Nursing a Grievance? The Role of Healthcare Assistants in a Modernized National Health Service

Abstract

The complex division of labour in health care has encouraged the analysis of occupational boundary disputes between separate professions. Less attention has been directed at the divisions in individual occupational groups but in a context of intensive health sector workforce reform there has been a growth in lower status occupations. This article extends debate about lower status occupations by exploring the manner in which nurses and healthcare assistants engage in boundary work to advance their occupational interests. The UK government's modernization agenda has encouraged a more prominent role for healthcare assistants and the findings confirm that this agenda has reinforced occupational boundary disputes between nurses and healthcare assistants. Tensions between nurses and healthcare assistants took particular forms influenced by gendered notions of caring work. The consequences of these boundary management strategies in terms of work undertaken, pay and status are also explored.

‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care

“…Care is more likely to be left undone in wards where nurses perceive the practice environment to be worse. By contrast, although substitution for nurses by assistant practitioners is proposed as a means of improving the efficiency of care delivery33 we found no evidence that HCSWs were acting as substitutes or complements for RNs for the nursing tasks we studied.…”

The habitus of ‘rescue’ and its significance for implementation of rapid response systems in acute health care

“…While the holistic discourse in nursing emphasises the importance of 'basic hands on' care as a means of assessing patients emotional and physical condition (Bach, Kessler, & Heron, 2012), our research shows that nurses' technical competence in drug administration and care management allowed them to distance themselves from the bodily task of routinely taking patients' vital signs.…”

“…The routine checking of patients' vital signs was perceived by nurses to be a task that could be safely delegated to HCAs. Nurses, as part of the modernization agenda, have taken on additional technical and managerial responsibilities, including drugs administration and discharge planning, which have made them too busy to undertake elements of hands-on patient care (Bach, Kessler, & Heron, 2012). This shift was socially sanctioned by managers who rationalised that delegation of the task of taking vital signs to HCAs was necessary because of the need to maximise efficiency within the hospital setting.…”

Time, Space and Touch at Work: Body Work and Labour Process (Re)Organisation

“…The latter has occurred over and again in health services (c.f. Armstrong and Armstrong 2010) as, for example, nurses are assigned tasks that were previously doctors' prerogative (Doherty 2009) and health care assistants take on nurses' tasks (Bach, Kessler et al 2010). It is also found in other fields.…”