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Linda Nazarko: ‘Nurses must lead the discussion on HCA roles’

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The number of HCAs in the NHS has doubled in the past 10 years, and their role is changing. Once, care assistants who performed tasks traditionally considered part of nursing were rare.

Now they are increasingly undertaking tasks such as venepuncture, cannulation, compression bandaging and immunisation.

Chris Cox, RCN assistant director of legal services, has said there is no legal reason why HCAs should not take on almost all nursing tasks with appropriate training and supervision.

However, just because something is not illegal doesn’t mean it’s a good idea. Nursing is a craft, an art and a science. We use the science to work out what is wrong and what needs to be done and the art to reach out and build a partnership, enabling the person to recover their health and well-being.

When I assess and dress a wound, I am doing so much more. I am assessing the person’s general condition. I educate and enable. I identify other problems, work out how they will affect wound healing and work with the person to overcome these problems. That’s the value an educated and experienced nurse brings.

In breaking down nursing into a series of tasks, we risk losing the holistic overview that nurses bring. We risk losing the soul of nursing, replacing it with a mechanistic model that cannot meet the complex needs and aspirations of vulnerable people.

Employers are expanding the role of the HCA for several reasons. First, registered nurses are considered to be expensive. In fact, they are cost-effective because they improve outcomes and reduce mortality rates. The problem is that we do not shout this from the rooftops.

Everyone knows that teaching assistants are not the same as teachers but we are not getting a similar message across in nursing. Some nurses do not understand or demonstrate the value of nursing and focus on tasks rather than on caring for the whole person. Some delegate care to HCAs and concentrate on technical tasks. This does nursing a grave disservice.

Employers are delegating nursing to non-registered staff because we allow them to.

It’s time we articulated the value of nursing and defined the role of the HCA. There are plans to regulate care assistants and define their responsibilities and limits. Nursing must lead this discussion. Regulation and training should enable HCAs to practise as HCAs, not as registered nurses.

Linda Nazarko is an independent nurse consultant

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