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Adding nursing assistants to wards 'does not improve patient care'

  • 11 Comments

Hospitals should “exercise caution” when using nursing assistants to either work alongside or replace registered nurses because the impact on care “may not be positive”, according to new research from Australia.

Academics looked at whether nursing assistants who were brought into wards in addition to the required number of nurses, as opposed to substituting for them, would increase patient outcomes.

“It is possible that delegating basic patient care tasks reduces the opportunity for ongoing assessment by registered nurses”

Study authors

They found that for every 10% extra time patients spent on wards with nursing assistants who were used in addition to nurses, they had a 1% increase in the chance of developing a urinary tract infection and a 2% increase for developing pneumonia.

Contrary to expectation, the results indicated that adding nursing assistants to the staffing complement as an extra resource does not improve the quality of care provided to patients, said the researchers.

They suggested this could be due to nurses missing out on opportunities for ongoing monitoring and assessment, because they had delegated tasks to nursing assistants instead.

The study looked at 256,302 records from patients who spent time on medical, surgical or rehabilitation wards at 11 hospitals in Western Australia between 2006 and 2010.

Seven adverse patient outcomes – death in patients with complications, death in hospital within 30 days of admission, falls with injury, hospital-acquired urinary tract infection, pressure injury, pneumonia and sepsis – were compared for patients on wards with nursing assistants and those without.

On wards with the extra nursing assistants, the results showed three significant increases in adverse outcomes – death in patients with complications, urinary tract infection, falls with injury – when comparing observed outcomes with those expected, but one significant decrease in mortality.

“The introduction of assistants into ward staffing in an additive role should be done under a protocol”

Study authors

Those wards without additional assistants showed a significant decrease in pneumonia between the observed and expected adverse outcomes, but one significant increase in the number of falls with injury.

The researchers said the link between increases in poorer outcomes and wards with additional nursing assistants implied that the practice of substituting registered nurses with nursing assistants was also not advisable.

In addition, they noted that bringing in more nursing assistants had effectively diluted the skill mix within the team.

The study “serves as a reminder that diluting the skill mix may be detrimental to the quality of care” and “should be implemented only with careful consideration,” they added in the paper published in the International Journal of Nursing Studies.

“Nursing surveillance is known to keep patients safe however, effective surveillance depends upon nurses having the knowledge, expertise and experience that enables them to detect cues, recognise patterns, differentiate, and anticipate problems,” said the researchers.

“It is possible that delegating basic patient care tasks to [nursing assistants] reduces the opportunity for ongoing monitoring, assessment and evaluation by registered nurses and that important cues are not recognised by the [nursing assistants],” they added.

However, the academics did note that the study results may have been affected by the fact the nursing assistants were not assigned to wards in a standard way or due to them looking after varying numbers of patients.

“The results suggest that the introduction of assistants in nursing into ward staffing in an additive role should be done under a protocol which clearly defines their role, scope of practice, and working relationship with registered nurses, and the impact on patient care should be monitored,” concluded the study.

  • 11 Comments

Readers' comments (11)

  • michael stone

    Interesting:

    'Academics looked at whether nursing assistants who were brought into wards in addition to the required number of nurses, as opposed to substituting for them, would increase patient outcomes.'

    If there are ALREADY enough nurses to perform all of the 'nursing tasks' ('in addition to the required number of nurses') it does beg the question (thought about in the write-up of this study, so far as I can see - not in its design) of what these additional nursing assistants are actually doing.

    Although I think - with a cost-cutting government in place - that of more relevance to us, is research about staffing mix (it seems unlikely that there will be an abundance of 'additional' in the near future !).

    This seems more relevant for us:

    'Those wards without additional assistants showed a significant decrease in pneumonia between the observed and expected adverse outcomes, but one significant increase in the number of falls with injury.'

    In simple terms, have staff doing what they are competent at, and have enough staff to do what is required: and do not require staff to work outside of their limitations.

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  • I agree entirely with the above as I have stated in previous comments. It's all very well delegating things like observations to HCAs but unless they have the skills to interpret results then it's a waste of time. Nurses who aren't doing hands on care also require HCAs to notice changes in patients and report their findings. You either need more nurses or highly trained HCAs. It's not just a case of having more hands on deck.

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  • I remember research from many years ago which showed that wards fully staffed by registered nurses actually had better outcomes than those where extra unqualified staff were employed. HCA's are taught many baseline skills but through no fault of their own are unable to see the reasons for variations in these. Before people start attacking me for writing this I would hasten to add that HCA's who have undergone a recognised course achieve competencies but not in depth knowledge and I write this as a retired nurse teacher and HCA teacher,assessor and verifier. More HCA's with less qualified nurses results in a dilution of the overall nursing skills in a ward or area as the qualified staff are trying to cover everything and everybody.

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  • If more registered nurses are on duty , the quality of patient care will be improved and can prevent falls,pressure sores, UTI,pneumonia and various other complications.The amount of money spend for treating the above problems will be four times more than the pay of an extra registered nurse. I don't think to understand this simple logic there is any need for research too.

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  • This research adds to that already availabe confirming the relationship between the amount of care provided care by RNs and patient outcomes. If these findings were related to a medical procedure or treatment they would be adopted. What is it that blocks acceptance when it comes to assuring enough RNs?

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  • Bringback the State Enrolled nurses!
    These nurses were trained to UKCC standards, could give drugs and do dressings etc. etc. etc., where HCA's cannot.

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  • I completely agree with the comments from Anon 9.54pm 7th October.

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  • We don't need SEN's or the new associate role we need more RGN's properly trained healthcare assistants and far less totally unnecessary paperwork.

    The hierarchy will only understand when they have spent a good few shifts actually doing the job on the wards and facing reality rather than the tick box pretence that helps nobody.

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  • Love my HCA team! Fortunate to be so well supported by the auxillary staff. I do however, hate the way it can take you away from those nursing assessment opportunities e.g. washing, toileting, nutrition, hydration etc.

    I make every effort to participate in the fundamentals of care but more often than not it is the HCAs delivering this. I feel they are doing what I trained 3 years to do whilst Im stuck filling out forms :-/

    All respect to the support workforce.

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  • https://twitter.com/ShaunLintern/status/697200854470791169/photo/1

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