Is it a dangerous game? : registered nurses' experiences of working with care assistants in a public hospital setting : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University
Financial constraints in the rapidly changing health care climate have resulted in a trend towards the employment of care assistants in public hospitals. Registered nurses are often the staff who work most closely with these care assistants. The aim of this qualitative descriptive study was to explore the experiences of registered nurse participants who worked with care assistants in a particular public hospital setting. Although there is a considerable amount of international research on registered nurses working with care assistants and issues relating to this topic, this topic has not been researched in the New Zealand context. This study's participants were drawn from a regional hospital that formally introduced a training programme for care assistants in the mid-90s. Before this some hospital aids with no formal training were employed by the institution. These hospital aids were then encouraged to join the care assistant programme. Eight registered nurses participated in semi-structured interviews. The data were analysed using Burnard's (1991) thematic content analysis, which led to the development of three overarching themes. The first theme, 'I'm not sure what care assistants should be doing', reflected the perception of the participants that the role of the care assistants was ill defined, and that the care assistants' contribution was limited by their lack of qualification. In the second theme 'we have overall responsibility for the work of the care assistant', the participants perceived that their job had become more difficult with care assistants, and that they had to be careful when assigning tasks to the care assistants for fear of compromising patient safety. The participants' perception of the registered nurse being responsible for unregulated care assistants and the legal implications this could have on their own nursing practice was of concern. The final theme, 'we were never really taught to delegate' reflected participants' concerns that they had no formal education in delegating to and supervising care assistants. Furthermore, the participants' lack of involvement in care assistants' training and in assessment of their competency resulted in the participants being unaware of the care assistants' capabilities. Overall, the study suggests that clear directives be put in place for registered nurses when working with care assistants', and that registered nurses require further education about their own legal obligations as health professionals. If registered nurses are to be involved in delegating work to and supervising unregulated staff, then they need to have formal education in these skills.