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”
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”
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.