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Doctors back healthcare assistant regulation

  • 20 Comments

Doctors’ representatives have backed a call for the regulation of healthcare assistants as part of a drive to ensure health services are “properly regulated”.

The British Medical Association annual representatives meeting in Cardiff last week backed a motion saying the union “demands providers of health services are properly regulated where there are potential risks to patients in the form of invasive procedures, interventions with the potential for harm, or the exercise of judgement which could substantially impact on the health or welfare of vulnerable patients”.

Helena McKeown, a GP from Salisbury who proposed the motion, and other supporters, said they wanted to see the Care Quality Commission sufficiently funded to properly regulate providers. It has recently admitted its work is limited by its budget.

However the doctors also said all health professionals should be regulated. Dr McKeown told the meeting: “The motion not only demands regulation for all but effective regulation.”

It adds to calls for professional regulation for healthcare assistants. The government has said it is against the move. But Nursing Times last week reported a growing movement hoping to amend the Health Bill, as it passes through Parliament, to introduce the change (28 June, news, page 3).

  • 20 Comments

Readers' comments (20)

  • is it really preferrable to make hca's a seperate profession, negotiating their workload at handover along with social workers, ot's, pt's, consultants, etc; or couldn't nurses simply read the care plan before signing it off after they've "delegated" an assistant to write it up, check through the referral paperwork before it gets faxed, satisfy themselves that the assistant is capable and qualified of performing that invasive procedure, and whether national guidelines and local procedure allows the assistant to carry out that procedure?

    maybe if nurses understood the art of delegation, and their responsibilities regarding the work of those that assist them, then this nonesense about registration with a professional body would disappear.

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  • We already have the situation where RN posts are being slashed and fewer and fewer wards have safe staffing levels. Many of the acute medical wards in my own trust will have 3 RNs on in the morning for 30+ patients along with double the number of HCAs/support workers. Guess who ends up doing most of the personal care? I currently know of a colleague who has been disciplined because a patient was injured whilst she was the nurse-in-charge on a shift with no other RNs and 4 HCAs. She has been suspended until the Trust decides what its next move will be.
    I have a great deal of respect for HCAs but I don't think that they realise just how difficult the RNs position is when signing off work that the HCAs have done. Its all very well saying that you should only document what you have actually done /seen for yourself ( skin integrity, fluid balances etc) however, if, as my colleague did, you fill in daily IR1s about staffing levels, complain and stick up for your workmates and refuse to complete paperwork because you cannot document things that you haven't seen for yourself, this is what happens to you. I do think that the longterm goal in NHS hospitals is to replace RNs with APs in almost all areas as the fools believe it will save money. No other country in the supposed developed world behaves like this.

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  • if you can mentor, why can't you delegate?

    students don't have to register until after they've qualified. students come with a range of prior experience and qualifications, from those without nvq's to those with diplomas and bachelors in various subjects. why do qualifieds find it easier to mentor students than to manage their assistants.

    or is "nurse-in-charge" an oxymoron?

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  • if you can mentor, why can't you delegate?

    students don't have to register until after they've qualified. students come with a range of prior experience and qualifications, from those without nvq's to those with diplomas and bachelors in various subjects. why do qualifieds find it easier to mentor students than to manage their assistants.

    or is "nurse-in-charge" an oxymoron?

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  • @ dino-nurse | 6-Jul-2011 12:31 pm

    you make a good point about the difficulty of effective delegation with unsafe staffing levels. and semi-autonomus professionally registered hca's won't mean more rn's on shift.

    instead of management shifting the blame for the mistakes that inevitably occur with inadequate staffing onto nurses, should nurses be able to shift the blame onto hca's? where will it all end? cleaners held to account for medication errors?

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  • Why are doctors so interested in regulation of HCAs? Is this because they will be commissioning community services and they are thinking of using HCAs instead of RNs? Could it be due to the fact that HCAs are cheaper to employ than nurses?!

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  • may be because their hands on and completed compentces and rn's are very good at delegateing the work to them? because their so bissy? dus it take two rn's to take a drugs round omitting c d drugs which takes two for countersigning and i tought when giving out drugs you
    a) check the wrist band for name,number,d o b B) give the patient meds C) then sign drug chart their are very few that do that and drugs left on pt tables get knocked off how many staff nurses can hold their hand up and say thay havent done that? yet h c a's csw ap's are incompedent

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  • Yet again we have a thread that has turned into a slanging match. I hate to say it but this is the problem with a female dominated profession (I am female myself before the comments start).
    In order of asking
    1) mentor versus delegation
    From my own experience, junior student nurses work alongside the RN so they are not left unsupervised. As they become more senior then they are let off the leash, so to speak. At the same time they are being assessed by the university. its a different kettle of fish entirely when you are the sole RN on with several HCAs...you cannot shadow them in the same way. Its all very well saying delegate, thats the easy part. The difficult part is having to rely on HCAs to self regulate/decide when to get hold of the RN. I am not saying that HCAs are not good at their jobs, most are....but they are not RNs or even student nurses. I have been in a situation when transfering a patient from ICU to the ward when another patient on the ward was also being handed over (only one RN for both patients). The second patient was from recovery....RN told HCAs to get post op patient settled, do baseline obs and then find her. I handed over my patient to her and helped settle him (she was the only RN) which took about 20 minutes....I had to walk past the other patient to get off the ward....he looked a bit off, so I went over and found he had a resp rate of about 5 and was unrousable...quick check revealed that his PCA syringe was in the bed, unclamped and pumpless. HCAs had recorded his obs (EWS triggering) but had not come back to the RN. Patient could have died. Policy here is that recovery only send an RN if they have one, otherwise its porters and HCAs.
    2) the real issue here is not whether HCAs need to be registered, its how do we get safe staffing levels on the wards. Most medics also understand that lack of RNs means poorer quality care however no one listens to them either.
    3) to any HCAs that think they could be the nurse-in-charge....ask to shadow for a day as part of your KSF development. I can assure you, it will be an eye opener.
    4) The reason drug rounds take so long is because we are not just dishing out tablets without thought...we are also assessing the patient to see if all the tablets are appropriate (some drugs cannot be given unless certain baseline obs are ok), checking for stock levels of tablets, checking that the prescription is correct (give the wrong dose because the chart was wrong, its our fault not just the doc for writing it incorrectly)and thats just for starters. I'm sorry if this seems like we are shirking but we really aren't.

    Safe staffing levels are the ONLY thing that will solve most of our problems. Unfortunately, in the cash strapped NHS we are not going to get them.

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  • very well said and the consequences of low staffing, as dino-nurse, illustrates above is truly dangerous to the health and safety of the patients, and also to the welfare of the staff. Just think of the what would have ensued if that patient had died.

    As well as all the recent media reports on negligent care such stories should also be cited so that the authorities and the general public get a more balanced view of what is going on in our healthcare institutions and perhaps this might drive these organisations and their management and the relevant government departments to greater action.

    the only thing I would add to the above comment is about the slanging match. isn't this what debate and argument is all about, a sort of brainstorming or think tank, to get opinions from as many different perspectives as possible and then thrash them out to find the best possible solutions or compromises? isn't this the process that leads to creativity and generating new and positive ideas and throwing out others which have proven not to work? it doesn't need to be offensive or personal by pointing a finger of blame at one particular group or individual.
    what do you think?

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  • thats it a good h c a is there to help the nurse we are no marter if we didnt work we are classified as waste of time you may be right perhaps there should be only trained personal no hca,csw, etc and then see what happens ?

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