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Are nurses sunbathing while HCAs do the work?


The first healthcare assistant I worked with was called Maria. Maria was tough. She could, if she wanted, lift a car should there be one stopping her from making a bed or bathing an 80 year old patient with advanced dementia.

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Maria worked very hard. When she was not hurtling around the old decrepit ward we worked on she had a large family to care for, did a cleaning job part time and enjoyed welding. I liked Maria, she had worked on that ward for over 20 years and taught me more than the nurses did.

After I had earned my stripes so to speak - by doing the dirty jobs willingly and being polite - she was kind enough to listen to me when I said I thought some of what we were doing was less gentle than it could be. She didn’t have to listen to me, after all I was just passing through and she must have seen hundreds like me before. So I think listening was generous and it’s good to notice when other people are generous.

Anyway Maria and her colleagues did most of the direct patient care along with the students. This was 1986. New research tells us that healthcare assistants are doing the bulk of direct patient care. I know a lot of things pass me by - who noticed Wimbledon for example - but why is anyone surprised?

‘The government is setting up phone lines for people to call in with ideas on how to save money - can I suggest we have fewer government call centres?’

We know that in many care settings - particularly those for inpatients - it is healthcare assistants who are undertaking the fundamental care. We know that this raises all sorts of questions, not least: how does it redefine the role of the nurse? Are we ensuring that healthcare assistants are supported? And, is it the case that care delivery is designed not by things like “skill mix” or policy but simply by economics? Still?

But it seems to me that in a climate like the current one, where the government is setting up phone lines for people to call in with ideas on how to save money (can I suggest we deport Prince Andrew and have fewer government call centres?), the problem with rediscovering how hard healthcare assistants work is the extent to which it becomes an excuse to save money by - for example - denigrating nursing.

Now if healthcare assistants were delivering care while trained nurses were out the back on sun loungers reading about research methods I could see there was a problem. But they are not. Despite the sometimes hysterical criticisms healthcare assistants are not delivering hands on care because nurses have degrees, or don’t like patients, or are all doing the work formerly done by junior doctors. Nurses are too busy to do everything and so they gather assistance. There are not enough nurses and thankfully they have healthcare assistants to help them.

Let’s not use information like this - information that should enable us to appreciate and value healthcare assistants for the excellent job they are doing - as a means to belittle nurse education or the nursing role. It is self defeating and inaccurate. In times like these we need to value each other all the more rather than give anyone an excuse for you to make do with fewer staff tomorrow.


Readers' comments (76)

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

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  • 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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