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We need a definition of nursing as HCAs take on more tasks

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Over the years many of us have engaged in debates about what nursing is; the philosophy that informs what we do and the way this influences how nursing is practised. Our philosophy of care guides decisions about how care should be organised, when it is appropriate to delegate care and whether nurses should take on new roles and responsibilities.
While considerable amounts of time and paper have been dedicated to the pursuit of a definitive definition, it has been difficult to pin down.

Most nurses would agree that they should provide care that is focused on patients and tailored to their individual needs. Words like trust, empathy, listening and compassion spring to mind.

Yet how do these ideals translate into daily practice as the boundaries of the registered nurse’s role are changing?

It is interesting that conversations about nursing practice frequently focus on the delegation of tasks to healthcare assistants, and registered nurses accepting new and more
complex tasks delegated by doctors.

These sorts of changes at the boundaries of professional practice have always happened but the rate of change in recent years has accelerated. It is therefore important that nurses define for themselves what can and cannot be delegated. They also need to work together to ensure that when care is delegated, this is appropriate and the patient is not exposed to risk.

One particular area for concern in continence/urology is the delegation of catheterisation to HCAs. There are excellent examples where delegation has been successful; however,
the process of thinking about delegation throws up some interesting debates.

HCAs who currently catheterise undergo training and assessment before undertaking the task. However, it is apparent in clinical practice that some newly registered nurses are qualifying but are not competent to catheterise patients. This highlights some interesting questions about whether these registered nurses can delegate catheterisation to an HCA whose competency has been assessed.

There is clearly a need to look at the competencies of the newly registered nurse and whether the pre-registration curriculum is equipping nurses with appropriate skills. There is a view that delegation of technical tasks previously seen as the responsibility of the registered nurse is inevitable, with catheterisation being just one example. It has been suggested that most nurses’ work can be broken down into component parts and each part can be carried out by an HCA with specific training. Nurses need to consider whether this focus on tasks challenges and alters what nursing is and, more importantly, what impact this has on patient care.

We would be interested to hear your views.

Eileen Shepherd, editor, Continence Journal

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