A systematic review of activities undertaken by the unregulated Nursing Assistant

Abstract

AimTo identify activities performed by Nursing Assistants in acute and primary healthcare.DesignSystematic review.Data sourcesThe databases MedLine/PubMed, ProQuest and Google Scholar were searched for empirical studies published in the English language between 2008 and 2018 that addressed the work of Nursing Assistants.Review methodsFrom an initial yield of 2,944 publications, 71 publications were retained for full text review and 20 publications included in this review. Activities undertaken by Nursing Assistants from eight countries were extracted and categorized into one of six categories.ResultsOver 200 activities were identified as being delegated to Nurse Assistants globally. Many of these activities are beyond the training of the Nurse Assistant and are being performed with limited Registered Nurse supervision.ConclusionPatient safety is at risk. Nurse Assistants' roles vary widely, with some seeing their role as similar to that of a regulated nurse, while recognizing their need for additional training.ImpactOver 31% of activities delegated to Nurse Assistants require skill and comprehension beyond their level of training. Patients and regulated nurses need to have confidence that Nursing Assistants responsible for care provision are appropriately trained and practicing within regulatory standards.

Nurses' assessments of staffing adequacy in care services for older patients following hospital discharge

“…Our finding is in line with recent national statistics showing a continuing increase in the number of FTE's in unqualified care workers (Helsedirektoratet, 2018) and may reflect the substitution of cheaper care assistants for more expensive nurses for cost‐containment purposes (Gautun et al., 2016). Our findings are consistent with international research emphasizing that services may benefit from a more balanced skill‐mix by taking a closer look at whether and when unqualified staff are being used to supplement, complement or replace qualified nurses (Blay & Roch, 2020; Dubois & Singh, 2009). In Norway, strategies at the national and municipal level target enhancement of competences at all levels, including education of unqualified care workers.…”

The impact of an additional nurse assistant during evening shifts on nurses’ perceptions of job demands, job resources and well‐being

“…Future studies on the impact of the addition of a nurse assistant to the nursing team could also consider outcomes for patients, rather than just for nurses. Research is still inconclusive about whether or not adding nurse assistants is beneficial for patients (Blay & Roche, 2020; Twigg et al., 2016). This impact may also vary across healthcare settings, as nurse assistants’ training level varies across countries.…”

“…In the past decades, nurses have been facing increasing workloads due to rising healthcare demands and personnel shortages (Duffield et al., 2011). Efforts to address personnel shortages and workloads at low costs have focused on extending nurse teams with nurse assistants (Blay & Roche, 2020; Duffield et al., 2014) – also called healthcare assistants (UK), unlicensed assistive personnel (USA), support workers (the Netherlands), or assistants in nursing (Australia)(Walker, 2019). Nurse assistants can perform routine tasks (e.g., bathing, cleaning, and providing emotional support), which, in turn, can allow licensed nurses to spend more time on their core clinical tasks and decrease their workload.…”

Nursing assistants' desired roles, perceptions of nurses' expectations and effect on team participation: A cross‐sectional study

“…Internationally, nursing assistants are not considered health care professionals, although they provide direct patient care in health care facilities (Afzal et al., 2018; Blay & Roche, 2020; Lancaster et al., 2015; Munn et al., 2013). Nursing assistants' tasks are institutionalized as job descriptions, and their roles have been studied in terms of these tasks.…”