Making claims on nursing work

Throughout the NHS, the traditional boundaries between professional groups are breaking down to promote more flexible ways of working to deliver patient-centred care. Registered nurses (RNs) have responded to changing care demands through the development of innovative roles and extended roles and responsibilities. However, there are increasing numbers of healthcare assistants (HCAs) being employed by the National Health Service (NHS) in the UK to support RNs in providing nursing care. To date, little is known about the make-up of the health care assistant workforce and the changing nature of their role. This paper reports the findings of a single case study using mixed methods (survey, interviews, participant observations, focus groups and documentary analysis) to generate an in-depth account of HCAs' work in one UK hospital setting. The study is built upon what HCAs say they do, compared with what they actually do in practice and RNs’ perceptions of the HCA role. It explores how and whether the work of HCAs is adequately supervised, tensions between the work of HCAs and RNs and the subsequent effects on teamwork and patient care. There are policy expectations associated with the work of HCAs. However, this study reveals significant deviations from these goals. The workplace arena, and the informal negotiations between HCAs and RNs that take place within it, actively shape the HCAs’ work. The changing roles of RNs have direct implications for the roles of HCAs: as RNs take on extra duties and responsibilities they are conceding some of their roles to HCAs. An important element of the RNs’ role must now be to consider how HCAs can best be deployed, to assess their competence for carrying out nursing work, and to monitor and supervise their work so as to maximise, and further develop, the HCAs’ contribution to patient care and to ensure quality standards.