Unison is calling for the formal registration of healthcare assistants and national minimum competencies.
Unison will unveil its own draft set of core competencies and specialist extras for areas including acute and mental health at its HCA conference in September.
Unison head of nursing Gail Adams said the study funded by the National Institute for Health Research made the case for change in the sector.
She told Nursing Times: “There needs to be a decision over the core elements of an induction programme.
“HCAs experience a postcode lottery depending on whether they work for a good organisation. More often than not they have had to fight for every piece of training they have received.”
She said Unison’s research found the Agenda for Change programme had led to HCAs in mental health being paid at band 3 while those in the acute sector were at band 2 - with no apparent justification in terms of skills or experience.
She said cutbacks would mean trusts having to look again at their skill mix, but she stressed the dangers of doing that without a thorough examination of HCA skills.
“Mid Staffs has taught us that you can’t substitute HCAs for nurses without doing a full skill mix review,” Ms Adams said.
“Unless we address the induction programme then people won’t be confident in delegation. They need an understanding of what they can do and, more importantly, what they can’t.”
The NIHR research found the poor definition of HCA roles left nurses anxious over how much they could delegate to them.
A survey of 689 nurses said their main concern with regard to HCAs was accountability, as Nursing and Midwifery Council rules say a nurse is responsible for a task they have delegated to an HCA.
One nurse told the researchers: “Now everybody’s thinking you’ve got to protect your registration. Because at the end of the day, if you’re working with an HCA and they go off and do something that they shouldn’t do and it comes back to bite you, you can’t say well I didn’t do it, because actually you’re supposed to be supervising the healthcare.”
A further problem for nurses was the perception that some HCAs were overambitious and overestimated their abilities, and sought to extend their role “to the neglect of core care activities”.
Survey responses revealed that, while nurses thought the most important tasks for HCAs were bathing, feeding and bed making, HCAs themselves ranked taking patient observations as one of the tasks they most enjoyed.
But the report said tensions between nurses and HCAs should not be exaggerated.
A survey question asking if nurses felt HCAs on their shift were a burden found most did not. But another asking if they were confident HCAs fully understood what they were doing on the ward elicited an ambivalent response - indicating nurses were not always confident.
Unison calls for formal HCA registration