Continence nurse blog: Health care assistants, who needs them?

Who needs health care assistants? Well I certainly do. Within the sphere of continence, like elsewhere, the HCA is an often much maligned and misunderstood grade of staff who have a considerable amount to offer.

There are so many examples where they come up trumps for us, it surprises me why we ever thought that they couldn’t.

Let’s take a look at what HCAs do now in both primary and secondary care and then see how that can be transferred to continence.

In the last three years I have regrettably experienced inpatient status for surgery (ENT), cardiology (coronary care unit) and most recently, last November, a repeat visit to cardiology for another procedure.

The three experiences were, from a patient’s perspective, not dissimilar.

Out of the 24 hours, the staff group I saw most of was the HCA, including initial clerking and a tour of the premises (and the loos).

Mealtimes were mostly managed by HCAs. Dealing with getting up and going to bed? That’s right, them again.

Basic routine monitoring was actually undertaken by machines, but on several occasions it was the HCA who did the business.

They were there to support the trained staff who undertook certain procedures and it was interesting that while the trained staff carried out the procedures, some of which were less than pleasant, it was the voice of the HCA doing the reassuring.

Now I must state clearly that the various ward sisters, staff nurses, doctors and other professionals were superb, and undertook all of their duties in exactly the manner I expected, so much so that I even wrote to the chief executives of both the ambulance services trust and the acute care trust.

I am not known gladly suffer fools gladly or give praise, as I have always expected all staff to do the job that they were paid to do. After all, the job is the job.

I was, it would seem, quite impressed and this led me to open my eyes and heart to the role of the HCA. What about allowing the HCA to undertake some of the less mundane jobs and perhaps more of the ‘nursey’ ones?

It’s not unheard of. In primary care settings this has been a fairly normal practice for many years.

The most contentious issues that were floating around a few years ago were whether a HCA could undertake catheterisation? Even then my belief was, ‘why not?’, if properly trained, with checks and balances in place to ensure competence.

Catheterisation can fall into the realm of continence, urology, or both.

Certain catheterisation procedures like ISC (intermittent self-catheterisation) speaks volumes. This can be performed by patients as young as four years old. If a child has the ability and competence, why not a trained adult?

As the trained nurse’s role has significantly changed, it probably is not unreasonable that the role of the HCA will also change. Perhaps we need to ask why it hasn’t.

Before my restirement due to ill health, my team also consisted of a HCA, and over time her role changed with training. and plans were afoot to change and develop still further.

Training was the key to her development, is that any different to nurses’ development?

Her KSF was updated at least annually, and we agreed a development plan that supported the wishes of the staff member, her development and KSF requirements.

So is there a role for the HCA in continence services? My belief is there are many additional roles that the HCA can do, but we must abide by guidelines, standards and protocols, and we must be prepared to accept change and use development plans to fulfil KSF requirements.

By doing this we can provide better care, better value for money and then we can deliver a better quality care within available resources.

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