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Practice question

Unqualified support staff are doing patient observations with minimal training.  Do standards exist for this work?

  • 1 Comment

Support workers are well placed to carry out patient observations. 

  • Skills for Health apprenticeships advocate training of support workers to progress and develop their skills along a structured career pathway
  • The Open University runs modules and foundation degrees for support workers
  • Trusts often provide competency training for performing observations
  • Support staff need not only to be able to record observations, but also ensure they are acted on

The most critical issue is that support workers gain competence, which will provide the necessary assurance about patient safety.  Procedures must be in place to facilitate five key components: clear lines of accountability, delegation, supervision, training and assessment (Hopkins, 2008, Nursing and Midwifery Council, 2008; Royal College of Nursing, 2006).

Support workers form a large group of healthcare staff, namely all non-registered practitioners whose salaries range from Band 1 to 4 of the NHS pay scales (DH, NHS, KSF, 2004).  Typically they constitute up to 35% of a staffing establishment on a typical NHS ward. Where this is the case they support predominantly delegated or shared nursing activities and are known as healthcare assistants (RCN, 2010). 

However, in the context of the NHS as a whole, support workers are not uniquely healthcare assistants - they can be employed to perform a wide range of skills and observations in numerous hospital and community departments.  For example, in ophthalmology, a multidisciplinary ambulatory pathway and process of care is assisted by healthcare support roles, where they perform field vision testing, laser photography scanning and observation of vital signs.

At a national level, a general framework for performing observations has been available for a long time via Skills For Health (2011) and is supported by the domains and descriptors within the NHS Knowledge and Skills Framework (DH, 2004).  Skills for Health apprenticeships also advocate training of support workers to progress and develop their skills along a structured career pathway.

The Open University announced new learning opportunities for healthcare assistants in the form of modules or foundation degrees, thus providing flexible learning in response to changing and expanding roles (RCN, 2010, NMC, 2008). And Scotland has announced regulatory measures for support workers, with England likely to follow shortly with the regulation of assistant practitioners. This will provide a minimum level of training, paving the way for parity of training and support.

At a local level, individual hospital trusts often provide their own competency training for performing observations.  For example, at the Heart of England NHS Foundation Trust, support workers are required to attend a workshop, which includes completing the theoretical and practical application of the modified early warning system.  This is followed by supervised practice and assessments signed off by a practice mentor.  This training is the same for registered or unregistered staff.  Pivotal to training is the ability to recognise patient deterioration, where the support worker has a crucial role in not simply recording observations, but ensuring they are acted upon (NMC, 2008).

Given the scope of support worker roles it is entirely a “no brainer” to query more and more “unqualified” staff performing observations.  We need to view this positively and value the skills support workers can offer within a clinical team. No doubt, throughout the forthcoming NHS reforms there will be a need to re-think processes to plan for efficiencies needed in the current global financial climate.  As uncomfortable as this may seem it will stimulate radical thinking in the NHS and spread new practices and perhaps more new roles to support appropriate delegation from registered staff.  In this case as a minimum, job descriptions and relevant training and competency must support a framework for the roles.  Consequently, strategic planning and support in practice is vital (NMC, 2008).

Liz Leesis consultant nurse and clinical dean, Heart of England Foundation Trust, Birmingham


  • 1 Comment

Readers' comments (1)

  • John Howes

    "No doubt, throughout the forthcoming NHS reforms there will be a need to re-think processes to plan for efficiencies needed in the current global financial climate"

    There you have it, the cycle continues. For those of us who are able to remember the 60's a shortfall of Enrolled Nurse's was responded to by giving a series of 24 lectures to Assistant Nurses who became State Enrolled Assistant Nurses.

    Into the 70's we were then trying to absorb a large number of Enrolled Nurses onto the Level One Register.

    We have lost the patient dependency criteria for determining staffing levels, now we use a benchmarking exercise created by Management Consultants. If we are to fall back to a skills and task base delivery, why bother to train nurses at all, we can simply have a range of technicians who will be paid according to the complexity and volume of the tasks they carry out this will be quicker and cheaper than producing graduate nurses.

    We no longer have Ward sisters, they are now Ward Managers. In my own hospital, at the last head count, 25% of the total staff were Admin & Clerical and Management, matrons exist in droves and despite this sop to the media and idiot politicians whose concept is that Matrons will save the day we are reminded on a daily basis of cuts in the number of nursing staff. After 48 years as a Nurse and still practising in a large Intensive Care Unit I am aware that this rant will be due to my advancing years but it is really a cri de coeur for a return to sanity rather than spin.

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