Nursing Support Workers and Tasks Performed, Delayed or Not Completed

Purpose: Direct patient care has been undertaken by a combination of licensed and unlicensed nurses for many years. However, persistent nursing workforce shortages and increased patient acuity and throughput has led to increased employment of large numbers of nursing support workers internationally (Bureau of Labor Statistics, 2013; Health Workforce Australia, 2012; NHS, 2013). Concurrently, tasks formerly completed by registered nurses have moved to the nursing support worker (Gillen & Graffin, 2010; Plawecki & Amrheim, 2010). This change has raised questions regarding the role and effective utilization of support workers. However, there has been limited research on the impact of these workers in the acute hospital workplace. This paper compares the nature of tasks performed, delayed or not completed by nursing support workers and licensed nurses, and the factors associated with these outcomes.

Methods: This paper reports a secondary analysis of data collected in three studies of medical and surgical units across three states of Australia. Data from a recently completed project were combined with that from two previously reported studies (Duffield et al., 2011; Roche, Duffield, Aisbett, Diers, & Stasa, 2012). In total, data were collected on 132 randomly selected units in 25 public general acute hospitals across three Australian states between 2004 and 2010. Data collection procedures in all studies were similar. All direct personal care workers on the selected wards were asked to complete a survey anonymously. An overall response rate of 60.4% was achieved (3945 of 6528 potential consenting respondents). The survey included demographic items, employment characteristics, six questions on specific tasks performed, and 11 questions on direct-care interventions delayed or left undone at the end of the most recent shift. The survey also included the Practice Environment Scale (Lake, 2002) and the Environmental Complexity Scale (O'Brien-Pallas, Irvine, Peereboom, & Murray, 1997; O'Brien-Pallas, Meyer, & Thomson, 2005). In addition, a profile of each unit that included bed numbers, support services and other characteristics was obtained. Analyses explored differences between groups and potential explanatory factors via regression models.

Results: Significant differences were found between nursing support workers and licensed nurses in tasks undertaken, delayed and not completed. As expected, nursing support workers undertook more tasks such as delivering meal trays and housekeeping, although also undertaking some tasks that may have been out of their scope of practice. Nursing support workers also reported fewer tasks delayed (completion of vital signs, responses to call bell, routine mobilization and documenting nursing care). Unit support services, the practice environment, violence towards nurses and overtime were important explanatory factors in relation to tasks delayed or not completed for both licensed nurses and support workers.

Conclusion: Increasingly, nursing support workers are providing direct care to patients in the acute hospital setting and this may have implications for patient safety and quality of care. Along with effective delegation of tasks, an important consideration is the model of care  (i.e. a substitutive or supportive model) adopted when support workers are included in the staff mix. The ongoing shortage of registered nurses and increased use of support workers challenges nursing unit managers to effectively integrate these staff into their workplace and to confirm these support workers are operating within their scope of practice.