Health Care Assistant-Registered Nurse dyads: A new concept of nursing team

Health Care Assistants (HCAs) are integral to adult nursing teams. Their role and responsibilities have been widely debated. However, it is unclear how HCAs enact their role in an adult in-patient ward environment. The aim of this study was to explore how HCAs enacted their role in an adult, in-patient environment. The objectives were to; gain an understanding how HCAs connected, interacted, and related to people at work; ascertain HCAs perceptions of the enactment of the HCA role; and to develop a construction of how HCAs enacted their role. From within a constructivist paradigm, the focused ethnographic study, consisting of 148 hours of observation and 108 interviews, was used to describe and explain the HCAs’ role and their contribution to the nursing team. This data was collected from four wards in one UK hospital. Analysis found that HCAs and Registered Nurses (RN), when paired for a shift, formed a dyadic team. Within this HCA-RN dyad, the HCA joined and separated from the RN in order to ensure that all nursing tasks for the shift were complete. To contribute to the HCA-RN dyad, HCAs needed to be able to work non-dependently from, and inter-dependently with, their RN partner. Non-dependent working was achieved through carrying out the ‘routine scaffolding’ comprise three levels of tasks; compulsory timed tasks, mandatory flexible tasks, and RN requested tasks. The extent of the success of non-dependent working was reliant on the RN having trust in the HCA. Inter-dependent working included any tasks that required two people and relied upon the willingness of the RN to co-work. When an HCA was able to work non-dependently and inter-dependently, their contribution to the HCA-RN dyadic nursing team was considered successful and effective by both partners. Through exploration of how HCAs enact their role, the importance of the relationship with the RN has been highlighted. Completion and documentation of the nursing tasks for their bay of patients was successful when the HCA and the RN worked as both separate entities and a co-operative pair throughout the shift. The impact of the discovery of the intertwined relationship between the HCA and their RN partner is a fresh understanding of how HCAs enact their role. The newly defined model of care delivery reflects the contemporary ward environment from the perspective of the HCA.