The Use of Unregulated Staff: Time for Regulation?

Abstract

Internationally, shortages in the nursing workforce, escalating patient demands, and financial constraints within the health system have led to the growth of unlicensed nursing support workers. Recently, in relation to the largest publicly funded health system (National Health Service), it was reported that extensive substitution of registered nurses with unskilled nursing support workers resulted in inadequate patient care, increased morbidity and mortality rates, and negative nurse outcomes. We argue that it is timely to consider regulation of nursing support workers with their role and scope of practice clearly defined. Further, the addition of these workers in a complementary model of care (rather than substitutive model) should also be explored in future research, in terms of impact on patient and nurse outcomes.

A comparison of nursing tasks undertaken by regulated nurses and nursing support workers: a work sampling study

“…However, among the 10 direct care tasks observed here, some are inappropriate for AINs to undertake (procedures, medication and assessment) as they are out of their usual scope of practice (Bureau of Labor Statistics , Duffield et al . ); posing a potential risk to patient safety (McKenna et al . , Spilsbury et al .…”

“…Referred to as assistants in nursing (AIN) in Australia, unlicensed assistive personnel in the USA and healthcare assistants in the UK, the generic term often used is nursing support worker (Duffield et al . ). While these staff can be used in a complementary role (adding nursing support workers to a unit), they are more commonly used in a substitutive role (replacement of regulated staff).…”

Does nurses’ health affect their intention to remain in their current position?

“…In 2014 there were 97 843 nurses and midwives registered in NSW (Nursing and Midwifery Board of Australia ), with Assistants in Nursing (AINs) estimated at 25% of the Australian nursing workforce (Duffield et al . ). It was impossible to gauge actual numbers invited given the diverse recruitment techniques, but with 5446 surveys submitted, and 405 (7.4%) excluded because of missing data or ineligibility, a total of 5041 responses were analysed.…”

“…Intention to leave was sought with the question ‘Do you have plans to leave your current job?’ in the next 6 or 12 months (Duffield et al . ).…”

Teamwork in Acute Care: Perceptions of Essential but Unheard Assistive Personnel and the Counterpoint of Perceptions of Registered Nurses

“…Consistent throughout recent decades have been concerns related to an “uneasy alliance” (Kleinman & Saccomano [], p. 162) between professional registered nurses (RNs) and nursing assistive personnel (NAP). Workforce redesign in the 1990s and nursing shortages worldwide have led to increased use of unlicensed caregivers (Duffield et al, ). Advantages and disadvantages of increasing use of unlicensed assistants were reported in the 1990s (Krapohl & Larson, ; Orne, Garland, O'Hara, Perfetto, & Stielau, ), and more recently concerns related to patient safety have been documented (e.g., Aiken et al, ; Blegen, Goode, Park, Vaughn, & Spetz, ; Ebright, ).…”