The challenges of upskilling health care assistants in community nursing

Abstract

Community care is at the forefront of the National Health Service reforms. Role redistribution from registered nurses to health care assistants is growing. This paper examines the challenges of upskilling community health care assistants to undertake catheterisation for uncomplicated patients in the community. Social constructivist methods facilitated reflective practice. Challenges included fears around delegation, accountability and the responsibilities involved in supporting the development of health care assistants. Recommendations suggest that community health care assistants offer a valuable and much needed contribution to health care delivery and are enthusiastic to upskill in catheterisation. However, reluctance from community registered nurses around delegation delayed the process. Registered nurses will need to address these fears and engage in workforce planning to proactively influence role developments and safe practice. National guidance needs to be structured around clear pathways to support these valued participants in delivering health care.

The role of unregulated care providers in home care: A scoping review

“…However, the language and terminology used to describe these skills were inconsistent. Terms used included: advanced care (Swedberg, Michelsen, Chiriac, & Hylander, ; Swedberg et al., ), delegated or assigned care (Axelsson & Elmstahl, ; Barken et al., ; Craftman, Hammar, von Strauss, Hillerås, & Westerbotn, ; Odegård & Andersson, ; Pierratos et al., ; Pringle, ; Sharman et al., ), medically complex care (Moorman & MacDonald, ), nursing activities (De Vliegher et al., , ), clinical procedures (Hittle et al, ), upskilling/cross‐skilling (Pringle, ; Stanmore & Waterman, ) and task shifting or transferred tasks (Barken et al., ; Denton et al., ; Guay, Dubois, Desrosiers, Robitaille, & Charest, ).…”

“…As UCP roles expand, the risk for compromised care quality increases unless adequate teaching, appropriate delegation and supervision can be provided. This is particularly relevant for nurses as they often act in the role of UCP supervisors in home care settings (Giosa et al., ; Pringle, ; Royackers et al., ). While UCPs, like all health care providers, have a duty of care and are accountable to the law and their employer, individuals delegating care are responsible for assessing the competence of the UCP, ongoing clinical decision making and monitoring the skills and competencies of the UCP to ensure quality care (Pringle, ; Vaughan et al., ).…”

“…When assigning an added skill or care activity to UCPs, nurses are expected to assess the appropriateness of teaching the skill and availability of supervision and support (CNO, ; Pringle, ; Royal College of Nursing, ). According to the practice guideline by the College of Nurses of Ontario (2013) on working with UCPs, the nurse is required to determine the UCP's competence level to perform the procedure safely, ensure the UCP is aware and understands his/her responsibilities, and provide ongoing assessment of patient care needs.…”

“…UCPs were also employed in the care of patients requiring complex medical interventions such as home mechanical ventilation (Swedberg et al, 2015) and home haemodialysis (Pierratos et al, 2017). Swedberg et al (2015) (Pringle, 2017;Vaughan et al, 2014).…”

“…Notably, restricted or controlled acts, typically considered potentially harmful if performed by unqualified persons, are being delegated to UCPs in home care. While UCPs in institutional care settings often work in teams and are supervised by those authorised to delegate care, UCPs in home care usually work alone in unpredictable, complex environments without direct supervision or control over their work and work environments (Butler-Williams, James, Cox, & Hunt, 2010;Pringle, 2017). The uncontrolled and unregulated home care environment undoubtedly poses numerous safety risks and ethical concerns with serious implications for both patients and UCPs (Lang, Edwards, & Fleiszer, 2008;Lang et al, 2006;Storch, Curry, Stevenson, MacDonald, & Lang, 2014).…”