Registered nurses working as Healthcare Assistants (HCAs)

The NMC (Nursing and Midwifery Council) website contains valuable information for those with an interest in the established fact that many registered nurses (and/or midwives) are working as HCAs (Healthcare Assistants).  The nursing profession is regulated by the NMC.  Healthcare Assistants are not regulated at all.  Problems  emerge when a Registered Nurse is employed by a care provider as a Healthcare Assistant but works outside of that role and still fails to provide the care required of a registered nurse.

A couple of direct quotes from the NMC are essential.  The full text of the NMC information is available .

First quote (my use of red below, not that of the NMC) :

Accountability

If a nurse or midwife is employed to fulfil the role of an HCA, they should only undertake the roles and duties outlined within their job description. However, by virtue of their registration, they would remain accountable for their practice. This means that they would be bound by the code regardless of their HCA status and their fitness to practise could be called into question if they were found to be in breach of any of the terms. The code states that nurses and midwives are required to “provide a high standard of practice and care at all times”

The code states:

“you are personally accountable for actions and omissions in your practice and must always be able to justify your decisions”

“you must be able to demonstrate that you have acted in someone’s best interests if you have provided care in an emergency”

Therefore, in an emergency situation, there may be occasions, where a nurse or midwife could be required to work outside the scope of the HCA role parameters. As a registered nurse or midwife they would be expected to use their professional knowledge, judgement and skills to determine occasions where it would be appropriate to work outside their HCA role parameters and should be prepared to account for their actions should they make the decision to do so.

Second quote:

Vicarious liability

Vicarious liability means that the employer is accountable for the standard of care delivered and is responsible for employees working within agreed limits of competence appropriate to the abilities of that employee. To remain covered by an employer’s vicarious liability clause, an employee must only work within this area of assessed competence and within the responsibilities of their role and job description.

Nurses or midwives who undertake HCA roles should therefore, inform their employer that they are on the NMC register as a nurse or midwife and that in exercising their professional accountability, they may be required to step outside their contract of employment as an HCA. They should also seek to ensure that their contract recognises the extent of their role and that the job description is clear as to what would be expected of them in this role.

End of quotes.

It’s well-known that HCAs are not regulated.  A system of voluntary registration will not be good enough.

Dr Peter Carter, head of the RCN (Royal College of Nursing), said recently that the NHS is too reliant on  HCAs who are asked to pick up nursing skills as they go along.  Untrained, unregulated, cheap labour.

“Many hospitals employ healthcare assistants as opposed to registered nurses, and many of them don’t give them as much as an hour’s training.

“This happens in some care homes and domiciliary care too.”

“It is wholly unacceptable that the elderly should be cared for by people who are not given the rudimentary training.”

He also said “Cheap care is poor care.  Poor care ends up being more expensive.”

The RCN refers to itself as ‘the voice of nursing across the UK and the largest professional union of nursing staff in the world with more than 400,000 members’.  It also invites Nurses qualified outside of the UK working as health care assistants, ‘who are not and have never been registered with the Nursing and Midwifery Council (NMC)’,  to join the RCN at a concessionary rate for the first year.

The RCN offers advice to registered nurses and midwives who do not meet NMC requirements, providing information for overseas nurses who cannot register to work as a registered nurse or midwife but who are currently living in the UK.

On 11 January 2012 the Guardian featured an article about ‘Healthcare Assistants working out of their depth’ and mentioned several respondents to a survey conducted by Nursing Standard magazine who said that HCAs monitored patients’ vital signs but did not understand the results.

‘ 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.’

Are some care home providers in the UK employing NMC Registered Nurses ‘on the cheap’ by contracting them to work as HCAs and thus by-passing regulatory requirements?  Are some care home providers in the UK doing so because they are fully aware that the registered nurse is not ‘fit for purpose’ as a nurse?  Are some care home providers in the UK employing staff  as HCAs but still allowing them to perform the functions of a registered nurse even though the care provider is aware of the inadequacy of the registered nurse in question?

Vulnerable care home residents are placed at risk.

“Cheap care is poor care.  Poor care ends up being more expensive.”

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Filed under accountability, nursing, personal responsibility, professional responsibility

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