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If healthcare assistants are the eyes and ears of a ward, they should also have a voice in the team


The first wave of nursing associates will take up their posts this year, and there has been much discussion around their roles and responsibilities and how they will fit into nursing teams.

These debates are not new and have been rehearsed over the years in discussions around delegation of tasks to healthcare assistants (HCAs) and assistant practitioners.

For example, the question of whether workers in these roles can apply compression bandaging has been hotly debated for years and the jury is still out on whether this complex treatment for leg ulcers can be delegated or should be designated as a nurse-only responsibility.

“I wonder how often they are involved in team discussions about the people they care for”

In many clinical areas, HCAs provide essential patient care, but I wonder how often they are involved in team discussions about the people they care for, and whether they are properly supported with education and training.

A few months ago, we published a blog by Elaine Wright, an HCA who works in a paediatric/teenager oncology unit. She described how patients do not always ask the “Am I dying?” question in scheduled ward rounds but do so instead on the way to X-ray or during a blanket bath.

Wanting to learn how to respond to the young people she cared for, Ms Wright looked for training and development opportunities but was told that HCA training was on a ‘need-to-know’ basis. Despite many hurdles she persisted and has now completed an MSc in palliative care, equipping her to deal with the challenges she faces.

Ms Wright’s experience is echoed in a research article published this week in Nursing Times that looks at HCAs’ views on the sexual health needs of people with severe mental illness. The author points out that HCAs are often the staff who spend the most time with patients but that this group is generally not listened to and is under-represented in research.

The study found that HCAs often work in isolation from the multidisciplinary team and cite examples of HCAs forwarding issues relating to patients’ sexual health needs to nurses but not being informed at to whether or not these issues were then being addressed.

“Healthcare assistants bring a wealth of experience to their roles that is not formally recognised”

The author raises a number of questions about how HCAs are integrated into teams and suggests that they need to be fully included in the running of a ward, as they are its ‘eyes and ears’.

HCAs bring a wealth of experience to their roles that is not formally recognised. They may not want to progress to nursing associate or registered nurse training but that does not mean they do not want to improve their knowledge and widen their experience.

Education and training opportunities should be available to everyone involved in patient care and we should not create artificial barriers based on hierarchies that prevent individuals from fulfilling their potential. We know the power of educating nurses to improve outcomes for patients, and the value of multidisciplinary team working.

If unregistered staff are expected to carry out nursing care, they should receive appropriate education – not just task-based training – and be acknowledged as members of the team who are likely to have important insights into the patients they spend so much time with.


Readers' comments (5)

  • Eileen, a really thoughtful article I hope it is picked up by Directors of Nursing and other nurse leaders.

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  • eileen shepherd

    Thanks Peter. I hope so too!

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  • michael adaarewa

    I am a Return to Nursing Practice nurse and I do shifts as an HCA for money. I am in support of the idea to involve HCA's as much as possible, and I think this a brilliant suggestion for the benefit of our patients. But personally I think the issue is not about involving HCAs , it is about rewarding HCA satisfactorily. The money HCAs get in nursing homes and hospitals is pathetic and very little considering their contributions. We are discussing about increasing more workload on HCAs without mentioning anything about their income. I do not want to say much about an issue we are all aware of. Please let us campaign for good wages for our hardworking HCAs

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  • eileen shepherd

    Thanks Michael. You make an important point about salaries and we should be discussing this.

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  • This article started talking about Nurse associates and quickly became about HCA's. Wouldn't it have been more sensible to have a better training programme for HCA's rather than waste money on the associate programme which just seems to add another layer of staff who's role isn't properly designated.

    As it is currently the band 5 and above nurse who has the responsibility for the HCA and the patients I don't think HCA pay is that bad in comparison.

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