Politics of Professional Practice - Essay Example

?Running head: POLITICS OF PROFESSIONAL PRACTICE Politics of Professional Practice Insert Insert Grade Insert 21 January Politics of professional practice Introduction Recently, an increase in the number of support workers involved in the NHS activities has been on the rise. These support workers have achieved a very high profile in the recent times, while their importance in the provision of care to the patients is unquestionable. However, there is generally very limited explanation as to why the support workers are used by the NHS. Moreover, the consequences of their usage in the provision of healthcare to various stakeholders involved in the provision of healthcare have not been adequately explained. This paper will attempt to come up with clear explanations of the usage of support workers in order to foster the understanding of the impacts of their usage in the provision of healthcare to the patients. The paper will explicitly explain the roles of the support workers, as well as the risks posed by the use of the support workers mainly due to their lack of training. In addition, the paper will explain the regulation that has been put in place to regulate the activities of the healthcare support workers (HSW) and any regulation that should be put in place to regulate their future activities to ensure that their usage does not compromise the quality of healthcare provided by the NHS. The impact on the other stakeholders involved in the healthcare provision will also be explained. By so doing, we hope to have a clear understanding of the different dimensions of usage of the healthcare support workers. The paper will mainly use the articles by the NHS, RCN and other relevant bodies, as well as the recent research findings to have a more recent perspective on the development of the issue of healthcare support workers. Role of support workers in NHS nursing healthcare There has recently been a rapid increase in the number of healthcare support workers in the healthcare workforce in England; indeed, the number of the healthcare support workers has more than doubled since 1997 (RCN, 2007, p. 4). The support workers are involved in most of the areas in the NHS. These include receptionists, drivers, caterers, and performance of assistance roles to health professionals (RCN, 2007, p. 4). The support workers in nursing healthcare are of significant important especially during periods where there is a shortage of the nursing students who have graduated from the nursing schools (Great Britain: Parliament: House of Commons: Treasury Committee - 2007 p. 76). Generally, the shortage of nurses is the main reason that led to the integration of the support workers in the provision of healthcare services by the NHS. The support workers help in easing the workload on the nurses and other healthcare providers by providing the healthcare services that can easily be provided by other parties. The shortage of the nurses was mainly due to the low pay nurses receive compared to other professions (Great Britain: Parliament: House of Commons: Treasury Committee, 2007, p. 76). The support workers perform several roles in the NHS; there are support workers who are involved in the performance of non-clinical activities, whose roles include catering, maintenance, and hotel services. In addition, other support workers are involved in clinical activities; they may be involved in the provision of primary care to the patients i.e. GP surgeries, provision of care in nursing homes, patients homes and walk-in hospitals. The support workers may also be involved in the provision of secondary healthcare to the patients, mainly involving the provision of healthcare services to the patients in the hospitals (NLIAH, 2009, p. 2). However, there has been a general evolvement in the work performed by the support workers perform, which was mainly done by either the doctors or the nurses before. The work performed by the support workers can also be categorized as primary care or secondary care. Primary care involves the feeding and washing of the patients whereas the secondary care involves the provision of services that do not have direct contact with the patient such as bed making and washing of the patients clothing. Most of these jobs used to be done by the RNs. Nevertheless, the support workers sometimes do more caring to the patient than the RN (Kessler et al, 2010, p. 68-69). The above tries to categorize the jobs that the support workers perform in the provision of healthcare services. However, the HSW are used in most of the areas of the healthcare sector. In fact, there are cases where the support workers provide services that are performed by the nurses. These services include cleaning and dressing of the wounds of the patients, caring for the old, providing support to biomedical scientists and even as assistants in the diagnostic and imaging equipment. Generally, no specific qualification is requited for support workers in order to be employed by the NHS. Most of the support worker should not necessarily have prior experience in the provision of the relevant service; the support workers receive on-the-job training. This group of workers is generally temporary and mainly works under the supervision of the experienced doctors and nurses. Due to the temporal nature of their employment status, which allows them to move between healthcare provision and provision of social services, their terms of employment are simple. They are mainly employed on demand and they receive a generally low pay package compared to the nurses and other people who work for the NHS on a permanent basis. Due to the low pay package, most managers employ the support workers as a method of ensuring that they continue providing the healthcare services in a cost effective way (national institute of health research, 2010) Delegation of the nurse to support staff and the legal implications Delegation is the process by which a registered medical practitioner allocates certain tasks to a healthcare support worker who is thought to have the necessary competence required to perform certain duties. However, delegating should not compromise the quality of the services provided to the patient. NMC (2008) clearly outline the regulation regarding the provision of healthcare by a registered nurse (RN) to a patient. The RN should ensure that the patient receives the highest quality of service that is available. In treating the patients, the NMC states that the nurses should ensure that the confidentiality of the patients is respected (p. 2). Therefore, the nurse should inform the patient in advance, why the information that he provided is being shared to other people who may be involved in their care. These people include the support workers. The RN must therefore ensure that he gains consent from the patient to treat him and to transfer the treatment and in effect, any information regarding the treatment to other parties, who include the support worker (p. 3). The RN should therefore ensure that he provides the healthcare services to the best interest of the patient. The nurse can therefore delegate the provision of the healthcare services to the supporting workers as long as the quality of the services is not compromised. In delegating the services, the nurse should ensure that the person who will perform the work would be able to work according to the instructions that the nurse will offer. The RN should therefore ensure that the support worker is supervised and is given support whenever necessary. In addition, the outcome of the work should conform to the required standards (NMC, 2008, p. 5). If the support staff performs any action that puts the patient at risk, the RN who delegated the work is usually held accountable to the actions of the actions of the support staff and may even have his practice license withdrawn. Rights of patients regarding treatment by HSW All patients have the right to access treatment from the NHS services. In provision of the services, the patient must not be discriminated based on gender, race, religion, sexual orientation, or even age (NMC, 2008, p. 6). The patient also has the right to receive treatment from people who are qualified, experienced, and approved by the relevant bodies. The patient can therefore refuse to be treated by HSW if the patient feels that the HSW does not meet the above conditions. In case the provision of the healthcare service is delegated to the HSW, the patient has the right to have someone monitor and supervise the services provided by the HSW to the patient (NMC, 2008, p. 7). In case any of the parties provides services that the patient feels are unsatisfactory to the patient, the patient has the right to complain to the NHS so that investigation on the specific person may commence. The patient should also receive support in lodging his complaint, and the lodging of the complaint should not affect their future treatment. In addition, the patient has the right to know the outcome of the investigation report (NMC, 2008, p. 8). This protects the patients from receiving services that he feels are substandard and are against his expectations. In addition, this ensures that the nurses and doctors provide high quality healthcare services as failure to do so may lead to there being reported to the NHS for poor quality service provision, which may even lead to the withdrawal of their practice. Moreover, the healthcare providers must receive the consent from the patient receiving the treatment before the onset of the treatment. If the person cannot give a valid consent, someone else who is legally able to act on his behalf can give the consent for treatment. This ensures that the patient receives treatment that he or she consents to. In addition, this prevents the patient from receiving treatment from people whom he does not consent to offer them the treatment. Moreover, the patient has the right to refuse treatment from other parties recommended by the person who was primarily offering the treatment. In addition, since the support workers are not subject to any professional registration, should their actions lead to a compromising of the health of the patient, the responsibility lies squarely on the registered medical practitioner who delegated the duty to the support worker (CSP, RCSLT, BDA and RCN, 2006, p. 8). Critical issues of health care provision by the support workers: regulation, risks posed and competency Lack of regulation of the support workers’ activities may pose great risks to the patients under the care of the support workers. This is due to the fact that most of the support workers are involved in almost all the sectors of healthcare provision and most of them have no prior experience in the performance of the duties. The NMC should therefore ensure that the HSW are regulated to reduce and manage the risks posed by the HSW. The HSW are generally involved in provision of various services which mainly complement the services provided by other medical practitioners. The HSW who are involved in the provision of support to the biomedical services do activities that require training so as to be able to handle the activities effectively. One of the activities involved in the biomedical laboratories include carrying out of tests to determine the health conditions of various patients. The use of the HSW poses the risk of getting the wrong diagnosis, as the HSW may mix different chemicals in a wrong proportion; here, wrong diagnosis may have various negative repercussions to the patients. As outlined previously, there is no prior requirement needed in order for a person to be employed as a HSW; these people mainly get training while on the job. Upon completion of the training, the HSW can then be allowed to perform various tasks relating to his competency (Cardiff and vale NHS trust, n.d., p. 1). In delegation of the duties to the HSW, the nurse must ensure that the specific HSW has the right competency that will enable him to perform the duties efficiently without compromising the health of the patient. The nurse therefore requires the HSW to provide the treatment program or therapy which is relevant to her competency skills before the onset of the treatment by the HSW. In addition, the HSW works towards aims set by the registered practitioners (CSP, RCSLT, BDA and RCN, 2006, p. 9). The registered practitioner and the support worker also agreed on a specified duration of time when the registered practitioner can supervise the progress of the activities of the support worker in the provision of the healthcare services. This ensures that the HSW does work that meets the required standards. The supervision also helps in the solution of various problems, which the HSW may be faced with in the provision of the healthcare services. Among the main reasons for the regulation of the HSW activities is the reduction of the risks that the support workers may pose to the public in the provision of the healthcare services. However, the regulation may also increase the risks posed to the public. Regulation of the HSW will ensure that they have the necessary competency required to perform certain skills that are generally done by the trained medical practitioners such as doctors, nurses, and other technical personnel involved in the provision of healthcare services. In addition, the regulation ensures that nurses delegate their duties in a proper method and anyone who is under them receives the help that he/she requires (NMC, 2008, p. 5). Regulation of the HSW has the potential of reducing the number of HSW. This may increase the workload of the registered medical practitioners and cause further delays in the provision of the healthcare services due to an increase in the patient to nurse ratio. This is evidenced by the fact that there is generally a shortage of the nurses in UK due to the low pay of the nurses. Delays in provision may pose a great risk to the patients, as they would not be able to access the healthcare services at the time when they mostly need it. The regulation of the HSW usually raises many questions as to the methods that the relevant bodies should use. The question therefore arises as to whether, should the HSW be regulated as nurses or simply as healthcare support staff or be promoted to nurses and therefore regulated as the nurse (Griffiths and Robinson, 2010, p. 34). However, most of the bodies are in agreement that the HSW should be regulated so as to ensure that the work they perform meets certain standards. Ramifications for the future of nursing, and advantages and disadvantages of HSW for NHS Nursing is among the lowest paying jobs in the UK, an aspect that has led to many people not preferring to venture into the area. The government has therefore been taking measures to promote the profession and encourage many people to join the profession. This is further necessitated by the fact that there has been an increase in the average age of the nurses with most of the nurses nearing the retirement age. This will make the UK to need more nurses in the future in order to fill the gap in manpower left by the retiring nurses (Great Britain: Parliament: House of Commons: Treasury Committee, 2007, p. 76). The government should therefore formulate methods of recruiting, training, and retaining more nurses in order to cater for the reduction in the workforce. There has been a general transformation in the work of the nurses. The nurses initially used to provide healthcare services that were not technical and generally did not require extensive training. Most of the services they provided were mainly in preparation of the patient to being attended by a doctor. However, the work of the nurses has been shifting from this traditional role; nurses nowadays are an integral part of healthcare provision, and are involved in various activities which were initially provided be qualified doctors. The activities include prescription of drugs, consultation services, provision of community healthcare services, homecare support services and the management of chronic diseases (Great Britain: Parliament: House of Commons: Treasury Committee, 2007, p. 76). The nurses have also led to the revolutionizing of various services, leading to the improvement in the quality of the healthcare services (Great Britain: Parliament: House of Commons: Treasury Committee, 2007, p. 76). The nurses are expected to form an integral part of healthcare provision in the future. The government should therefore come up with methods that will lead to the improvement in the quality of the services provided by the nurses. Therefore, the increase in the responsibility of the nurses necessitates the government to come up with increased regulation to control the activities of the nurses. The future shortage of the nurses is also expected to lead to an increase in the number of HSW who in future are expected to perform most the work that is currently being performed by the nurses. The increase in the HSW is expected to be accompanied with an increase in the regulation of the work of the HSW. Regulation of the HSW has many advantages; the regulation will ensure that the HSW meet the required educational standards (RCN, 2007b, p. 5), leading to an improvement in the quality of the services provided by the HSW and other people who are involved in the provision of healthcare services. In addition, regulation will ensure that the HSW are people who only have character suitable for them to work in the provision of healthcare services to the patients (RCN, 2007b, p. 5). Only people who are friendly show care and are able to meet the needs of the patients will be employed as HSW. This further leads to an improvement in the quality of the services provided by the support workers and the ultimate satisfaction of the patients. Improvement in the regulation on the HSW will lead to the formulation of a common code of conduct between the HSW and the RNs. This will outline the responsibility of each group and therefore lead to an improvement in the cohesion and teamwork of the nurses and the HSW, a feature that is very important in the provision of quality healthcare to the patients (RCN, 2007a, p. 10). Increase in the regulation may also lead to the reduction of the people who are employed as HSW, as some may fail to meet the minimum standards required in order to obtain employment or retain employment as support workers. This is expected to pose serious problems to the NHS, as the demand for nurses is generally high. The lack of manpower may pose other serious problems such as delays in the hospitals due to increase in the patient to nurse ratio. In addition, due to the fact that the HSW are generally paid much less income than the RNs, lack of the HSW may lead to an increase in the working hours of the RNs and in effect, lead to an increase in the cost of healthcare provision to the NHS. The most prominent feature of the increased regulation of the HSW would ultimately be the increase in the quality of the services provided by the HSW. Moreover, the increased regulation will lead to the improvement of the public protection from HSWs to ensure that the services are of the desired quality (RCN 2007a, p. 6). This would lead to the improvement in the confidence of the patients in the services provided by the HSW. However, increased regulation may also be disadvantageous to the patient. Regulation may prevent the HSW from performing certain duties that they used to provide, thereby increasing the workload on the RNs, and leading to provision of low quality healthcare services. References Cardiff and vale NHS trust. N.d. A comparison of HCSW skills, training and support mechanisms: a Florence Nightingale travel scholarship. NHS Wales. (Online). Available from: http://www.glasgows.co.uk/florencenightingale/images/posters/Tessa%20Callaghan%20Cardiff%20and%20Vale%20UHB.pdf (accessed on January 20, 2011) CSP, RCSLT, BDA and the RCN. 2006. Supervision, accountability and delegation of activities to support workers: A guide for registered practitioners and support. RCN. (Online). Available from: http://www.rcn.org.uk/__data/assets/pdf_file/0006/78720/003093.pdf (accessed on January 20, 2011). DH. 2010. The NHS Constitution for England. London Department of Health. (Online). Available from: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_113645.pdf (accessed on January 20, 2011) Great Britain: Parliament: House of Commons: Treasury Committee. 2007. The 2007 Comprehensive Spending Review: prospects and processes, sixth report of session 2006-07, report, together with formal minutes, oral and written evidence. London, the stationery office. (Online). Available from: http://books.google.co.ke/books?id=k3iyOiSvkHsC&pg=PA76&dq=shortage+of+nurses+support+workers+NHS&hl=en&ei=uMQ3Tby2B4Wt8gP8rtzoCA&sa=X&oi=book_result&ct=result&resnum=1&ved=0CCUQ6AEwAA#v=onepage&q=shortage%20of%20nurses%20support%20workers%20NHS&f=false (accessed on January 20, 2011) Griffiths, P. and Robinson, S., 2010. Moving forward with healthcare support workforce regulation: A scoping review: Evidence, questions, risks, options. National Research Nursing Unit. Kings College London. (Online). Available from: http://www.nmc-uk.org/Documents/Research%20papers/NNRU%20report%20into%20the%20regulation%20of%20HCSWs%20July%202010.PDF (accessed on January 20, 2011) Kessler, I. et al. 2010. The nature and consequences of support workers in a hospital setting. Final report. NIHR service delivery and organization program. (Online). Available from: http://www.sdo.nihr.ac.uk/files/project/155-final-report.pdf (accessed on January 20, 2011). NLIAH. 2009. Joining the NHS healthcare support staff. NHS. (Online). Available from: http://www.wales.nhs.uk/sitesplus/documents/829/NLIAH%20INF%2015%20eng%200511091.pdf (accessed on January 20, 2011). National institute of health and research. 2010. Research into the role of support workers. NHS. (Online). Available from: http://www.nhsemployers.org/PlanningYourWorkforce/SupportWorkforce/ToolsAndResources/Pages/Researchintotheroleofsupportworkers.aspx (accessed on January 20, 2011). NMC. 2008. The Code: Standards of conduct, performance and ethics for nurses and midwives. London NMC. Available from: http://www.nmc-uk.org/Documents/Standards/nmcTheCodeStandardsofConductPerformanceAndEthicsForNursesAndMidwives_LargePrintVersion.PDF (accessed on January 20, 2011). RCN. 2007a. The regulation of the healthcare support workers. RCN policy unit. (Online). Available from: http://www.rcn.org.uk/__data/assets/pdf_file/0003/287715/11-2007_the_regulation_of_health_care_support_workers.pdf (accessed on January 20, 2011) RCN policy unit. 2007b. Trust assurance and safety – the regulation of health professionals in the 21st century. Policy briefing 04/07. RCN. (Online). Available from: http://www.rcn.org.uk/__data/assets/pdf_file/0007/287737/04-07_trust,_safety_and_assurance_-_the_regulation_of_health_professionals_in_the_21st_century.pdf (accessed on January 20, 2011) Read More