Helpers being asked to look after intensive care patients and administer drugs without proper training, study finds
Healthcare assistants are taking on jobs, including looking after intensive care patients, for which they are not always properly trained, according to research.
A survey of more than 2,500 NHS staff found examples of healthcare assistants (HCAs) working beyond their competence, sometimes putting patients at risk.
Nurses cited cases in which HCAs had administered drugs without proper training, while others were left in sole charge of patients with complex needs.
Examples from the 2,554 people who responded to the Nursing Standard survey – made up mostly of qualified nurses and nursing students – said HCAs were also managing colleagues and running units and clinics.
Some nurses said HCAs had received training, but others said this was lacking or that HCAs were not competent in interpreting information about patients.
One respondent said HCAs were involved in "caring for 'low-risk' ventilated tracheostomy patients in an intensive care environment". The respondent added: "The registered nurse working next to them is expected to supervise and overlook everything they do, but this is an impossible task when they themselves are looking after a level three ventilated patient.
"As far as I'm concerned, this is dangerous practice and unfair on all parties concerned."
Several respondents said HCAs monitored patients' vital signs but did not understand the results.
Some HCAs took blood pressure readings "but do not know what is normal or not" while others fail to notice when a patient is deteriorating, according to the survey.
Other examples included HCAs drawing up care plans with no training, interpreting blood levels, caring for complex wounds and carrying out electrocardiograms (ECGs) for heart patients.
HCAs also gave antipsychotic medication without proper training, and one respondent said: "As a nurse manager, I tend to supervise any practice that is deemed complex. ECGs are the most common, but prior to being a manager I witnessed an HCA doing a catheterisation. They had no training and I was horrified."
There were further cases in which HCAs acted as members of emergency or resuscitation teams and "gave medication without knowing what the drugs are for and side effects".
Standards set by the Nursing and Midwifery Council (NMC) say nurses can delegate aspects of patient care to HCAs, including administering medicines. However, the nurse is "accountable to ensure that the … care assistant is competent to carry out the task".
But one nurse in the survey said: "There is sometimes an attitude from unregistered staff that it doesn't matter what they do because ultimately it is the registered nurse looking after the patient who will take responsibility.
"No matter how hard we try to uphold standards, it is impossible to be aware of everything going on with our patients, and we have to rely on support staff to provide a high standard of care without having to directly supervise them at all times."
In October, the government unveiled plans for a code of conduct and training for HCAs, but ministers are not in favour of statutory regulation.
The plan is designed to "bring clarity" to the training HCAs need to deliver more advanced tasks, although this training will be voluntary.
Dr Peter Carter, the head of the Royal College of Nursing (RCN), has said the NHS is too reliant on untrained HCAs who are asked to pick up nursing skills as they go along. He said assistants were employed to help nurses with basic tasks such as washing and feeding, but ended up doing much more.
Tanis Hand, an HCA adviser for the RCN, told Nursing Standard: "It is important for nurses to understand the principles of delegation and that HCAs are not put into situations that they are not fully prepared for."
Howard Catton, the RCN's head of policy, said: "These findings make it clear that, if we want to maximise patient safety, we need to push forward with mandatory regulation of support workers.
"There is also a clear need for education and training of support staff to ensure we do not separate tasks from the knowledge required for clinical assessment and decision-making."
The head of nursing for the union Unison, Gail Adams, said: "This list reaffirms our findings that HCAs are delivering most bedside nursing as well as many extended roles. I question whether some of these roles are appropriate, given the lack of consistency and training."
Carter said of the survey: "Today's findings add further weight to the case for mandatory regulation and guaranteed training standards for HCAs, which the RCN has been calling for for some years and throughout the health and social care bill process.
"The RCN is clear. A voluntary or optional scheme does not go far enough – not only would it continue to put patients at risk, it would also do a great disservice to the hardworking, dedicated HCAs who would welcome regulation."
Lord Howe, the health minister, said: "Healthcare assistants aim to give the very highest quality of care to patients, but they shouldn't be allowed to carry out tasks they are not qualified for.
"Employers must take responsibility for the quality of services provided, and professionals like nurses must ensure appropriate delegation and supervision of tasks." The Guardian
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