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Healthcare assistants carry out nursing tasks

  • 51 Comments

Healthcare assistants are routinely taking on tasks traditionally performed by registered nurses, but are becoming less inclined to take professional qualifications, a survey by Unison has found.

The union’s biennial survey of HCAs asked for the first time about the jobs they carried out and found the most common task performed by HCAs was monitoring and recording patients’ observations (see box below).

Despite the apparent widening of the HCA role, almost 60 per cent of respondents said they should be restricted in the tasks and duties they could perform - suggesting assistants have concerns about being asked to perform tasks they are not trained to do.

Unison surveyed more than 1,000 HCAs during July and August this year. The findings revealed that fewer HCAs now plan to start professional training than two years ago, when the survey was last carried out.

In 2008, 41 per cent of survey participants said they planned to start professional training. By 2010, this had dropped to just 33 per cent.

Unison said two “pathways” should be created, one for HCAs who want to progress their career through training, and one for those who do not.

Survey participants said their most common daily tasks included many “direct nursing” tasks. These included tasks that are often those most visible to patients, such as bed making, distributing food, and bathing and feeding patients.

HCAs also reported carrying out complex dressings, taking electrocardiogram readings, and inserting cannulas and female catheters.

Ian Kessler, a lecturer in employee relations at Oxford University’s Said Business School, coauthored Department of Health-funded research into the role of healthcare assistants. Its findings were revealed in a special HCA issue of Nursing Times this summer.

He said: “This tends to confirm our research that HCAs are not only carrying out direct care, such as making beds and feeding patients, but that they have started to move into what could be called low level technical tasks such as observations and taking blood samples.”

The Unison survey found the tasks that HCAs most enjoyed included taking blood samples, bathing patients, monitoring, and carrying out simple dressings.

Mr Kessler said the fact that bathing patients was ranked the most enjoyable task by HCAs demonstrated they valued direct contact with patients. But he added that the fact they also favoured some complex care tasks suggested that many of them were keen to develop their skills and careers further.

Tasks carried out by HCAs on a daily basis:

  • Monitoring/observations 70%
  • Making beds 60%
  • Distributing meals 55%
  • Keeping stores stocked 42%
  • Bathing patients 36%
  • Feeding patients 32%
  • Escorting patients to theatre/other wards 25%
  • Simple dressings 23%
  • Taking blood 18%
  • 51 Comments

Readers' comments (51)

  • rovergirl6@hotmail.com

    It is clear to me that the HCSA have taken the role of the Second Level Nurse. this role being discontinued for the same reason they discontinued the SEN ,who by the way was replaced by the second level. Money has always been a major factor in this.As as many people may be aware hospitals are a business,Yes there place in Society is to care for the sick but ultimately they are a business. albeit they are not in it to make a profit. The NHS has implemented a new level of nursing called the NVQ and the HCAS are required to attend this ,the problem we have is that the everyday HCAS is a mother who goes out to work purely to help with the family income ,although i will not generalise as some are there because they really want to be nurses but have not had the ability to pass the exams. We need to encourage the NVQ or go back to ,the two levels of Trained nurses one who does mainly ward based care and in this i mean direct patient care and the second who does the more specialised care as in dressings cannula, TPR. Medicines. until such time patients will be cared for by untrained staff and trained nurses will be on their guard as they are accountable for the HCA who is on duty on their shift.

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  • What a surprise.

    This reasearch goes to show that the gap between what the NHS Employers feel nurses should be doing, and what we in the profession feel should be done, is so wide that patient care will be compromised.

    What l want to know, is who the heck is protecting the interest of the general public?

    When qualified staff can be removed from the register for placing the public at risk, why aren't the NMC taking action, or is it simply that they have no authority to do anything?

    When the training of nurses was provided by schools of nursing and students formed a major part of the workforce, the threat of withdrawal of their training facility, was a very powerful weapon.

    It is now time for the trade unions, NMC and politicians to determine what is required to protect the vulnerable general public.

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  • I have been working as a HCA for 2 years now in the emergency department of my hospital.
    It is compulsary that we undertake regular training in order to maintain the safety of patients and ourselves. We do everything that a registered nurse does apart from administering medication. We are accountable for our actions therefore we do not take part in any procedure that we are not trained to do. I feel that many of us are undervalued and if you speak to many HCA's they will tell you that they have been put off going into nursing and getting a qualification as a registered nurse because of the way we have been treated. I have started my NVQ 3 although it is not compulsary in my trust, but I feel that it is the only way that I will progress and be seen as something more that just a HCA. It is a fact that our department would struggle without the presence of HCA's and I feel that we should be given more credit for what we do. I for one love my job despite the disrespect that HCA's sometimes endure.

    The best thing about being a HCA is when a patient recognises that you generally care and come and say thank you. That is a feeling that is second to none because you feel that you are worthwhile and somebody can see your passion, hard work and your love for your job.

    There should be more training oppertunities for those of us who want to progress and become something more and further our career in Nursing.

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  • This is the very reason we have established the Professional Carers Association. To encourage an excellence in practice and to replace the attitude of "I am just a health care assistant" to one of "I am a professional health care assistant, proud of what I do and happy to follow a career path in my chosen vocation." To find out more or to join us please visit www.professionalcarers.co.uk

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  • I am very sure most of this has been reviewed when the issue of Registering HCAs was raised not long ago (and oh boy were there some contentious views posted to that!).
    How on earth have we gotten into this position? The HCA who says she has had training in A&E skills is very lucky. The vast majority of HCAs do not in fact have formal training at all, its a case of learn VERY quickly on the job! It takes 3 years to qual as a nurse, to undertake obs etc to say the least, but we expect HCAs to pick it up in a quickee session on the ward.
    As an ex HCA I had no formal training at all. I learned from others. All very well that I understood the practical element of taking blood pressures (for example), but I did not have any underpinning knowledge whatsoever. I do recall a 'mature' nurse telling not to waste time waiting an entire minute when counting resps, but to do this in 15 secs! Great advice eh?

    So, as I see it reinstating the SEN role has unofficially taken place alrerady. HCAs catheterising, doing venopuncture/canulating/wound care is the SEN role, as well as the hands on stuff. In fact most of that is what the RGN ought to be doing, but we already know that most RGNs come no closer to those practices than the porter does . Not a critisism of RGNs but a critisism of the trusts not providing enough RGNs in the first place.

    HCAs are designated as ASSISTANTS. If they wish to become nurses, then let a program be developed to allow some cadetship or similar that properly recognises the skills they currently have and let this lead to an SEN qualification. If the then SEN wants to move up, then cana convert/upgrade to RGN. What is wrong with this?

    And it is worth remembering the HCAs that dont want to become nurses, but want to be HCAs. The pressure they are under to carry out clinical tasks is enormous.

    Posters who comment on the RGN degree only course are correct... it is already scaring away large numbers of potentially very good students. Where do we go then when all nurses have a degree.... have them all do a masters?

    The old schools of Nursing were very much better than now. Shunting the nursing training over to uni's was the worst decision made. I

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  • Why on earth did they get rid of the State Enrolled nurse (SEN'S) and replace them with HCA'S.
    At least SEN'S could administer drugs and the HCA's could give good bedside patient care!
    Are we not going round in circles?

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  • Absolutely, round in circles..........but the only objective is to make those circles cost less! It is all about money not about quality of care. I have written on here before about HCAs with zero previous experience being recruited into jobs previously advertised as 'E' grade RN posts. They are given a few weeks training then off they go to look after home ventilation, tracheostomies, gastrostomies etc. I urged one of these new recruits to make sure she documented all the patient's seizures (the patient was having several different types of seizure) as we were trying to assess their frequency........she did not know what was a seizure and what wasn't; why would she, she was working in a well known supermarket a couple of months before! What are the NMC doing to protect the public and those of us who have studied for years and continue to study? No prizes for guessing the answer; we are all sleep-walking into being made redundant. We will soon be almost completely surplus to requirements and we are meant to be the clever ones...doh!

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  • Some all round good comments seen from all sides. I am a hca trained to nvq level 3 and have been put off becoming a nurse as they do very little hands on. Well on my ward anyway. As someone previously mentioned we do everything apart from administer medications. Although when I go to get patients up their tablets are just left on the table for us to give, as if its the norm. The hca will do that!
    We do all the tprs and blood sugars ect the nurses don't have a clue what's going on, on the ward unless we tell them. We work two trained staff to four untrained staff in a morning and two trained and to untrained in an evening. They are at the station and we are all on the shop floor so to speak. We didn't ask for this just each day are tasks and work load increased and increased, and if your happy to do the tasks people will let you.
    I do understand what I am doing and why I am doing it and would be happy to have some accountability and to do further studies where required. But yes I have seen some hca who just haven't got a clue, who should be only allowed to undertake the basic ward tasks.
    Many nurses today don't want to undertake the tasks we do any more, I have heard students refusing to toilet patients, make beds ect saying their not here for that!
    People should be happy we are willing to do the jobs many of them now think are too menial.

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  • The article includes the statement 'low level technical tasks such as observations' which I would like to challenge. Technically taking a patient's pulse or blood pressure may be a straightforward task, however, intrepretation and picking up the subtle changes in a patient's condition is a skilled nursing activity.
    Delegating tasks such as patient observations to assitant practitioners should be done with caution and not as a routine. Nurses are increasingly criticised for failing to notice patient deterioration and perhaps this is because they have delegated this task too often and lost one of the most important skills of nursing- observing the patient.
    I appreciate that the current workload and skillmix in many acute areas results in support workers undertaking the monitoring of patients but nurses must remember that this is a delegated task and one that they are accountable for monitoring and interpreting outcomes.

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  • Although dementia is creeping upon me, l do remember this type of discussion taking place back in 1964.

    However, it is a fact of life that we do have the ability to throw the baby out with the bathwater from time to time.

    Let no-one doubt that there is and always has been a need for nursing staff with bedside skills to assist the qualified nurse with the delivery of high standards of care.

    Personally l do not really mind what we call them, what is important is that it is the profession which determines what role they are take on and what training is necessary to enable them to carry that role out effectively and safely.

    Once that has been achieved, it is then up to the organisations that represent nursing staff to ensure that they are not being abused.

    I just wonder what would the legal position be, if HCA's were placed in a position of carrying out these tasks and something goes wrong?

    My understanding is that as the HCA is not legally responsible for her actions, and therefore the Trust would be vicariously liable for the HCA's actions and any compensation that is paid out.

    Could this support the view that to continue using a supposedly "cheap" option, no disrespect to the HCA's concerned, is in reality a false view?

    This issue is really about boundaries and resposibilities. We had similar debates back in the 1980's, only then it was called the "extended role of the nurse", as Nurses were being encouraged to take on more medical tasks.

    Anonymous 10.50pm you do talk sense.



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