The Royal College of Nursing (RCN) has issued formal definitions of nursing support workers, including a new distinction between healthcare assistants (HCAs) and registered nursing associates.
A collaboration between various committees within the college led to the development of the new definitions, which were published earlier this month.
“We are seeking to ensure that staff and patient safety is upheld”
Wendy Preston
A nursing support worker is now defined as a “collaborative member” of a nursing and multidisciplinary team providing person-centred nursing care, with this care always being delegated and supervised by a registered nurse.
Under the new definitions, two types of nursing support worker have been distinguished: “supportive” and “assistive” level.
Supportive level workers includes HCAs, healthcare support workers and equivalent roles who typically perform “task-oriented” care which is “routine”, “high-volume” and has little variance.
Meanwhile, assistive-level nursing support work includes that of registered nursing associates, assistant practitioners and other equivalent roles.
RCN defined this level as having a “deeper level of knowledge, skills and training” and performing a “broader range of activities”, using their “initiative” and problem-solving skills within their scope of practice, particularly in “familiar, low-risk and predictable situations”.
This level can, RCN said, oversee the work of supportive workers, while themselves remaining under the supervision and responsibility of a registered nurse.
The definition firmly sets out that all nursing support workers performing work beyond their defined roles, particularly that which is reserved for registered nurses, known as role substitution, is not acceptable.
RCN’s new definitions for support workers come as part of the college’s ongoing work to define the “levels of nursing”, which previously saw new definitions issued on enhanced, advanced and consultant nurses.
The project, the college hopes, will help improve consistency across all sectors of the nursing workforce and improve understanding and recognition among the workforce, service users and employers.
Following their publication, RCN head of nursing workforce Wendy Preston said she hoped the definitions would provide “clarity” on the identity and accountability of nursing support workers.
“This is a positive step for the nursing workforce,” she said.
“Members have informed us that they are sometimes asked to work outside their scope of practice, and we are seeking to ensure that staff and patient safety is upheld.
“Registered nurses are sometimes not fully aware of their responsibility and accountability that delegation brings.
“This definition and level descriptors will help to provide clarity; more work will follow on education standards and guidance for employers.”
RCN’s definitions of nursing support workers – in full
Nursing support workers are collaborative members of nursing and multidisciplinary teams, providing person-centred nursing care across health, social care and education settings.
While they are responsible for their own actions, all nursing care they deliver is delegated and supervised by a registered nurse. Their role supports and assists registered nurses in delivering safe and effective care for individuals and populations.
Supportive – e.g healthcare assistants
They will work within the team under the supervision of a registered nurse, delivering delegated task orientated care consisting of routine, high-volume activities with little variance. They have knowledge and understanding within the nursing support worker context, developed by education and training to the standard set for this level by the country of employment within the UK. They are responsible for recording their activity promptly and accurately, with any matters of concern escalated promptly to the registered nurse.
Assistive – e.g nursing associates
In addition to the supportive level descriptors, staff at this level have a deeper level of knowledge, skills and training, meeting the standards set for this role by each country in the UK. For nursing associates, this includes the NMC standards. This enables them to carry out a broader range of activities, use their initiative and apply problem-solving skills within their agreed scope of practice, particularly in familiar, low-risk and predictable situations. Where appropriate, they can be delegated to guide the supportive level nursing support workforce, while remaining under the supervision of the registered nurse.
