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EXPANDING THE ROLE OF THE HEALTHCARE ASSISTANT IN IRELAND

A POSITION PAPER

History of the Healthcare Assistant

“The use of unqualified workers in healthcare is not new and the use of nurse’s aides working alongside the wider nursing staff has been traced back to the 1850’s “(Stokes & Warden, 2004).

There has always been an untrained category of Health worker.  Referring to a time at the end of the 17th Century Gerard Fealy says “A particular concern was the custom in Dublin hospitals of combining the duties of assistant nurse and ward maid” P24 ( Fealy G.M 2012)

Healthcare Assistants (HCAs) have always worked in this country in nursing homes and residential care centres, county homes and hospitals carrying out a variety of personal and domestic tasks. They were known by a variety of titles: nurses aids, nursing assistants, auxiliaries etc.

The Role of the Healthcare Assistant

Today “The role of the HCA is to support the delivery of patient care under the supervision and direction of qualified nursing personnel” (Shannon et al., 2001).  (HSE 2006)

“Healthcare Assistants provide assistance, support and direct personal care to patients and residents in a variety of institutional settings such as hospitals, clinics, nursing homes and aged care facilities. They generally work in support of health professionals or associate professionals.” (P21) (SANCO/1/2009)

HCAs began to be employed in ever increasing numbers in this country from the 1990’s and today they are pivotal to the delivery of care in all sectors of the health services nationally.  There contribution is vital to the continuance of the service.

It is difficult to assess the numbers of Healthcare Assistants working, in both the public and the private sectors of the Health Services Nationally; however having contacted a variety of healthcare providers we suggest that the number is approximately 50,000.

The members of the Alliance of Health Care Assistants in Ireland (AHCAI) believe it is time the role of HCA was accepted as a discipline in its own right.    The greater numbers of HCAs have chosen this work because they enjoy the caring relationship; providing essential care while supporting the patient in carrying out the activities of daily living.  Many would like to extend their role by taking up some basic nursing duties.

The potential for the Healthcare Assistant role to contribute to the overall health services of this country are largely untapped.  The HCA ought to be trained to fulfil a wider role of personal and clinical care in the delivery of the health services.  This would free those Registered Nurses, who so wished, to undertake more complex tasks at the upper end of their scope of practice.

The Senior HCA would work under the supervision and guidance of the Registered Nurse but would have autonomy in certain areas of his/her work.

Present Situation

HCAs work in all sectors of the Health Services; their duties depend largely on the needs of their particular service.  Some are trained up and signed off as competent to carry out specific clinical tasks which are not normally regarded as the remit of a HCA.  According to Quality Qualifications Ireland (QQI), it is the Registered Nurse who should train and assess student HCAs studying the Healthcare Support Course at level 5, however in some nursing homes and hospitals it is the experienced (senior) HCA who is given the responsibility of mentoring/training student HCAs, while the Nurse assesses their competence and marks them in specific activities. This is a responsibility the experienced HCA is quite capable of shouldering and for which he/she should receive some extracurricular training.

The discipline of Healthcare Assistant is unregulated, has no national, written scope or code of practice and the requirement to have a QQI level 5 qualifications in Healthcare has been withdrawn by HIQA as a standard for qualification.  The suitability of the individual for the role of HCA is up to the individual employer.

HIQA states in the 2016 standards:

7.1.1 “Staff are recruited in compliance with employment and equality legislation, and recruitment and selection processes are informed by evidence-based human resource practices.”

7.18  “The skills and competencies of each staff member are reviewed during their probationary period and on an ongoing basis as part of their performance appraisal.”  (HIQA 2016)

The employer is required to train staff in Fire Prevention, Elder Abuse and Emergency Procedures.

It is up to each provider to determine how to comply with the regulations.

Regulation

The Alliance has given notice to CORU of our intention of applying for regulation for HCAs in the near future.  We envisage the HCA as being a regulated practitioner having:

1. A national, written, core scope of practice;
2. A national written code of practice.
3. A national curriculum

Training

Healthcare Assistants are here to stay as a vital part of the Irish Health Services.  To enable them to give the best service possible they will require further training.  We believe:

• The basic training, of one academic year, for personal care of the patient should be the QQI Major Award at Level 5
  1. with improvements to module content to reduce repetition and ensure that each course includes a module on Anatomy & Physiology and Human Growth and Development
  2. better supervised placements
  3.  basic training for the placement mentors

•  Followed by a year’s experience working in the role of Healthcare Assistant
• Then further training, at QQI Level 6, in basic clinical care to the level of Senior Healthcare Assistant
• The Senior HCA, in addition to personal care of the patient, would be trained to take much of the routine, time consuming work of the Registered Nurse such as,
  1. vital sign recording,
  2. Chronic wound dressings,
  3. Urinary catheterisations and catheter care,
  4. Ostomy care to include colostomy and urostomy, .
  5. Pressure sore assessment and prevention.
  6. Fluid balance monitoring and recording
  7. PEG feeding

• Training in other tasks which may be required in the particular environment in which the HCA is working.
• While there may be some management training in this course further training in Management at QQI Level 7 would provide the HCA with management and leadership skills.

Conclusion

When HCAs are regulated with CORU and their discipline accepted and respected with a defined career path such as:

Level 1

• Personal care working as part of a team.

Level 2

• Personal and basic clinical care (such as listed on Page 4)
• Mentor and train student HCAs on placement;
• Manage a team of HCAs in a unit or department;
• Work effectively and take a more active part in a multidisciplinary team.

Level 3

• Manage a residential care home (This is not a nursing home)
• Manage a day centre for elderly or cognitively impaired patients.

HCAs will then be an even greater asset to the Health Services Nationally.

We do not envisage seniority by length of service but rather by training and qualification.

Sources

Stokes J & Warden A. (2004) “The changing role of the healthcare assistant”, Nursing Standard. 18(51).33 – 37.

Fealy G.M.2006, A History of Apprenticeship Nurse Training in Ireland  UK Routledge (P24)

(HSE 2006) Report of the High Level Group on Health Care Assistant regarding . https://www.hse.ie/…/hrstrategiesreports/Report%20of%20the %20High%20Level%20…

Final Report on the Project

Development and Coordination of a Network of Nurse Educators and Regulators (SANCO/1/2009) to the European Commission, DG SANCO  P21

National Standards for Residential Care Settings for Older People in Ireland

2016  HIQA

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