i'm busier than they are.

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• Anonymous | 3-Jul-2010 12:29 pm

  I have just moved from a very busy ward with numerouse support care workers (SCW) to a small district hospital with none. I really prefer it as I have time to do everything for my patients and really get to know them. My ability to assess their condition has improved and I don't have to worry that the SCW has decided to carry out care without my request or supervision. Saying all that though, the good ones were worth their weight in gold and enrich the team enormously. It's not just skill mix but attitude mix, a willing and capable SCW can become disillusioned and beligerant if their supervising nurse does not trust them to do their job. Likewise the less concientious and workshy CSW can revel in this relationship. Having had my foot in both camps now it's not perfect but as an RN in my previous job, I don't know how we would have coped without them.

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• Anonymous | 3-Jul-2010 2:18 pm

  Nurses can learn 'on the job' jjjez, many of us did just that! and the best ones keep learning 'on the job' throughout our careers.
  I haven't worked on a ward for a long time (I am still in a clinical role) and I have to say that in my humble opinion support staff should not have been encourraged to take on aspects of the role such as Obs, blood sugars etc (which traditionally were done by student nurses and ENs) as most do not have the underpinning knowledge to evaluate the results. But I have worked with superb support staff throughout my career,

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• Anonymous | 3-Jul-2010 5:15 pm

  An NA is as good as their training and supervision allows. Having been an NA and deciding to go on to train in nursing I found it aided me as basic knowledge and personal skills are something I feel some nursing students are lacking in. A good NA is worth their weight in gold on the ward and beneficial to the team. I don't think anyone sunbathes on the ward policies and shortages have put pressure on all the ward team and with the increasing paperwork for nurses a good NA plays a crucial role. I sometimes think that the NA gets a raw deal always being blamed for poor care when really its pressures and the environment or lack of team work that is to blame.

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• mike | 3-Jul-2010 7:12 pm

  Anonymous | 3-Jul-2010 2:18 pm I agree absolutely that NA's or HCA's or whichever title is next should never have been given expanded roles to the extent they do now, precisely because they do not have the same level of training or accountability.
  
  And I would like to say that opinions such as that are not HCA bashing in any way shape or form.
  
  Like I said earlier it is about remembering the different types/levels of care.
  
  HCA's conduct basic care, washing, bedmaking etc.
  
  Nurses conduct clinical/specialist care.
  
  We all have a role to play, they are just different. Simple as that.

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• Anonymous | 4-Jul-2010 0:58 am

  I would have to say that I am a firm believer in giving NAs an expanded role a void had been left with the decline in ENs and a push towards degree level nurses and NAs have been pushed into this gap. They should have the basic training and knowledge skills to be able to full understand obs and bms etc as this would utilize their role more on the ward. It would benefit the ward team and the patient. Healthcare and roles need to move forward.

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• Anonymous | 4-Jul-2010 5:50 am

  The question: 'Are nurses sunbathing while HCAs do the work?' is in essence a ridiculous one. If the contributor meant it as a hyberbole, its a rubbish one.
  
  Perhaps using politicans verses rubbish men is also a lousy selection but it may illustrate my point.
  
  David Cameron has a job to do. And that is not to collect rubbish. That is someone elses job. He sees after vastly more important matters. It would be ridiculous to suggest that because he doesn't chuck rubbish in rubbish trucks means he's doing nothing, 'sun bathing'.
  
  Nurses dont do as much basic patient care as HCA's because its basic. HCA's don't do any or as much clinical/specialist work because its clinical/specialist. Each person has a role to play and must play it.
  
  Comparisons are more fittingly made between persons of the same rank, i.e HCA vs HCA or nurse vs nurse, and still, such comparisons are just as illogical and childish.
  
  
  
  
  
  
  
  

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• Anonymous | 4-Jul-2010 5:53 am

  Healthcare should move forward. But someone still needs to do the basic patient care...

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• Anonymous | 4-Jul-2010 8:12 am

  I've worked with some fantastic HCA's when I was on the wards and some very scary ones. Exactly the same goes for my experience of nurses and doctors...and receptionists and ward clerks.
  In my current dept the HCA equivalents have been given the room to make limited, initial assessments of medical problems which for the most part they have enjoyed and do it well. However when situations have arisen where clinicians have changed or overruled decisions and the explainations offered as to why, they have been horrified at what the variety of urgencies that information could mean. Their practice unfailingly improved for this knowledge when offered in a constructive way and they felt supported.

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• mike | 4-Jul-2010 8:14 am

  Anonymous | 4-Jul-2010 0:58 am,
  
  I agree with you to an extent. However, the level 3 and 4 HCA's are taking roles in which they are not fully trained in, nor are they accountable. If they were both of those, I would have a different view.
  
  And Anonymous | 4-Jul-2010 5:53 am has it right. The making of beds, the washes, the cleaning of bedside tables, etc etc always needs to be done. This is why we have HCA's (note the clue is in the title, health care ASSISTANTS).
  
  Clinical care, which is what staff Nurses give (and I might add can also be at the bedside despite all the extra work which is done away from the bay) should be left to those who are fully trained.
  
  There are two distinct roles here, and people in both roles work very hard.

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• Anna Lincoln | 4-Jul-2010 9:11 am

  The HCA's maybe doing all the basic care. But as the lone RN for a large number of patients I am singlehandedly doing all the meds, doctors rounds, prescribed treatments, assessments, admissions, discharges, emergencies, communication with the MDT, etc etc etc. The HCA's take breaks, go to lunch, and leave on time.
  
  I have no choice but to skip lunch and stay over at the end of my shift by an hour or two unpaid to finish everything.
  
  I resent the implication that bed bathing is the be all end all of nursing care.

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• tim stokes CAMHS | 4-Jul-2010 9:12 am

  i am of the opinion that for qualified nurses to abandon basic nursing care is wrong. although i work in psychiatry your basic care is the same throughout, it is a nurturing when the patient is most vulnerable that allows a trusting relationship to build.
  
  HCA's are becoming as skilled as old style nurses were and will displace them if we become so highly skilled and expensive as we become "medic light" with all the attendent distance from care nessecitated by such a role.
  
  until this comes around nurses must set the standard and modelling of care for HCA's,is a an important part of our role. this is how we set standards! also how can we evaluate data if we know nothing of the patient it comes from, particularly in areas where direct observations do not give direct qualitative results such as pain management or mood.

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• Anonymous | 4-Jul-2010 9:25 am

  I have been a HCA for 5 years in both the hospital setting and the GP practice. When I started at the hospital I had training on what is considered a high bp, how to take bm's, when to refer to a nurse when there is a problem, etc, etc. To say that a HCA is only there to make beds as they are not qualified is an old fashioned opinion. The ward I worked on the nurses and HCA's worked as a team and no-one thought they were better than someone else. A lot of the nursing students had less practical knowledge and training than the HCA's. I am now back in the GP setting and have attended training courses and have been deemed competent in a lot off areas that the practice nurses are. In fact the nurses admit that the HCA's a more competent in phlebotomy than they are. So please do not belittle the HCA's as only being able to make beds!

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• Anonymous | 4-Jul-2010 10:08 am

  I have worked in maternity for a few years now and have to say that as a HCA I feel like a do almost everything seeming as there's only one HCA on duty each shift, I bed-bath, take bloods, go into theatre, take bp, temp, stats etc., sometimes look after patients on my own with little input, help with deliveries, bleep doctors, set up rhesus and many other things beds usually come at the bottom of the list and sometimes I feel; as a band 3 HCA that I have a lot of responsibility

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• Anonymous | 4-Jul-2010 11:40 am

  As an ex MCA (maternity care assistant) working alongside midwives I had my own caseload (under supervision of m/w) which was ostensibly the babies, but sometimes, if midwives were pressed, then mums as well for basic obs. I also trained to do venapuncture (on adults) and looked after the babies that were poorly, but not poorly enough to go to scbu including heel pricks for low bm's, jaundice and guthrie. I managed the paediatric clinic and those babies on phototherapy. Then i did my RN (child) training and i am not allowed to do heelpricks any more. Strange, but true. The role of the nursing/care assistant really needs to be formalised, so that we can get the best from all the staff in whatever environment they work. In these times of scant time/funds we have to be able to ensure that situations like Anna Lincoln's do not persist; it is unfair, unsafe and the sort of practice that makes nurses leave the profession. But then i suppose NA's are cheaper to employ!

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• Stephen Jobling | 4-Jul-2010 11:56 am

  How bloody rude! @ jjjezhotmailcom (second comment).. I'm an Assistant Practitioner how very dare you suggest i do less work now.. I can tell you I've never worked harder, staying late every shift to ensure my patients are cared for

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• Jacqueline de Laporte | 4-Jul-2010 12:08 pm

  When I was a student nurse, too many decades ago I fear, student nurses did the bulk of all care, including the cleaning I might add. Whilst I wouldn't want to go back to that, HCAs now seem to have taken on that role, however we were giving the training to underpin what we were doing, supervised by the Staff nurses.
  
  Recently, I have been able to observe, whilst my husband had a major operation, the different competencies of HCAs.
  
  During his pre-op assessment the HCA did his basic observations, filled in all the forms, took blood, did an ECG and the MRSA swabs. This she did with a cheery efficient manner. a task no doubt she did many times a day and was very good at it. However, she was not required to interpret any of the results and this is the difference and a good use of resources.
  
  Whilst on his ward, which was mainly post op neurological conditions, I observed a different HCA going from bed to bed, without washing her hands or using a hand gel, doing the neurological observations. She was following a standard set of observations without the slightest understanding of what she was doing. These consisted amongst other things to ask him to pull her hands towards him and to push them away. As my husband didn't have any neurological problems above his waist before the operation it was not very likely that he had developed them afterwards! There was no joined up thinking and a complete waste of time and care was not tailored to the individual patient. These should have been done or supervised by a trained nurse because they did need interpretation, not merely ticked in a box at the end of the bed that no one ever saw. The important problems were missed because they weren't on the tick box, something hopefully a trained nurse would
  have noticed.
  
  ENs generally were the answer, they had two years of training and education and gave high standards of care and were very
  good in what they did. If HCAs had the training and supervision that ENs then that would solve a lot of problems.
  
  I work in General Practice and I have an excellent HCA who does the bulk of the blood taking, this releases me to concentrate on the interpretation of the results during my varied consultations with patients and make appropriate decisions.
  
  Anon, 4th July is doing the work of a maternity nurse, (not midwife), a role again previously taken by an EN who had had two years training. Shame on the overworked Midwives who allow this.

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• Anonymous | 4-Jul-2010 1:09 pm

  I am HCA band 3 and i work with a great team of STAFF NURSES,HCA,SUPPORT WORKERS.I have worked for the nhs for 19 years and what i have learnt and achieved was all down to the qualified nursing staff.I gained my NVQ 2 and 3 within the nhs by the help and support of the nursing team i work along side with.They are amazing nurses and work very hard on a really busy ward.The trust they have in their HCA really makes me proud and lucky to work along side them.Working as a team,communication, is very important between all staff and they always praise us for what we do.We are there to assist and help them and the responsibilies that Qualified nurses have and the importance of their roles,(medication,ivt,mdt meetings,ward rounds,drug rounds,care plans,interventions,discharges,transfers, handovers,dealing with doctors,patients,relativies,hca,managers, physio"s,students,matrons,bed managers,pharmycists,on call doctors,out reach team,care homes,carers,and many more.HCA responsibilities are taking observations(which we now need to be trained and signed off for by a Mentor ie Qualified nurse),ECG"s also training and signed off for,Patients Hygiene ie washing,dressing,mouth care.All care of patients reguarding their needs,feeding,assisting to toilet,weighing,heighting,escorting to appointments to other hospitals.Qualified nursing staff also help with patients hygiene,Observations,Bladder Scans,ECG"s,ALL the job roles we have they do these as well,they have a much greater responsibilty than we has HCA have but they trust us,respect us,rely on us,and treat us as a equal and trust our judgement,Listen to our views,ideas,and most important our reports of patients observations,any changes,and any other imformation reguarding care,concerns that we have about patients,they put there trust in us and work with us and to me that IS WHAT IS IMPORTANT.

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• Anna Lincoln | 4-Jul-2010 2:19 pm

  You are wrong Tim Stokes.
  
  Well educated nurses need to be at the bedside providing direct patient care (including bed bathing). They understand that better than anyone.
  
  What has happened is that management is refusing to pay for enough RN's to be on duty per shift. Often we only have one for 28 patients. This is why the health care assistants are doing the basic care. It is not because the Nurse's themselves don't want to be doing it. She is just overwhelmed being the lone RN.
  
  This kind of staffing is happening all over. WE have contacted the NMC, Unison, the RCN, the care comission and even the media. Nothing is getting done about the recruitment freezes and the poor RN staffing.
  
  When health care assistants do all the basic care important nursing assessments get missed.
  
  And everyone knows that except for the hospital chiefs and the hca's themselves. Abd camhs nurses obviously.
  
  I am slightly annoyed that someone who works for Camhs could possibly think they understand the situation on the medical wards.

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