Health Care Assistants (HCA) /Support workers now make up around a third of the caring workforce in hospitals, and research suggests that they now spend more time than nurses at the bedside. Health Education England (HEE) is leading work nationally to maximise the capabilities and contribution of Health Care Assistants/Support Workers, which includes progression routes for Health Care Assistants / Support Workers to enter nurse training (How to ensure the right people, with the right skills, are in the right place at the right time: A guide to nursing, midwifery and care staffing capacity and capability, DH, 2013).
With this acknowledgement that it is the unqualified workforce that is providing the vast majority of basic nursing care to patients, what is the rationale for offering them a route into nurse training which would remove them from the very role that we need more of? Furthermore, what does it mean to be a nurse in the 21st Century? It seems to me that there are very mixed messages being given out, muddled by how “educated” the nurse should be rather than seeking clarity on the unique role of a nurse, as distinct from the unique role of a doctor, physiotherapist or any other health care professional. It is curious that we seem to be the only professional group who wish to cease practicing their unique role – nursing care – as soon as possible and take on board tasks that other professional groups are willing to hand to them e.g. phlebotomy, surgical assistant, endoscopy. In my clinical days this was called the “extended role” and, despite their higher education – nurse graduates, consultants, clinical nurse specialists, etc, there seem to be increasingly fewer nurses who want to remain as hands-on nurses, and nurse.
Do student nurses really know what is meant by nursing before they start their course? Has the role of the nurse changed so much that it is time to re-define what it means to be a member of the Nursing Profession? Is it time to accept that the boundaries of ‘nursing’ are infinitely flexible and that nursing will never be a coherent profession?
Or, is it time to accept that true nursing is, indeed, a vocation and takes a certain type of person who really does want to spend time caring for people who are unwell, rather than collect degrees and go on extending their role. In which case, is it about time to re-badge HCAs as nurses – i.e. a person trained to care for the sick or infirm – and call nurses Health Care Professionals / Health Support Workers?