In defence of healthcare assistants

Oh dear, a silly set of comments by a silly man has unleashed a torrent of bile aimed at healthcare assistants.

This work is now done by assorted auxiliaries who have been taken away from the routine cleaning duties they used to perform so that they can act up to do jobs for which they are not trained. Jobs that used to be done by the nurses. The auxiliaries do not do the jobs well, just as the nurses who have left nursing for more important matters do not do whatever it is they now purport to do very well.

and…

I’m sure they were dirty and I’m sure they did talk over him about innappropriate topics: this is standard in much of the NHS today.

However, he was wrong about one key thing. They were not nurses. He was almost certainly descibing ‘Health Care Assistants’ - what we used to call Auxilliary nurses. They used to provide support care under the direction of ward nurses. Now, of course, they do all the nursing while the real nurses are chained to their desks filling out forms.

This seems to be an emerging trend on the health blogosphere. HCA-bashing is turning into the new nurse-bashing (not that the old nurse-bashing has gone anywhere). So, I’m going to put in a bit of balance by saying a few words in their defence. Here’s a homage to the Poor Bloody Infantry of the NHS: underpaid, understaffed and under a big pile of poo…the healthcare assistants.

Most senior doctors will tell that you there were plenty of occasions when the RNs saved their bacon when they were either a medical student or a junior house officer. Likewise, as a student nurse and then a newly-qualified RMN the HCAs were often a lifeline to me. The HCAs are the ones who have the most contact with patients/clients. In the case of somebody who has a lot of contact with services, they may well have known that particular patient/client for years. They provide the one-on-one time with a client that the RNs sadly too often don’t have the time to do, and as a result they’re often best placed to know what makes a particular client tick. They’re also often the first to notice when something untoward is happening. That knowledge is invaluable.

It would be wrong to dismiss HCAs as all being a bunch of nice-but-dim yokels who aren’t bright enough for that fancy book-larnin’ that “proper nurses” have to do. The HCA on your ward is often a student nurse or medical student working part-time on the bank. On the psychiatric wards, a surprising amount of them are psychology graduates gaining experience of mental health in the hope of going on to become clinical psychologists. And of course, a very high proportion of today’s RNs started out as HCAs before heading off to uni.

It is true that there is an issue with the level of training HCAs receive. It’s not that there isn’t any available, but it’s ad hoc and varies wildly in both quantity and quality. There’s probably a case for restoring some modern-day equivalent to the old Enrolled Nurse qualification (or to the Licensed Practical Nurse qualification that they have in the US). Here on Mental Nurse, Beakie has made some suggestions for how this could be achieved through the use of foundation degrees. Failing that, more rigorous implementation of the NVQ schemes (perhaps making it a statutory requirement that every HCA starts an NVQ on day one of the job) might be another way of adding more structure to the training.

But…it’s not just training that makes a HCA good or bad. I’ll probably get some stick for saying this, I’m convinced that in many ways its the motivation, personality and attitude of a HCA that’s more important than the actual training. Obviously there’s certain areas of training that have GOT to be done - manual handling, infection control, health and safety etc. However, if it’s a choice between working with an inexperienced, undertrained HCA who’s keen and with a great attitude, or somebody who’s been around for years, has a qualification but has an attitude that stinks…I’ll take green-but-keen over been-there-for-years-and-don’t-give-a-shit any day of the week.

So, let’s not be so hard on the men and women doing a tough job for less money than they’d earn stacking the shelves at Tesco. I can deal with uninformed and silly rants from toffs burbling in the House of Lords. It’s just part of the natural order of things. I have a significantly lower tolerance for it, though, when it comes from fellow clinicians.