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To determine the impact of nursing support workers on the type of patient care activities completed on nursing units (wards) with and without nursing support workers.
Methods:
Cross-sectional analysis of work sampling data. Data were collected from ten sampled wards in public general acute care hospitals in Perth, Western Australia between March and October 2013: 5 wards with AINs and 5 without. Nurses were observed using a validated data collection tool (Pelletier & Duffield, 2003; Urden & Roode, 1997), in randomly assigned time slots between the hours of 0700 and 1900, over a two-week period per unit. Most of the nurses on each unit consented to being observed (n=452). Electronic tablets were used to collect and store the data, which was then uploaded to a secure server. Inter-rater reliability was performed every 24-36 hours to ensure consistent coding (of at least 80% agreement) between the data collectors. Data were analysed in 2 steps: descriptive comparison between between AINs and other staff for 25 work activities, and comparison of work activities between regulated nursing staff on wards with or without AINs. In the latter analysis, logistic regression models were developed to investigate whether regulated nurses were more likely to undertake direct or indirect patient care tasks across the different ward types. Ethics approval was obtained from two universities and three hospitals.
Results:
A total of 81,594 observed activities were collected, equivalent to 13,599 hours of nursing activities. AINs spent the majority of their time engaged in direct patient care tasks, such as admission and assessment, hygiene, and mobility. Regulated nurses were less likely to perform direct care tasks compared to AINs. On AIN wards, regulated nurses undertook more direct care relative to those who worked on non-AINs wards.
Conclusion:
Nursing support workers are perceived as supports to registered nurses and undertake tasks that require substantial amounts of interaction with patients. They display widely varied skills and may be associated with changes to the proportion of direct care activities undertaken by regulated nurses.