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NSW DEPARTMENT OF HEALTH
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Produced by:
Workforce Development & Innovation Branch
Health System Support Division
NSW Department of Health
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© NSW Department of Health 2009
SHPN (WDL) 100137
ISBN 978 1 74187 472 3
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Further copies of this document can be downloaded from the
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August 2010
Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package NSW HEAltH PAGE 1
Contents
Section 1Introduction ................................................................................................................................................ 4
Section 2Incorporating Assistants in Nursing into the acute care clinical skill mix ............................................. 52.1 Stage1:IdentifyingopportunitiesforAINpositionsinacutecareclinicalareas.......................................................6
2.2 Stage2:SkillmixreviewandmanagementprocessforincorporatingAINs.............................................................8
2.3 Stage3:KeyquestionstoevaluatetheStage2skillmixreviewprocess................................................................ 10
Section 3 Education and Development ....................................................................................................................143.1 GeneralinformationontheHLT32507CertificateIIIinHealthServicesAssistance................................................ 15
3.2 Recommendedcompetencyunitsfortheskillset“AssistinginNursingWorkinAcuteCare”............................... 16
3.3 AssessmentsincludedinHLT32507CertificateIIIinHealthServicesAssistance
(Descriptor:AssistinginNursingWorkinAcuteCare)........................................................................................... 19
3.4 UpskillingexistingworkerstotheHLT32507CertificateIIIinHealthServicesAssistance
(Descriptor:AssistinginNursingWorkinAcuteCare)........................................................................................... 19
3.5 Clinicalplacementguidelinesforclinicalareas...................................................................................................... 20
3.6 Careerpathwaysinnursing.................................................................................................................................. 21
Section 4Scope of practice of acute care Assistants in Nursing..........................................................................234.1 PositionDescription–AssistantinNursing–AcuteCare....................................................................................... 23
4.2 AcuteCareAssistantinNursing–CareActivitiesList............................................................................................ 26
Section 5Delegation and supervision .....................................................................................................................30
Section 6Definitions ..................................................................................................................................................32
Section 7References ................................................................................................................................................37
PAGE 2 NSW HEAltH Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package
ListofTablesandFigures
List of TablesTable1: KeyquestionstoevaluatetheStage2skillmixreviewprocess....................................................................... 11
Table2: NSWHealthPreferredCoreUnitsandElectivesforHLT32507CertificateIIIinHealthServicesAssistance
(Descriptor:AssistinginNursingWorkinAcuteCare).................................................................................... 15
Table3: SummaryofcontentcoveredintherequiredelectivesforHLT32507CertificateIII
inHealthServicesAssistance(Descriptor:AssistinginNursingWorkinAcuteCare)....................................... 16
Table4: AcuteCareAINCareActivitiesList................................................................................................................ 27
List of FiguresFigure1: StepstoidentifyopportunitiesforutilisingAssistantsinNursing................................................................... 7
Figure2: TheskillmixreviewandmanagementprocessforincorporatingAINs........................................................... 9
Figure3: CommonunitsofcompetencyacrosstheHLT32507CertificateIIIinHealthServicesAssistance
(Descriptor:AssistinginNursingWorkinAcuteCare)andnursingqualifications........................................... 22
Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package NSW HEAltH PAGE 3
Abbreviations
ADL ActivitiesofDailyLiving
AHS AreaHealthService
AIN AssistantinNursing
ANMC AustralianNursingandMidwiferyCouncil
CIAP ClinicalInformationAccessProgram
CS&HISC CommunityServicesand
HealthIndustrySkillsCouncil
CVAD CentralVenousAccessDevice
DMF NationalFrameworkforDecisionMaking
byNursesandMidwives(ANMC,2007)
VAD VascularAccessDevice
EEN EndorsedEnrolledNurse
EEO EqualEmploymentOpportunity
EN EnrolledNurse
IIMS NSWHealthIncidentInformation
ManagementSystem
N/A Notapplicable
NUM NursingUnitManager
O2 Oxygen
OHS&R OccupationalHealthandSafety
andRehabilitation
PEG Percutaneousendoscopicgastrostomy
PICC PeripherallyInsertedCentralCatheter
RN RegisteredNurse
RPL RecognitionofPriorLearning
RTO RegisteredTrainingOrganisation
TPR Temperature,pulse,respirations
PAGE 4 NSW HEAltH Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package
Theavailabilityandskillofhumanresourcesinhealthisthe
foundationofasustainablepubliclyfundedhealthsystem.
AustralianHealthMinistershaveundertakeninitiatives
aimedatadoptingastrategicapproachtoworkforce
planninginthehealthsector.Demographicand
epidemiologicalfactorscontinuetoshapethechanging
contextforthehealthworkforce,demandingmore
co-ordinatedandintegratedservices.Thishasmanifestedin
redesigningpatientcareprocessesaroundpatientneeds
ratherthanhavingservicesplannedaroundthehealthcare
professionalbasedonhistoricalpracticearrangements.This
environmenthasprovidedthestimulusfortheHealthcare
AssistantInitiative,aprojectimplementedbyNSWHealth.
AsapartofthisInitiativeaprocessofconsultationhas
occurredtoestablishaconsistentapproachtothe
education,roleandemploymentofassistantswithin
nursingservicesintheNSWpublichealthsystem.This
resourcedocumenthasbeeninformedbythatconsultation
anddevelopedtoassistwithestablishingconsistent
practicesattheHealthServicelevel.Itisenvisagedthat
practicesofemploymentandclinicalallocationofAssistants
inNursingaswellaspromotionoftheroleasavaluable
teammemberwithinacutecarenursingserviceswillbe
supportedbytheuseofthisresource.
Thetitle“AssistantinNursing”(AIN)isusedthroughout
thisdocumenttodescribeahealthcareproviderwho
assistshealthcareprofessionalsintheprovisionofnursing
caretopatientsinacutecaresettings.
ThisresourcedocumentsupportstheHealthcareAssistant
Initiative,theaimsofwhichinclude:
n improveutilisationofAINsinnursingteamsinaward
orunitsettingtosupportmodelsofcareandbetter
integrateassistantsinnursingintoteamworkpractices;n furtherdevelopassistantrolesinsupportinghealth
professionals,andbetterutiliseskillswithinthe
professionalworkforce;n facilitateappropriatetrainingprogramsfornursing
assistantroles,inconsultationwithhealthprofessionals;
andn standardisetitlesandpositiondescriptionsforAINs
acrosstheNSWpublichealthsystem.
Thedocumentiscomprisedoffoursectionscovering;
1. Processestoassessandevaluatetheincorporationof
AINsintoclinicalenvironments,
2. AnoverviewoftheeducationanddevelopmentofAINs,
3. Thecomponentsestablishingthescopeofpracticeof
anAIN;and
4. Delegationandsupervisionguidelines.
Theguidelineswithinthisdocumentwillbesupportedby
furtherinformationandresourcestoidentifyspecific
practiceswithregardtotheemploymentofallAINsinNSW
Health.Furtherdevelopmentandsharingoftoolsor
guidelinestoassistinsupportingtheintegrationand
effectivenessofAINsasteammembersisencouraged
withinandacrossHealthServices.
SECTION1
Introduction
Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package NSW HEAltH PAGE 5
Thissectionincludesanumberoftoolstoassistmanagers
tomakedecisionsabouthowtoincorporateAINswhen
reviewingtheskillmixintheirclinicalareas.Determining
themostappropriateskillmixisacomplexprocess.These
toolsarethereforeprovidedasaguidetoassistnurse
managersnavigatethroughthestepsandtakeintoaccount
arangeofconsiderations.
Thefollowingthreestagesarerecommendedtoidentify
suitableareasforAINsandeachstageisexploredinmore
detailinthisSection:
Stage1–IdentifyappropriateopportunitiesforAINs
inacutecareclinicalareas
Stage2–Reviewthenursingskillmixandmanage
theprocessforincorporatingAINs
Stage3–AskkeyquestionstoevaluatetheStage2
reviewprocess
SECTION2
IncorporatingAssistantsinNursingintotheacutecareclinicalskillmix
Implementation recommendations:
n Reviewallresourcedocumentsandmodifytolocalrequirementsn ReviewandmodifyAHS/facilityorganisationalstructuretoincorporateAINsn Developtherequiredpolicies,protocolsandguidelinesrelevanttoincorporatingAINsintoclinicalenvironmentsn EstablishtheclinicalareasthatareappropriateforAINpositionsn EstablishtargetpositionsforAINsn Developachangemanagementplann DevelopanAINemploymentplan
PAGE 6 NSW HEAltH Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package
2.1 Stage 1: Identifying opportunities for AIN positions in acute care clinical areas
Stage1identifiesbroadstepstoassesstheclinical
environmentanddevelopsupportforspecificclinicalarea
reviewswithaviewtoincorporatingAINsintheclinical
skillmix1.
Figure1representsaprocesstoidentifythese
opportunities.Itisimportantfornursemanagerstouse
aprocesstoclearlydistinguishbetweeneachofthesteps
intheflowchart,whichinclude:
n Legislativeorregulatoryrequirementsthatcould
prohibittheallocationofanAINinanyparticularclinical
area,forexample,dothePoisonsandTherapeutic
GoodsAct1966,thePoisonsandTherapeuticGoods
Regulation2008,ortheNursesandMidwivesAct1991
prohibittheallocationofAINsinanyclinicalareas?n Practicestandardsorevidencethatindicatesaspecific
nurseskillmixinaclinicalarea.n Thepatientcasemixdependencylevelsofaclinicalarea
andhowthisalignswiththecareactivitiesandscope
ofpracticeoftheAIN.ThisImplementationPackage
containsanagreedscopeofpracticeandAINpatient
careactivitiestoassistwiththisstep.Thisstepinvolves
askingquestionssuchas:
-Whatarethepredominantpatientcareactivities
withintheclinicalenvironment?
-Whichofthosepatientcareactivitiesalign
withthescopeofpracticeofanAIN?
-Whatistheratio/averagenumberofpatients
whohavepredictableoutcomestopatientcare
activitieswithinthescopeofpracticeofanAIN?
-Whatistheratio/averagenumberofunstable
patientsthatrequireconstantapplicationof
technicalskillsbeyondthescopeofpractice
ofanAIN?
1 “Skill mix” refers to all staff that deliver nursing care
n TheskillmixcapacityforsupervisionofAINsinaclinical
area.Thisstephelpstoidentifythelevelofdecision
making,supervisionandsupportregisterednursescan
affordwhenconsideringskillmixandtheabovepatient
dependencycharacteristics.
Duringeachofthesteps,evidenceisreviewedtoidentify
orcreateopportunitiestointroduceAINsinappropriate
clinicalareas.Insomecases,theevidencemaynotsupport
theuseofAINsintheskillmixofparticularclinicalareas
anditisimportanttoidentifythesesituations.
Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package NSW HEAltH PAGE 7
Figure1:StepstoidentifyopportunitiesforutilisingAssistantsinNursing
Reviewbackgroundandscopeofpractisedocuments
Arethereanylegislativeor
regulatoryrequirementsforan
RN&/orE/ENonlyskillmix?
Aretherepredictablepatient
outcomesregardingADLs&
routinemonitoring?
YES
Go to STAGE 2
YES
Reviewmodelofcare.
Implementappropriatemodel
ofcaretoaccommodateall
members.
NO
YES
Istherecapacity
forsupervisionofAINs?
YES
Endreviewprocess
Identifyandreview
requirements
NO
Endreviewprocess
AlignAINpositiondescription
andScopeofPractice
documentswithward/unit
patientclinicalmix/dependency
NO
Endreviewprocess
Reviewskillmix:nNo.ofNursesinTransitionnNo.ofRNsnNo.ofENsnUseofcasuals
Isthemodelofnursing
careappropriate?
PAGE 8 NSW HEAltH Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package
2.2 Stage 2: Skill mix review and management process for incorporating AINs
Stage2providesspecificelementstobeconsideredwhen
undertakingaprocessofskillmixreviewandmanagement
toincorporateAINs.
ThestepsinStage2reflectareviewandmanagement
processthatstartsattheconclusionofStage1.Stage2
consistsofthefollowingfoursteps:
n Step A: Assessment,recommendstheanalysis
andalignmentofpatientneeds,staffnumbers,staff
characteristicsandtheclinicalenvironmentusing
establishedandlocallydevelopedtools.n Step B: Plan,recommendsstrategiestopreparethe
environmenttosupporttheintroductionofAINs,
includingidentificationofrolechangesandstaff
developmentneeds.n Step C: Implement,recommendsstrategiestomove
forwardwithskillmixchanges.n Step D: Evaluate,identifiespatient,nurseand
environmentaloutcomesthatcouldbereviewedto
determinetheeffectivenessoftheskillmixchanges,
usingestablishedandlocallydevelopedtools.
PleaserefertoFigure2whichpresentsaflowchart
representingtheabovefourstepsintheskillmixreview
andmanagementprocessforincorporatingAINS.
Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package NSW HEAltH PAGE 9
Figure2:TheskillmixreviewandmanagementprocessforincorporatingAINs
A. ASSESS Patient needsn numbern clinicalmixn complexityn dependency
Staffn numbersn availabilityn scopeofpracticen experiencen support
Environmentn physicaln supportservicesn culturen ModelofCaren NUMs’spanofcontrol
-clinicalleadership
-policyinfluence
MA
TCH
D. EVALUATEPatient outcomesn clinicalindicatorsn changesinnursesensitive
patientoutcome
-(IIMSdata)
-anecdotalevidence
Nurse outcomesn changesinrosterflexibilityn perceivedworkloadn perceivedresponsibilityn sickleaven communicationn rolefocus/utilisation
Environment outcomesn staffattritionratesn budgetaryn roleoverlapn collaborativeculturen policy/protocoladherence
B. PLANn Rostering–identify
appropriateAINnumbersand
shiftsn Staffdevelopment/educationn Developmonitoringand
feedbackmechanismsn ModelofCarechangesn Supervisionguidelinesn Roleredesignn Reviewlocalworkflow
practicesn Localprotocol/policy
developmentn Preimplementationdata
collectionn Reviewemploymentprocessesn Supportnetwork
C. IMPLEMENTn Provideorganisational
supportn Promulgaterelevantpolicies
andprotocolsn Maintainappropriatestaffing
consistencyn Delivereducationandtrainingn Establishtools/resources/
documentsn Commencemonitoringand
feedbackmechanisms
PAGE 10 NSW HEAltH Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package
2.3 Stage 3: Key questions to evaluate the Stage 2 skill mix review process
Stage3iscomprisedofanumberofkeyquestions
toaskwhenevaluatingtheStage2skillmixreview
andmanagementprocessforincorporatingAINs
inclinicalareas.
Alistofpossiblequestionsthatcouldbeaskedis
representedinTable1.Thequestionsaredesignedtohelp
reviewandevaluateconsiderationsobservedduringthe
fourstepsinStage2.
The‘Yes’,‘NotApplicable’(N/A)and‘Tobeaddressed’
columnsinTable1canbeusedtoidentifyassessments,
relevantstrategies,outcomes,elementsforfurtheraction
andnewstrategydevelopmentsovertime,astheprocess
isfollowed.
Questionscanbemodified,addedand/orremoved
accordingtotherequirementsoftheHealthService,facility,
orward/unitwheretheskillmixreviewprocessisunderway.
Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package NSW HEAltH PAGE 11
Table1:KeyquestionstoevaluatetheStage2skillmixreviewprocess
A. Assessment Yes N/A To be addressed
1 Arethepatientneedscentraltoallskillmixdecisions?
2 Aretheremechanismsinplaceformatchingtheskillmixwithpatientneeds/dependency?
3 Arepatientnumbers(census)maintainedconsistently?
4 Arethereprotocolsformanagingtimeswhenclinicalareasareoverpatientcensus?
5 Isthepatientclinicalmixconsistent?
6 Aretherelowtonolevelsofoutlierfluctuations?
7 Istherelittleornochangeinpatientcomplexitypatternsacrosstheunit/ward?
8 Arethereprotocolsforskillmix/numberresponsestochangesinpatientcaredemands?
9 Arethereprotocolsforredeploymentofstaffinresponsetostaffdeficitse.g.unplannedleave?
10 Arenursingskillmixdecisionsconsistentwithregulatory/mandated/recommendedrequirements?
11 Arenursingstaffdecisionsmadebyanurseleader?
12 Aretherepolicies/guidelinesforongoingevaluationofnursingstaffskillmixdecisions?
13 Aretherolesandresponsibilitiesofnursingcareprovidersarticulatedinpoliciesandpositiondescriptions?
14 Aretheresufficientresourcestosupporttheimplementationoftheidentifiedskillmix?
15 Isstaffsafetyconsideredinskillmix?
16 Isthephysicalenvironmentconsideredinskillmixdecisions?
17 Doskillmixdecisionssupportthebestuseofallnursingresources?
18 Doskillmixdecisionsconsiderpatientoutcomesrelativetothemodelofnursingcaredelivery?
19 Areskillmixdecisionsmadeandevaluationsconductedinconsultationwithothermembersofthenursingteam?
20 Doestheprocesstomakeskillmixdecisionsmeasurepatientacuity,complexity,variabilityandnumber?
e.g3
21 Doskillmixdecisionsallowflexibilityinresponsetochangesinpatientacuity,complexity,variabilityandnumber?
22 Doesevidencesupportskillmixdecisionsregardingworkload,productivity,availability,numberandemploymentstatus(i.e.fulltime,parttime,casual,agency)?
23 Doskillmixdecisionsrecognisethecompetenciesandexperienceofthestaffprovidingnursingcare?
24 Dostaffhaveopportunityforinputintoskillmixdecisions?
25 Aretheresultsfrommonitoringandevaluationusedtoimproveskillmixdecisions?
Elements to be addressed
Number Issue Action
e.g.20 Nocurrentmechanismformeasuring.Daytodaydecisionsbasedontheprofessionaljudgementapproach,andlongertermdecisionsutiliseGeneralWorkloadCalculationTool.
Supportthedevelopmentofprocessesthatarealsosensitivetopatientdependencychangesandsafecarestandards.AllocatespecificresponsibilitytoaNurseManager.
PAGE 12 NSW HEAltH Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package
B. Plan Yes N/A To be addressed
1 Haveidentifiedelementsofassessmentrequiringactionbeenaddressed?
2 Istherosterreflectiveofappropriatecapacityforsupervisionrequirements?
3 Havestaffattendededucationandtrainingregardingpositionroles,responsibilities,accountabilitiesandsupportmechanisms?
4 Havemonitoringandfeedbackmechanismsbeendeveloped?
5 Hasthemodelofcarebeenevaluatedandappropriatechangesmade?
6 Arestaffresourcesandguidelinesavailable?
7 Havestaffparticipatedinprocessestoreflectonandidentifyproductiveandprogressiveworkpractices?
8 HasaformalanddocumentedprocessbeendevelopedtoensureAINactivitiesareappropriateandmonitored?
Elements to be addressed
Number Issue Action
C. Implement Yes – evidence To be addressed
1 Hastherebeenanorientation/resourcebook/packagedevelopedforAINs?
2 ArethereestablishedmechanismstosupportstaffandAINteambuilding/development?
3 Arestaffawareofmechanismstomanageskillmixconcerns/disputes?
4 HavehealthcarecolleaguesreceivedcommunicationregardingnursingteamchangesandAINrole?
5 HavenursingsupportstaffreceivedcommunicationregardingnursingteamchangesandAINrole?
6 Aretherestrategiestosupportconsistentmessagesregardingnursingteamrolestopatients/consumers/significantothers?
7 Aretools/resources/documentsreadilyavailabletoallstaff?
8 Havemonitoringandfeedbackmechanismsbeencommunicatedtostaffandputinplace?
9 AreallnursingstaffawareofprocessestoreviewAINactivities?
10 AreallnursingstaffawareoftheprocesstomonitorandmaintainappropriateAINactivities?
Elements to be addressed
Number Issue Action
Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package NSW HEAltH PAGE 13
D. Evaluation/Outcome Yes – evidence To be addressed
1 Havetherebeenpositive,negativeornochangesidentifiedandreportedinclinicalindicatorsrelatedtoskillmixdecisions?
e.g¸3
2 Isthereotherevidenceofappropriateskillmixdecisions?
3 Hastherebeenstabilityorimprovementtorosterflexibility?
4 Arestaffexpectationsofteammemberrolesreasonable?
5 Arestaffexpectationsofteammemberresponsibilitiesreasonable?
6 Havetherebeenanytrendsidentifiedinsickleaverelatedtoskillmixdecisions?
7 Dostaffexpresssatisfactionwiththeircommunication?
8 Dostaffrecogniseroleboundariesandminimisepracticeoverlaps?
9 DoRegisteredNursesreportconfidenceintheirsupervisorycapabilities?
10 Havetherebeenanytrendsreportedinattritionratesattributedtoskillmixdecisions?
11 Isthecostofskillmixdecisionssustainable?
12 Arethereovertandcovertsignsindicatingpositiveprogresstowardscollaborativepracticewithintheallocatedskillmix?
13 Aretherepositivesigns/reportsindicatingadherencetopolicyandguideline?
14 Doskillmixdecisionsmakethebestuseofresources?
15 Aretherecostsavingsrelatedtoturnover,reducedabsenteeism,andreducedovertime/agencystaffthatcanbelinkedtoskillmixdecisions?
16 Aretherecostsavingsrelatedtoimprovednursesensitivepatientoutcomesthatcanbelinkedtoskillmixdecisions?
Elements to be addressed
Number Issue Action
e.g1 Increaseinmedicationerrorsintwoareasthathaveexperiencedrecentskillmixchanges.Anecdotalevidencesuggestsperceivedambiguityinrolesandresponsibilitieswithinteam.
nReviewincidentinvestigationsnReviewandensureeducationandtraininghasbeenprovidedandattended
nReviewcommunicationandfeedbackmechanismsandconsultstaff
PAGE 14 NSW HEAltH Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package
EducationandDevelopment
SECTION3
Thequalification,HLT32507CertificateIIIinHealthServices
Assistance(Descriptor:AssistinginNursingWorkinAcute
Care),isthenationallyrecognisedqualificationtotrainas
anAssistantinNursingintheacutecareenvironment.
Thissectionprovidesinformationonthequalificationas
wellasotherinformationrelatedtotheeducationand
developmentofAINs,including:
n TheunitsofcompetencyNSWHealthhave
recommendedstudentscompletetoobtainthe
qualificationandsupporttheiremploymentasacute
careAINsintheNSWpublichealthsystem.Anumber
ofunitsinvolveaclinicalplacementcomponentinthe
acutecareenvironment.n Thecontentelements,essentialskillsandassessments
ofthesixrecommendedelectivesincludedinthe
qualification.
n Informationaboutupskillingexistingworkerstothe
HLT32507CertificateIIIinHealthServicesAssistance
qualificationwiththeskillset,AssistinginNursingWork
inAcuteCare.Theinformationcanbeusedtoidentify
andsupportexistingworkerstoconvertorupgrade
theircurrentqualificationsthroughaRecognitionof
PriorLearning(RPL)process.n Supervisionguidelinesforstafftoassistandsupport
studentsontheirclinicalplacementandtoencourage
developmentofpositiverelationshipsbasedonan
understandingoftheresponsibilitiesofallinvolved.n Theunitsofcompetencythatarecommonacrossthe
HLT32507CertificateIIIHealthServicesAssistance
(Descriptor:AssistinginNursingWorkinAcuteCare)
andhigherlevelqualifications,whichshowshowthe
CertificateIIIqualificationcontributestothepathway
intocareersinnursing.
Implementation recommendations:n Developrelationshipswithtrainingproviders(RegisteredTrainingOrganisations)tomaintainprogrammetopractice
relevancebymonitoringandfeedbackmechanismsn Disseminateinformationacrossnursingservicesn ReviewclinicalplacementprocessesforAINstudentsandmaximisepositivestudentandclinicalplacementareaexperiencen Identifyandsupportexistingworkersinnursingcareorhealthcareroleswhowouldbenefitfromconvertingtheir
qualificationsorgainingaqualificationn DeveloporincorporateAINsinestablishedmentoringsystemstoprogresstheircareerinnursingwheredesired
Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package NSW HEAltH PAGE 15
3.1 General information on the HLT32507 Certificate III in Health Services Assistance
HLT32507CertificateIIIinHealthServicesAssistance
qualificationincludestheoptionofanumberofskillsets
andcoversworkersinarangeofworkroles.Health
ServicesAssistanceinvolvestheworkerindirectclient
contactundersupervision.Thisqualificationhasbeen
structuredtoprovideeither:
n agenericqualificationthatcoversarangeofwork
functions,orn askill setwhichistargetedtospecificworkroles,
oneofwhichistheAssistinginNursingWorkinAcute
CarewhichtranslatestotheroleofAINintheacute
caresetting.
OutlinedinTable2belowistherecommendedskill
pathwayproposedbyNSWHealthfortheelectiveskillset
inAssistinginNursingWorkinAcuteCare.Itconsistsof
sixcompulsorycoreunitsandafurthernineelectives,sixof
whicharerequiredbytheHealthTrainingPackagetoobtain
thetargetedAssistinginNursingWorkinAcuteCare
qualification.
Thequalificationisdeliveredover360nominalhours,
withtheminimumrecommendedhoursfortheorybeing
310hoursandanadditionalminimum50hoursofclinical
placement.NSWHealthhasrequestedthatpreferred
trainingprovidersensureatleast50oftheclinical
placementhoursareconductedinanacutecaresetting.
Table2:NSWHealthPreferredCoreUnitsandElectivesforHLT32507CertificateIIIinHealthServicesAssistance(Descriptor:
AssistinginNursingWorkinAcuteCare)
CORE UNITS – 6 Units
Competency Code Competency Title
BSBFLM303B C ContributetoEffectiveWorkplaceRelationships
BSBMED201A C UseBasicMedicalTerminology
HLTAP301A C RecogniseHealthyBodySystemsinaHealthCareContext
HLTHIR301A C CommunicateandWorkEffectivelyinHealth
HLTIN301A C ComplyWithInfectionControlPoliciesandProceduresinHealthWork
HLTOHS200A C ParticipateinOHSProcesses
ELECTIVES – 9 Units
Competency Code Competency Title
HLTFA301B E ApplyFirstAid.
HLTCSD305B RE Assistwithclientmovement.
HLTCSD208B RE Transportclients.
HLTCSD306B RE Respondeffectivelytodifficultorchallengingbehaviour.
HLTCSD201B RE Maintainhighstandardofclientservice.
HLTAIN301A RE AssistNursingTeaminanacutecareenvironment.
HLTAIN302A RE Providesupportinanacutecareenvironment
HLTHIR403B E Workeffectivelywithculturallydiverseclientsandco-workers.
HLTHIR404B E WorkEffectivelywithAboriginalandTorresStraitIslanders.Or
Legend
C Compulsoryforissueofthisqualification
RE RequiredElectiveforAssistinginnursingworkinacutecare–aslistedintheTrainingPackagerules
E PreferredelectiveproposedbyNSWHealth.Whiletherearearangeofelectivestoselectfromtoallowforflexibilityrelatedtospecificworkplaceneeds,NSWHealthhasspecificallyrequestedpreferredtrainingproviderstoincludetheseelectivesinthequalification.
PAGE 16 NSW HEAltH Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package
3.2 Recommended competency units for the skill set “Assisting in Nursing Work in Acute Care”
Thissectionprovidesanoverviewofthecontentcovered
withineachofthesixrequiredelectives,whichmustbe
studiedtobeawardedthequalification,HLT32507
CertificateIIIinHealthServicesAssistancewiththeskill
set,“AssistinginNursingWorkinAcuteCare”.
Anoverviewoftheessentialskillsresultingfromthe
studyofeachunitofcompetencyisalsoincludedaswell
asinformationonhowthestudentisassessed.Further
informationonassessmentisprovidedinSection3.3.
TheinformationinTable3hasbeensummarisedfrom
theHealthTrainingPackage(HLT07)Version1Formore
detailedinformationpleasegotowww.cshisc.com.au
andlookundertrainingpackages–health.
Table3:SummaryofcontentcoveredintherequiredelectivesforHLT32507CertificateIIIinHealthServicesAssistance
(Descriptor:AssistinginNursingWorkinAcuteCare)
Competency Title Content Element Essential skills † Assessment
HLTCSD305BAssistwithclientmovement
Preparetoassistwithclientmovement
Operateliftingandtransferringequipment
Observationofperformanceinanactualorsimulatedworkplacesetting.
Assistwithclientmovement Assistaprofessionalwithclientmovement
Completeassistancewithclientmovement
Dealwithconflict
Assistclientswithmeals
HLTCSD208BTransportclients
Prepareclientfortransport Applysafeworkingpractices,includingmanualhandling
Thestudentmustprovideevidenceofspecifiedessentialknowledgeandskills.Assessmentoccursintheworkplaceorinsimulatedworkplaceconditions.
Interpretandfollowtheinstructionsandguidanceofhealthprofessionals
Transportclient Solveproblemsincludingtheabilitytouseavailableresourcesandprioritiseworkload
Workwithothersanddisplayempathywithclientsandrelatives
Deliverclient Usereadingandwritingskills
Useoralcommunicationskills
Usenumeracyskills
† Essential skills that are common across competency units are not repeated in list
Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package NSW HEAltH PAGE 17
Competency Title Content Element Essential skills Assessment
HLTCSD306BRespondeffectivelytodifficultandchallengingbehaviour
Planresponse Identifywhenassistanceisrequired
Mostappropriatelyassessedintheworkplace(simulatingdifficultorchallengingbehaviour)orinasimulatedworkplaceandunderthenormalrangeofworkconditions.
Applyresponse Maintainpersonalsafetyandthesafetyofothers
Foreseeandrespondquicklyandeffectivelytocontingencies
Maintaindutyofcare
Reportandreviewincidents Effectivelyusetechniquesformonitoringownserviceareaincludingclientsatisfaction
Speakinafirm,diplomaticandculturallyappropriatemanner
Remaincalmandpositiveinadversity
Thinkandrespondquicklyandstrategically
Remainalerttopotentialincidentsofdifficultorchallengingbehaviour
Monitorand/ormaintainsecurityequipment
HLTCSD201BMaintainahighstandardofclientservice
Communicateappropriatelywithclients
Workwithinroleandresponsibility
Mostappropriatelyassessedintheworkplaceorinasimulatedworkplaceandunderthenormalrangeofworkconditions.Establishandmaintainan
appropriaterelationshipwithclients
Complywithrelevantpolicies,protocols,guidelinesandprocedures
Actinarespectfulmanneratalltimes
Establishandmaintainrelationships
Interpretandfollowinstructions
Evaluateownworkandmaintainahighstandardofclientservice
Handlecomplaintsandconflictorreferasappropriate
Workeffectivelyaspartoftheteam
Useliteracyskillsinreading,writingandoralcommunication
Useproblemsolvingskillsto:
nEffectivelyutiliseavailableresources
nPrioritiseworkload
Demonstraterespectforclients
Communicateinanon-discriminatory,supportiveandinclusivemanner
Listenandrespondtocommunicationinitiativesofclients
PAGE 18 NSW HEAltH Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package
Competency Title Content Element Essential skills Assessment
HLTAIN301AAssistnursingteaminacutecareenvironment
Assistwiththedeliveryofnursingcaretoclientsinanacutecareenvironment
Communicateeffectivelywithclientswhencollectinginformationanddataandassistingwithpersonalcareneeds
Observationofworkplaceperformanceisessentialforassessmentofthisunit.
Supporttheclienttomeetpersonalcareneedsinanacutecareenvironment
Useequipmentandfollowproceduresforcollectingclientclinicaldata
Workinateamenvironment Operateequipmentandaidsutilisedinthedeliveryofpersonalcare
Workeffectivelyundersupervision
Workunderdirectionandsupervision
Workeffectivelywithclients,colleaguesandsupervisors
Dealwithconflict
Workinamannerthatrespectsthedignityofclients
Displayempathytoclientsandrelatives
HLTAIN302AProvidesupportinanacutecareenvironment
Maintainaccuraterecords Maintainclienthealthrecordsinasecureandconfidentialmanner
Observationofworkplaceperformanceisessentialforassessmentofthisunit.
Complywithadministrationprotocolsofanacutecareenvironment
Completeformsanddocumentsinaclear,conciseandfactualmanner
Collectandprocessworkplaceinformation
Collateanddispatchinformationaccordingtospecifictimeframesandorganisationalrequirements
Organiseandsupplyequipmentrequiredinanacutecareenvironment
Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package NSW HEAltH PAGE 19
3.3 Assessments included in HLT32507 Certificate III in Health Services Assistance (Descriptor: Assisting in Nursing Work in Acute Care)
Assessmentsundertakenaspartofthequalificationmust
meetthecriteriasetoutforRegisteredTraining
Organisations(RTOs)bytheCommunityServicesandHealth
IndustrySkillsCouncil(CS&HISC).
Eachofthecompetencyunitsareassessedinformal
classroomsettings,workplacesettingsand/orbysimulated
laboratory/clinicalassessments.
Theminimumspecificclinicalskillsassessmentsthat
astudentmustsuccessfullycompletetobeawardedthe
HLT32507CertificateIIIinHealthServicesAssistance
(Descriptor:AssistinginNursingWorkinAcuteCare)are:
n TPRmeasurementn Bloodpressuremeasurementn Bloodglucose/sugarlevelmeasurementn Simplewoundcleansinganddressingn Collectingandtestingurinespecimen(Urinalysis)n Handwashingn Cardiopulmonaryresuscitationn Manualhandlingn Patientphysicalmovement
3.4 Up skilling existing workers to the HLT32507 Certificate III in Health Services Assistance (Descriptor: Assisting in Nursing Work in Acute Care)
CurrentlythereareAINswithoneormoreofavarietyof
qualifications/experiencelevelsworkingintheNSWpublic
healthsystemwhohavenotattainedtheHLT32507
CertificateIIIinHealthServicesAssistancequalification
withtheskillsetAssistinginNursingWorkinAcuteCare.
Theseinclude:
n Undergraduatestudentsofnursingstudies;n ThosewhoholdtheCertificateIIIinAgedCare;n ThosewhoholdtheCertificateIIIinHealthServices
Assistance(GenericQualification);andn Thosewhohaveon-the-jobexperiencewithno
qualification.
Giventherangeofwaysinwhichpeoplecanbeemployed
asAssistantsinNursing,NSWHealthisdeveloping
resourcessuchasaPolicyDirectivetoclarifytheacute
careAINrole.Providingadditionalinformationthrough
resourcessuchasthesewillfacilitateHealthServicesto
employuniformpracticesindevelopingtheroleofall
AINs.Thefollowingprovidesinformationontheprocess
forupskillingexistingworkersforworkinacutecare
andrecognisingtheskillsandexperienceofexistingstaff
whomaynotholdtheacutecarequalification.
AttainmentoftheunitsofcompetencyintheHLT32507
CertificateIIIinHealthServicesAssistance(Descriptor:
AssistinginNursingWorkinAcuteCare)qualification
canoccurinanumberofwaysincludingthrough:
n Formalorinformaleducationandtrainingn Experiencesintheworkplacen Generallifeexperiences,and/orn Anycombinationoftheabove
Inawardingthequalificationtheprimaryconsideration
iswhetherthecandidateiscompetent,nothowthe
competencyisacquired.
SkillsRecognition(includingRecognitionofPriorLearning
–RPL)istheprocessthroughwhichaperson’sskills,
knowledgeandexperienceareassessedbyaqualifiedand
experiencedtrainer/assessorinordertoascertaintheperson’s
levelofcompetencyagainstarangeofvocationalskills.
Recognitionprocessescanonlybedeliveredby
appropriatelyqualifiedandexperiencedtrainers/assessors
onbehalfofaregisteredtrainingorganisation(RTO).
Recognitionprocessesaregenerallyprovidedaspartof
theenrolmentcostofacourse.However,iffullrecognition
servicesarerequestedbeforeenrolment,anRTOmay
chargeacommercialfeeforthisservice.
Typically,aperson’spreviousworkexperienceandcurrent
qualificationsareassessedandcomparedwiththeunits
ofcompetencycontainedinthequalificationinwhichthey
hopetoenrol.Dependingontheoutcome,someunits
ofcompetencyinthetargetqualificationmaybegranted
viarecognition(alsoknownasAdvancedStanding).Upto
anentirequalificationmaybegrantedviarecognition.
Thepersonseekingrecognitionisrequiredtoprovide
evidenceoftheirskillsknowledgeandexperience.The
PAGE 20 NSW HEAltH Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package
typesofevidencerequiredwillvaryfromassessorto
assessorandRTOtoRTO.Evidencemayrangefroman
interview,paper-basedqualificationsorreferences,and
examplesofwork.RTOsmayalsouseothermeans,e.g.
‘challengetests’(quizzesorpracticalactivitiesaimedat
gaugingcompetencies)toassesscompetency.
Whereapersonisdeemedbythequalifiedassessortobe
almostcompetentagainstunitsinaqualification,a‘gap
training’programisdesignedtotraininonlythoseskills
whicharecurrentlylacking.
Asaresultofrecognitionprocesses,apersonmaybeable
tocompleteaqualificationmorequicklyandcheaplythan
wouldbethecaseiftheentirequalificationhadtobe
completed.Thisalsoworksfortheemployerwhoisfunding
trainingasitmeansthatstaffwillgainqualificationsovera
shortertimeframe,potentiallyatalowercostandwithless
timeawayfromduties.
3.5 Clinical placement guidelines for clinical areas
ThissectionprovidesinformationonsupervisingAIN
studentswhoareundertakingtheHLT32507CertificateIII
inHealthServicesAssistancequalificationwiththeskillset,
AssistinginNursingWorkinAcuteCare,whilsttheyareon
theirclinicalplacementwiththeHealthService.The
informationisprovidedtoassiststafftosupportthe
studentsandencouragedevelopmentofpositive
relationshipsbasedonanunderstandingofthe
responsibilitiesofallinvolved.
Objectives:n Patientsafetyn Studentorientationn Studentlearning
Facilitation model:n RegisteredTrainingOrganisationswillprovidestudent
facilitatorswhilestudentsareonclinicalplacement.
Supervision:n Frontlinenursingunitmanagers(NUMs)areresponsible
forensuringthatthereisanappropriatelevelof
supervisionforstudentsintheclinicalareaorotherwise
seekingalternativearrangements.n Thesupervisionofastudentbyaregisteredorenrolled
nursemaybedirectorindirectaccordingtothepatient
careandstudentcompetencycontext.n Allsupervisingnursesareresponsibleforcommunicating
anyconcernswithstudentperformancetothefrontline
manager(NUM).
Direct supervision can be:n Continuous–requiredwhenthestudentisnewtothe
areaofpracticeandisoperatingatanovicelevel.n Frequent–requiredwhenthestudentisjudgedbythe
supervisingregisterednursestobenotyetproficientor
isexperiencingacrisisofconfidence.n Occasional – requiredwhenthestudenthasbeen
judgedbysupervisingregisterednursestobesafeand
proficientyetneedstobuildupconfidenceinthe
provisionofcare
(DepartmentofNursingandMidwifery,
SterlingUniversity,UK)2.
Accountabilities:n Aregisterednurseisaccountablefortheallocation
ofpatientcareactivitiestostudents,ensuringthe
studentcansafelyandcompetentlyperformthe
allocatedactivities.n Aregisterednurseatthepointofcareisrequired
todecide,accordingtothespecificpracticesetting,
theindividualstudent’scurrentcompetenciesand
thepatientneedsandstatusastothecareactivities
allocated.n Aregisterednurseorenrollednursesupervisinga
studentisrequiredtohavethelevelofcompetence
tobeabletoguideandassistthestudentinachieving
theclinicalplacementlearningobjectives.
Assessment:n Assessorsofstudentcompetenciesareprovidedby
theRegisteredTrainingOrganisation.Theassessments
willoccurduringclinicalplacementandlaboratory
simulation.
2 Department of Nursing and Midwifery, University of Sterling. Information for mentors. accessed from http//:www.nm.stir.ac.uk/mentors on 10.11.09
Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package NSW HEAltH PAGE 21
Performance Management:n TheRegisteredTrainingOrganisationisresponsibleto
addressandmanageperformanceissuesthestudent
mayhaveduringclinicalplacement.n Studentsmusthavetheappropriatetheoryand/or
simulatedpracticefromtheeducationprogrammeprior
toperformingdirectpatientcareactivities.
3.6 Career pathways in nursing
TheHLT32507CertificateIIIinHealthServicesAssistance
(Descriptor:AssistinginNursingWorkinAcuteCare)
qualificationwillsupportstudentstoworkasanassistant
innursinginacutecareenvironments.Completingthis
qualificationandgoingontoworkasanAINinacutecare
providesthepersonwiththeopportunitytogainvaluable
clinicalexperienceandalsohelpstofinanciallysupport
furtherstudiesinnursingateithertheCertificateIVor
Diplomalevelsinenrollednursingorabachelorofnursing
level.
Thisqualificationalsosupportsthedevelopmentofstudent
confidencebyprovidinganentryleveltowardsanursing
careerpathwaythatisflexibleandlessarduous,helpingto
meetvariedlifestyleresponsibilities.
CommoncompetencyunitsarefoundacrosstheCertificate
III,CertificateIVandDiplomaprogrammes,providinga
pathwayfromHLT32507CertificateIIIinHealthServices
Assistancetobecominganenrolled/division2nurse,by
completingHLT43407CertificateIVinNursing,HLT51607
DiplomaofNursingorHLT61107AdvancedDiplomaof
Nursing.
Onsuccessfulcompletionofaqualification,astudentis
abletoapplyforrecognitionandcredittransferifapplicable
tootherqualifications.
Figure3showsthecompetencyunitsoftrainingincluding
thosethatarecommonacrosstheHLT32507CertificateIII
HealthServicesAssistance(Descriptor:AssistinginNursing
WorkinAcuteCare)andhigherlevelqualifications.
PAGE 22 NSW HEAltH Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package
Figure3:CommonunitsofcompetencyacrosstheHLT32507CertificateIIIinHealthServicesAssistance(Descriptor:Assisting
inNursingWorkinAcuteCare)andhighernursingqualifications
AIN EN EN EN RN
CertificateIII CertificateIVinNursing
DiplomaofNursing
AdvancedDiploma
BachelorofNursing
HLT32507 HLT43407 HLT51607 HLT61107
(AssistinginnursingworkinAcuteCare)
(Enrolled/Division2Nursing)
(Enrolled/Division2Nursing)
(Enrolled/Division2Nursing)
15Compulsory(9Electives)
18Compulsory(4Electives)
21Compulsory(5Electives)
7Compulsory(5Electives)
BSBFLM303BnNoformallinkstoTertiaryQualifications
nIndividualinstitutionsmaydecidetoofferlimitedcreditpointstowardsaBachelorDegree
BSBMED201A
HLTAP301A
HLTHIR301A
HLTOHS200A
HLTCSD305B
HLTCSD208B
HLTCSD306B HLTIN301A
HLTCSD201B HLTFA301B
HLTAIN301A HLTHIR403B
HLTAIN302A HLTHIR404B HLTIN301A
HLTIN301A HLTOHS300A HLTFA301B‡HLTFA301B HLTAP401A HLTHIR403B‡HLTHIR403B HLTEN401A HLTHIR404B‡HLTHIR404B HLTAP501A HLTOHS300A
HLTEN507A HLTEN401A
HLTAP501A
HLTEN507A
Key
representcompetencyunitsthatmakeupthemandatorynumber
indicaterecommendedelectivecompetencyunitsforanAINqualification
identifycommoncompetencyunitsbetweenidentifiedCertificateIII,CertificateIVandDiplomaqualifications
identifycommoncompetencyunitsbetweenCertificateIVandDiplomaqualifications
‡ NSW Health recommended Electives in Certificate III
Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package NSW HEAltH PAGE 23
Thissectionprovidesthetwoprimarydocumentsoutlining
theroles,responsibilitiesandscopeofpracticeoftheAIN
workinginacutecareinNSWHealth.Thedocumentsaim
todevelopworkplaceunderstandingandconfidenceinthe
scopeofpracticeoftheAINworkinginacutecare.The
documentsinclude:
n AcuteCareAINpositiondescriptionn AcuteCareAINcareactivitieslist
BoththeAcuteCareAINpositiondescriptionandtheAcute
CareAINcareactivitieslisthavebeendevelopedthrough
wideconsultationwithkeystakeholdersincludingHealth
Servicenursingandworkforcestaff,DepartmentofHealth
staffandtheNSWNurses’Association.
4.1 Position Description – Assistant in Nursing – Acute Care
ThepositiondescriptiondescribestheacutecareAIN
positiondetails,qualifications,keyfunctions,scopeof
practiceandresponsibilities.Thestandardstatementsof
employeeobligationsareincludedasaminimumfor
individualHealthServicestoexpandonaccordingtotheir
establishedformats.
AnAINwillbeallocatednursingactivitiesthatarewithin
theparametersdocumentedintheNSWHealthposition
description.Anyadditionalcontextspecificnursing
activitiesallocatedmustfollowaformallydocumented
processthatreflectstheANMCDecisionMaking
Frameworkandhealthservicesguidelines
ScopeofpracticeofacutecareAINs
SECTION4
Implementation recommendations:n UtilisetheAINpositiondescriptiontoinformstaffoftherolesandresponsibilitiesoftheAINacutecareposition
anditscontributiontotheAINscopeofpracticen FormulatelocalprotocolandguidelinestosupportpracticesappropriatetoAINscopeofpracticen DeveloporutilisecurrentprocessesthatformallymonitorandauthoriseappropriateAINcareactivitiesn MaintainstandardisedAINrolesandresponsibilitieswithinHealthServices
PAGE 24 NSW HEAltH Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package
PositionDescription–AssistantinNursingAcuteCare,May2010
Position Requirements
1. Qualifications
HLT32507CertificateIIIinHealthServicesAssistance
(Descriptor:AssistinginNursingWorkinAcuteCare)
orequivalent
2. Key functions
Provisionofsupporttothenursingteaminthedelivery
ofnursingcareinanacutecareenvironmentasdirected
bytheRegisteredNurse
Providedirectcareactivitiestopatientsinaccordance
withthenursingcareplanandunderthesupervision
ofaRegisteredNurse
AssistRegisteredandEnrolledNurseswithpatient
careinterventionsasdirected
Contributetocollectingaccuratehealthcareinformation
andmaintainingaccuratehealthcaredocumentationas
required
Communicateeffectivelywithpatientsandotherhealth
careteammembersinaccordancewithappropriate
protocol
3. Scope of Practice
Assistantsinnursingworkwithinaplanofcareunder
thesupervisionanddirectionoftheRegisteredNurseand
withinthelimitsoftheAssistantinNursingposition
description
AssistantsinNursingretainresponsibilityfortheirown
actionsandremainaccountabletotheRegisteredNurse
forallallocatedfunctions
AssistantsinNursingpracticeinaccordancewithNSW
Healthguidelines,thepositiondescriptionandlocalpolicy
andprotocol
Position Description
Position Details
PositionNo:
PositionTitle: AssistantinNursing(AIN)–AcuteCare
Responsibleto: DirectorofNursingServices
Reportsto: NursingUnitManager
Division: Nursing
Award: PublicHealthSystemNursesandMidwives(State)Award
Location: NSWHealth–HealthServices
HoursofWork: Sevendayshiftworker
PerformanceManagement: Appraisalafterinitial3monthsthenannually
Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package NSW HEAltH PAGE 25
4. Responsibilities
Assistinthedeliveryofthefollowingdirectcareactivities
asallocatedbyaRegisteredNurse;
n showering,bathing,spongingn repositioning,pressureareaandskincaren hairwashing,shavingn mouthanddenturecaren eyeandearcaren assistancewithtoiletingn provision,removalandcleaningofbedpansandurinalsn generalwardambulationandsupportmobilisation
asperplanofcaren reinforceinstructionsonuseofaidsformobility
orcareasdetailedinplanofcare,whereappropriaten assistwithpositioning,posturemaintenanceand
comfortn observeandreportpatientcompletionofand
performanceoftasksinlinewithcareplann setupandassistancewithpatientmealsandfluids
forassessedlowriskpatientsn applicationofantithromboemboleticstockingsn simplewounddressingsn lastoffices/careofthedeceased
Assistinthecollectionofclinicaldataasallocated
byaRegisteredNurse;
n patientweighingandspecificmeasurementsn specificpatientobservationsn nursingadmission(notnursinghistoryorassessment)
Observepatientsphysicalandpsychologicalstatusand
responsesduringthecourseofinteractionswithinscope
ofknowledge,andreportchangestotheRegisteredNurse
Reportallpatientobservationstotheappropriate
RegisteredNurse
Documentallpatientresponsestodirectcare/assistance
given,includeinprogressnotesandclinicalrecordsin
accordancewiththeplanofcareandorganisational
protocols
Maintaintheappearanceandfunctionofequipmentsuch
asliftingandmobilisingaids,pressurereducingmattresses
andotherclinicaldevicesusedinnursinginterventions
Changeandmakeupoccupiedandunoccupiedbeds
Promoteandmaintainaclean,comfortableandsafe
environmentforpatients,staffandvisitors
5. Standard Statement of Obligations
(TobecompletedbyHealthService/nursingunit)
5.1Professionalpractice
5.2Educationandprofessionaldevelopment
5.3Infectioncontrol
5.4CodeofConduct
5.5OHSandR
5.6EEO
PAGE 26 NSW HEAltH Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package
4.2 Acute Care Assistant in Nursing – Care Activities List
TheAcuteCareAINCareActivitiesListprovidesboundaries
ontherangeofactivitiesthatanewlyqualifiedAINcanbe
reasonablyexpectedtoundertake.
AsindividualAINsgainexperienceandconfidenceintheir
role,nursingcolleagues’confidenceinthemwillalsogrow.
ToavoidunderutilisationorinappropriateextensionofAIN
activitiesduringintroductoryperiodsandwhileconfidence
increases,HealthServiceswillberequiredtodevelop,ifnot
alreadyavailable,aprocessformonitoringthepracticeof
anAINastheydevelopskillsandknowledgewithinthe
describedscopeofpractice.
WhereAINSareemployedaspartofthenursingteam,
responsibilitiesforpatientcare,supervisionandpractice
shouldbeviewedasfollows:
n Theprovisionofsafepatientcareisashared
responsibilityofallthoseinvolvedinthedelivery
ofnursingcare.n AINsaretoworkatalltimesunderthesupervision
ofaregisterednurse.n Registerednursesallocatepatientcareactivitieswith
predictablepatientoutcomestoAINs.n AINsretainresponsibilityfortheirownpractice,
reportingpatientcareoutcomestoregisterednurses
andworkingwithintheirscopeofpracticeandlevel
ofexperience.n AINsareresponsibleforusingtheirinitiativerelative
totheirscopeofpracticeandroleasasupportive
teammember.
TheAcuteCareAINCareActivitiesListispresented
inTable4.
Notes on Table:
1.Adefiningfactorofappropriateallocationtothe
activitiesidentifiedbelowisthecontextinwhichthe
decisionisbeingmade–pleaserefertotheAustralian
NursingandMidwiferyCouncilDecisionMaking
Framework3forpracticeguidelines.
2.Activitiesreferstothoseactivitiesthatarewithin
thescopeofpracticeofanAINwhohascompleted
thequalificationHLT32507CertificateIIIHealthServices
Assistance(Descriptor:AssistinginNursingWorkin
AcuteCare)i.e.expectedentrylevelskills.
3.Explanatorycommentsaremadewhereapplicable
andincludeexamplesofwhatcouldbeexpectedto
bereportedtoregisterednurses.
3 Australian Nursing and Midwifery Council. (2007)
Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package NSW HEAltH PAGE 27
Table4:AcuteCareAINCareActivitiesList
Activities Comments and general examples of what to observe and report
Direct Patient Care
Activities of Daily Living
Showering Mobility,skinintegrity
Sponging Skinintegrity,comfort,mentalorientation
Washes–FaceandhandsPerinealtoiletsPostopTepid
Skinintegrity,comfort,mentalorientation
GroomingShaveHygienePresentation
Skinintegrity,comfort,mentalorientation
SimpleeyecareOralhygiene
Discharge,comfort,inflammationofbrokenmucusmembrane
DietaryassistanceSetupmealsOralintake
LowriskfeedingasperriskassessmentIntakecapacity/appetiteAbilitytomanagediet
MobilisationAssistambulationPosturemaintenanceandcomfortReinforceinstructionsonuseofaids
AbilitytomaintainpostureComfortAbilitytomanageaidsRespiratoryrateonexertion
SkincarePressurerelieve/PressureAreaCareMoisturiseMaintainingadryenvironment
ConditionofskinIdentificationofpresenceofdressings
Patient Communication
Consultpatientregardingactivitiesofdailyliving(ADLs) Patientconcerns/issues
Reflectcommitmenttopatientrightsandresponsibilities Patientconcerns/issues
Reinforcepatientorientationtowardenvironment Patientdisorientation
Clinical data collection
TemperaturePulseRespirations Individualchanges
Bloodpressure(manualandelectronic) Individualchanges
Weight Individualchanges
Girth/thighmeasurements Individualchanges
FluidBalanceChart(basic) Individualchanges
Foodchart Patientconcerns/issuesIndividualchanges
Stool/emesischart Patientconcerns/issuesIndividualchanges
Urinalysis Individualchanges
BloodGlucoselevels Patientconcerns/issuesIndividualchanges
Neurologicalobservation BasicconsciousnessIndividualchanges
Wound care
Simpledressing DescriptionofwoundPatientexperience
PAGE 28 NSW HEAltH Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package
Activities Comments and general examples of what to observe and report
Specimen collection
Sputumviasterilecontainer Specimenobtained
Urineviacontainer/pan Specimenobtained
Stool Specimenobtained
Venous access observation
PeripheralCannulaobservationandreporting Stateofsurroundingtissue,dislodgement,entrysitedischarge
CentralVenousCatheter(CVAD)observationandreporting Stateofsurroundingtissue,dislodgement,entrysitedischarge
VascularAccessDevice(VAD)observationandreporting Stateofsurroundingtissue,dislodgement,entrysitedischarge
PeripherallyInsertedCentralCatheter(PICC)observationandreporting Stateofsurroundingtissue,dislodgement,entrysitedischarge
Vas-cathobservationandreporting Stateofsurroundingtissue,dislodgement,entrysitedischarge
Care of drains
ObservationofdrainRecorddrainageSimpledressingofdrain
Stateofsurroundingtissue,movement/dislodgement,output,entrysitedischargeReporttheneedforachangeofdressing
Patient Escort
AsassessedbySeniorRN Delays,individualpatientchanges,transportequipmentissues
Cardiac/vascular
BasicLifeSupport Asaccredited
Assistinrespondingtoemergencies,includingchestpain,asdirectedbytheRegisteredNurse
Fittingandapplicationofthromboemboleticstockings Changesinskincondition
Respiratory
AssistpatientpositioningforoptimalO2exchange Patientcomplaintsofshortnessofbreath/puffing/snoring,inabilitytopositionpatientappropriately
Repositioningofnon-invasiveestablishedO2supportdevices Contaminated/soileddevice,inflamed/brokenskinfromdevice,O2flowrateoff,patientunabletomanage/tolerate,patientremovingO2supportdevice
Endocrine/digestive
Recordfaecalelimination/bowelregularity Individualpatientchangesinfrequency,comfort,characterofbowelmotions
Observationofestablishednasogastrictube Changesinpositionoftubing,kinking,displacement,discharge.Inflammationoftissuearoundanchor/insertionsite
Observationofestablishedenteralfeeds Changesinpositionoftubing,kinking,displacement,discharge.Inflammationoftissuearoundanchor/insertionsite.Completionoffeeds,volumetricpumpalarm
ObservationofPEGTube Changesinpositionoftubing,kinking,displacement
SimplePEGsitedressing Position,stateofsurroundingtissue,entrysitedischarge
Positionandpreparepatientformeals Patientrefusaltoeat/dislikeofmeal,inabilitytopositionappropriately,changeinlevelofconsciousness,wrongmeal/diet
Feedingofpatientsaccordingtoriskassessmentandcareplan Difficultyswallowing,coughingduringmeal,loosedentures
Renal/urinary
Indwellingurinarycathetercare,observationandoutputrecording Changesinpositionoftubing,kinking,displacement,discharge.Inflammationoftissuearoundinsertionsite.DislodgementofanchorIndividualpatientchangesinamountand/orcharacterofurine
Supra-pubiccathetercare,observationandoutputrecording Changesinpositionoftubing,kinking,displacement,discharge.Inflammationoftissuearoundinsertionsite.DislodgementofanchorIndividualpatientchangesinamountand/orcharacterofurine
Nephrostomycathetercare,observationandoutputrecording Changesinpositionoftubing,kinking,displacement,discharge.Inflammationoftissuearoundinsertionsite.DislodgementofanchorIndividualpatientchangesinamountand/orcharacterofurine
SimpledressingofSupra-pubicandNephrostomycatheters Stateofsurroundingtissue,entrysitedischarge,movementofcatheter
Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package NSW HEAltH PAGE 29
Activities Comments and general examples of what to observe and report
Rehabilitation Nursing
Careandobservationoflegstumpsasperdirection/careplan Discomfort,patientinabilitytomaintainprescribedpositioning
Reinforceappropriateuseofprosthesisasperdirection/careplan Reportpatientdifficulties/management
Miscellaneous
Careofthedeceasedperson ObservefacilityandCoronialrequirementsReportbreachesofabove
Activities Comments and general examples of what to report
Indirect Patient Care
Documentation
Contributetocareplandevelopment Contributeownobservations
Documentationofindividualactionsincontemporaneousnotes(reports,includingadverseincident)
Ownactionsandobservations
Observationcharts Resultsofownobservations
Information systems
Intranetresourceretrieval:ClinicalPractice/PolicyManualContinuingEducationopportunitiesHumanResourceformsStaffdirectoryCIAPBulletin/communicationboards
Reportaccessdifficulties
IIMSreporting
Team communication
Workloadconcerns ReporttoappropriateRN
Patientissues ReporttoappropriateRN
Contributetoclinicaldecisions Communicateobservationsandpatientconcerns
Practicelimitations InformRNimmediatelyofownpracticelimitationsregardingdelegated/allocatedactivities
Patientcareomissions ReportpatientcareomissionsimmediatelytoRNwhenidentified
Equipmentissues Reportbroken/dysfunctionalequipmentthroughestablishedprocesses
Interpersonalissues Addressissues/conflictsassertively,obtainsupportfromcolleagues/RNin-charge
Positivecontributiontowardculture IdentifyandcontributestrategiestoapositiveworkenvironmentMaintainestablished/desiredstandards
OHS
Useofslidesheetsandpatientmanualhandlingequipment Issueswithequipment/environmentAnyinjurytoself
Useandmaintenanceofpatientlifters Maintenanceandoperationissues
Useofchemicalspillkit AnyspillsanduseofspillkitUnavailabilityofspillkit
Responsetobodycontamination(staff) AnycontaminationLackofPersonalProtectiveEquipment(PPE)
PAGE 30 NSW HEAltH Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package
Supervisionanddelegationresponsibilitiestolicensed
andunlicensedhealthcareprovidersarebeingincreasingly
recognisedasacriticalelementofaregisterednurse’s
practiceinpublichealthcaresettings.Allmembersof
thepatientcareteamshouldbeconfidentintheir
responsibilitiesandaccountabilitieswithregardto
supervision,assignment/allocationanddelegationoftasks.
TheAustralianNursingandMidwiferyCouncilhas
developedtwodocumentsthatcanbeusedtosupport
confidenceinresponsibilitiesandaccountabilitiesofnursing
teammembers.ItisrecommendedthateachNursingUnit
accessthesedocumentsanddiscussthemwithalllevelsof
staffinthenursingteam.
National Framework for Decision Making by Nurses and Midwives
TheNationalFrameworkforDecisionMakingbyNurses
andMidwives4(NationalDMF)isdesignedtoassistdecision
makingaboutnursingandmidwiferypractice.TheDMF
providesanationallyacceptedstandardforinformed
decisionmakingregardingprovisionofnursingand
midwiferycare.
‘TheANMCholdstheviewthatdecision-makingtoolsfor
nursesandmidwiveswillassistindevelopingahealth
workforcethatiseducatedandpreparedtomeethealth
consumerneedsintothefuture.Nursesandmidwivesusing
thesetoolswillcontributetoriskmanagementandto
ensuringaflexibleworkforce’(ANMC,2007).
WhilsttheDMFdoesnotdefinespecificpracticeactivities
orprocedures,useofthetoolswillassistnursesnavigate
thecomplexpracticeenvironmentswhenincorporatingthe
roleoftheAIN.
4 Australian Nursing and Midwifery Council. (2007). National framework for the development of decision-making tools for nursing and midwifery practice.
ANMC Guidelines for Delegation and Supervision for Nurses and Midwives
TheANMCGuidelinesforDelegationandSupervision
forNursesandMidwives5areapartoftheprofessional
practiceframeworkdesignedtosupportnursesand
midwivesinrelationtotheirpracticeobligations.The
nationalstandardsaredevelopedinrelationtothecurrent
regulatoryandlegislativeenvironmentsthatgovern
Australianhealthcare.
Theseguidelinesaredesignedtoassistnursesandmidwives
tomakesounddelegationandsupervisiondecisionsand
understandtheiraccountabilityandresponsibilitiesin
relationtodelegationandsupervision.Accordingly,the
ANMCguidelineswillsupportthedevelopmentofnurse’s
decisionmakingskillsandconfidenceinregardstotheir
ownandAINnursingcarepractices.
FortheNational Framework for Decision Making by Nurses
and MidwivesandtheANMC Guidelines for Delegation and
Supervision for Nurses and Midwives,pleaserefertothe
AustralianNursingandMidwiferyCouncilwebsiteatwww.
anmc.org.au
5 Australian Nursing and Midwifery Council. (2007). Guidelines for Delegation and Supervision for Nurses and Midwives
Delegationandsupervision
SECTION5
Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package NSW HEAltH PAGE 31
Recommended actions:n Establishresourcesinclinicalareastoprovideinformationregardingscopesofpractice,supervisionanddelegation
e.g.meetings,education,inservice,resourcefoldersn EstablishtheNationalDMFandlocalpracticalscenariosineducationandtrainingsessionsn Developmonitoringandfeedbackmechanismsforpracticereviewn Developtherequiredpolicies,protocolsandguidelinesrelevanttoincorporatingAINsintoclinicalpracticen EstablishsupportnetworksfornursesandAINstohelpresolveconflictandprovideprogressiveguidelines
PAGE 32 NSW HEAltH Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package
Thefollowingdefinitionsareincludedtointroducecommon
conceptswithinanursingcaredeliverycontext.Thelistis
notexhaustive,norinclusiveofallinterpretations,thoughis
offeredtofacilitateconsistentunderstandingin
organisationalandcollegialconversation,particularlywith
regardtomodelsofcareandAINsupervision.
Accountability
n Theobligationtoanswerfortheprofessional,ethical
andlegalresponsibilitiesofone’sactivitiesanddutiesn Cannotbedelegated
(AustralianNursingandMidwiferyCouncil2007)6
Activity/activities
n Aserviceprovidedtoaconsumeraspartofanursing
planofcaren Maybeaclearlydefinedindividualtaskormore
comprehensivecaren Thetermcanalsorefertointerventionsdesignedto
producebeneficialoutcomestohealthcareconsumers
(AustralianNursingandMidwiferyCouncil2007)7
Activities of daily living
n Proceduresareconsideredtoberoutineactivities
oflivingwhen:
-theneedfortheprocedure;
-theresponsetotheprocedure;and
-theoutcomesofperformingtheprocedure
havebeenestablishedovertimeand,asaresult,
arequitepredictable.Thesameproceduremay
bearoutineactivityoflivinginonesetof
circumstancesandpartofatherapeuticplanof
careinanother.
(CollegeofNursesofOntario2008)8
6 Australian Nursing and Midwifery Council. (2007). National framework for the development of decision-making tools for nursing and midwifery practice
7 Australian Nursing and Midwifery Council. (2007). National framework for the development of decision-making tools for nursing and midwifery practice
8 College of Nurses of Ontario. (2008) Practice Guideline; working with unregulated care providers. Toronto.
Assignment/allocation
n Allocationofpatientcareactivitiesamongcare
providersinordertomeetpatientcareneeds.Allocation
occurswhentherequiredcarefallswithinthefacility’s
policiesandpositiondescriptionsandthecarer’sscope
ofpractice
(CollegeofRegisteredNursesBritishColumbia2002)9
Assistant in Nursing (Public Health) (AIN)
n Aworkerwhoassistsnursestoprovidefundamental
patient/consumernursingcarewhoisnotlicensed
topracticeasaregisteredorenrollednurse/midwife.n TheminimumeducationalstandardforanAINworking
inNSWHealthinanacutecareenvironmentis
aCertificateIIIoralternativelyastudentcurrently
enrolledinanursingdegreeprogrammewhohas
completedaminimumof1yearstudy.n AssistantsinNursingareindividuallyaccountablefor
theirownactionsandaccountabletotheregistered
nurseandtheiremployerfortheirdelegatedduties.
(AustralianNursingandMidwiferyCouncil2007)10
Collaborative Care
n Collaborativecareseekstheactiveparticipationofeach
disciplineandcontributorinpatientcare.n Corecomponentsofacollaborativepracticemodel
aresuggestedas:
-Acommongroupofpatients
-Commongoalsforpatientoutcomesanda
sharedcommitmenttomeetingthesegoals
-Memberfunctionstotheirindividualeducation
andexpertise
-Anunderstandingbyteammembersofeach
other’srole
9 College of Registered Nurses British Columbia, (2002). Practice Standard: Assigning and delegating to unregulated care providers. Vancouver.
10 NSW Health Circular 2001/80. Employment of undergraduate nursing students as assistants in nursing in the public sector. Sydney Australia
Definitions
SECTION6
Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package NSW HEAltH PAGE 33
-Amechanismforcommunication
-Amechanismformonitoringpatientoutcomesn Thereisasetofrecognisedvalues/behavioursthatisthe
foundationofacollaborativepracticemodelnotedas;
-Mutualtrustandrespectamongallteam
members
-Knowledge
-Responsibilityandaccountability(independent
andshared)
-Effectivecommunication
-Cooperationandcoordinationthatpromotesthe
useofskillsofallteammembers
(PanCanadianPlanningCommitteeonUnregulatedHealth
Workers2008)11
Competence
n Theintegrationandapplicationofknowledge,skills,
attitudesandjudgementrequiredtoperformsafely,
ethicallyandappropriatelywithinanindividualspractice
orinadesignatedroleorsettingn Encompassesconfidenceandcapability
(AustralianNursingandMidwiferyCouncil2007)12
Complexity
n Thedegreetowhichapatient’sconditionand/or
situationischaracterisedandinfluencedbyarangeof
variablese.g.multiplemedicalconditions/diagnosis,
impaireddecisionmakingability,challengingfamily
dynamics
Context
n Theenvironmentinwhichnursespractice,whichinturn
influencesthatpractice,includes
-Consumercharacteristicsandcomplexityofcare
required
-Modelofcare,typeofserviceandphysical
setting
-Amountofclinicalsupport
-Availabilityofresources,includingstaffandskill
mixandaccesstootherprofessionaland/or
supportstaff
(AustralianNursingandMidwiferyCouncil2007)13
11 Pan Canadian Planning Committee on Unregulated Health Workers, (2008). Valuing health-care team members, working with unregulated health workers. Ottawa.
12 Australian Nursing and Midwifery Council. (2007). National framework for the development of decision-making tools for nursing and midwifery practice.
13 Australian Nursing and Midwifery Council. (2007). National framework for the development of decision-making tools for nursing and midwifery practice.
Delegation
n DelegationtoanAINoccurswhentherequiredtask
isprimarily(nothistorically)performedbyregisteredor
enrollednurses.Thedelegatedtaskisalwayspatient
specific,intheinterestsofthepatientandisnot
contradictedbyfacilitypolicy.Ifthetask/functionis
classifiedasa‘shared’(common)competencyitdoes
notrequiredelegation,howeverthepatient/context
complexityinfluencestheknowledge/skilllevelrequired
andaccordinglytheallocationofthetask/functionto
AINs,e.g.assistingapatientwithshoweringisan
allocatedtaskaccordingtothepatientcomplexitynot
adelegatedonen Anactiveprocessoftransferringauthoritytoa
competentindividualtoperformaparticularactivity
inaspecificsituationn Thosedelegatingretaintheaccountabilityforthe
decisiontodelegateandmonitoringoutcomesofthe
delegatedtask.
Responsibilities when delegating
n Teachingn Competenceassessmentn Providingguidance,assistance,supportandsupervisionn Ensuringpersontowhomdelegatingacceptsand
understandstheiraccountabilityn Evaluationofoutcomesn Reflectiononpractice
Responsibilities when accepting delegation
n Negotiateteaching,competenceassessment,support,
guidanceandsupervisionasrequiredn Notify/informdelegatorofinabilitytoperformthe
activityinatimelymannern Beawareoftheextentofthedelegationandany
monitoringand/orreportingrequirementsn Performdelegatedactivitysafelyn Participateinevaluationofthedelegationn Donotdelegatetheactivitytosomeoneelseunless
authorisedn Consultwiththedelegatorifcontext/situationchanges
(AustralianNursingandMidwiferyCouncil2007)14
14 Australian Nursing and Midwifery Council. (2007). National framework for the development of decision-making tools for nursing and midwifery practice
PAGE 34 NSW HEAltH Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package
Learning Organisations
n Learningorganisationsareorganisationswherepeople
continuallyexpandtheircapacitytocreatetheresults
theytrulydesire,wherenewandexpansivepatternsof
thinkingarenurtured,wherecollectiveaspirationisset
free,andwherepeoplearecontinuallylearningtosee
thewholetogether
(Senge1990)15
Patient Outcomes
n Theobservableevents/resultsofnursinginterventions,
careactivitiesorthecareenvironmentonpatientsn Theresponsesthatindicatethepatient’shealthstatus
and/orlevelofknowledgeasaresultofnursing
interventionsandactivities
(CollegeandAssociationofRegisteredNurses
Alberta2003)16
Predictable patient outcomes
n Theextenttowhichonecanidentifyinadvance
apatient’sresponseonthebasisofobservation,
experience,orscientificreason.n Involvesassessmentofhoweffectivelyahealth
conditionismanaged,thechangeslikelytooccur,
andwhetherthetypeandtimingofchangecan
bepredicted
(CollegeofRegisteredNursesNovaScotia2004)17
Registered Nurse responsibilities
n Theregisterednursepracticesindependentlyand
interdependentlyassumingaccountabilityand
responsibilityfortheirownactionsanddelegation
ofcaretoenrollednursesandhealthcareworkers.
Delegationtakesintoconsiderationtheeducation
andtrainingofenrollednursesandhealthcareworkers
andthecontextofcare
(AustralianNursingandMidwiferyCouncil,National
CompetencyStandardsforRegisteredNurses)18
15 Senge, P. (1990). The fifth discipline: The art and practice of the learning organization. Doubleday, New York.
16 College and Association of Registered Nurses of Alberta, (2005). Standards for supervision of nursing students and undergraduate nursing employees providing client care. Edmonton.
17 College of Registered Nurses Nova Scotia, (2004). Delegation guidelines for registered nurses. Halifax, Nova Scotia.
18 Australian Nursing and Midwifery Council. National Competency Standards for Registered Nurses.
Risk assessment/risk management
n Ariskmanagementsystemincorporatesthe
followingstrategies:
-Identifyrisks/hazards
-Assessthelikelihoodoftherisksoccurringand
theseverityoftheconsequencesiftherisks
dooccur
-Preventtheoccurrenceoftherisks,orminimise
(mitigate)theirimpact
(AustralianNursingandMidwiferyCouncil2007)19
Role Transition
n Aperiodofadjustmenttoanewworkenvironmentthat
requireslearningnewcompetenciesandreconfiguring
one’sprofessional/occupationalidentity
(KalliathP&KalliathT2003)20
n Examplesare;newgraduateregisterednurses,
reconnectnurses,experiencednursesrelocating
toadifferentclinicalspecialtyn Transitionprogrammesaredesignedtosupportthose
inroletransitiontodevelopnewlyrequired
competenciesassoonaspossible
Scope of Practice
n Fullspectrumofroles,functions,responsibilities,
activities,decision-makingcapacityandaccountabilities
whichoneiseducated,andauthorisedtoperform
Scope of Professional Practice
n Setbylegislationandprofessionalstandardssuchas,
competencies,codeofethics,conductandpracticen Influencedbypublicneed,demandandexpectation
Scope of individual’s practice
n Influencedbypracticeenvironment/context,
consumer/patientcarecomplexityn Levelofcompetence,education,qualifications
andexperiencen Serviceprovider’s/organisation’spolicy,qualityand
riskmanagementframeworkandculture
(AustralianNursingandMidwiferyCouncil2007)21
19 Australian Nursing and Midwifery Council. (2007). National framework for the development of decision-making tools for nursing and midwifery practice.
20 Kalliath. P. & Kalliath, T. (2003) Applying action learning concepts to role transition in a dyadic group setting. Accessed from hpt//:www.education.up.ac.za/alarpm/PRP_pdf/Kalliath&Kalliath.pdf on 23.11.09
21 Australian Nursing and Midwifery Council. (2007). National framework for the development of decision-making tools for nursing and midwifery practice.
Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package NSW HEAltH PAGE 35
Shared (common) Competency
n Askillorservicethatmaybeperformedbyeither
registeredorunregisteredhealthworkersn Theactivitieswithinthiscategoryarewithintheskill
|setandscopeofpracticeoftheinvolvedcaregivers.
Thedeterminationofwhoshouldperformashared
competencyistheactofassignment/allocationby
aregisterednurse
Skill mix
n Thecombinationofskillsavailabletoprovidedirect
andindirectnursingcaretopatientswiththestaff
mixprovided
Stable
n Situationsinwhichapatient’shealthstatuscan
beanticipated,theplanofcarereadilyestablished
andmanagedwithinterventionsthathavepredictable
outcomes
Supervision/supervise
n Therearethreetypesofsupervisionina
practicecontext:
1.Managerialsupervisioninvolvingperformance
appraisal,rostering,staffingmix,orientation,induction,
teamleadership,etc
2.Professionalsupervisionwhere,forexample,amidwife
preceptorsastudentundertakingacourseforentryto
themidwiferyprofession,oraregisterednursesupports
andsupervisesthepracticeofanenrollednurse
3.Clinically-focussedsupervision,aspartofdelegation
Inrelationtoconsumercareactivitiesdelegatedtoanother
personbyamidwifefromamidwiferyplanofcareorbya
registerednursefromanursingplanofcare,clinically-
focussedsupervisionincludes:
-Providingeducation,guidanceandsupportfor
individualswhoareperformingthedelegated
activity
-Directingtheindividual’sperformance
-Monitoringandevaluatingoutcomes,especially
theconsumer’sresponsetotheactivity
Thereisarangeofclinically-focussedsupervisionbetween
directandindirect.Bothparties(thedelegatorandthe
personacceptingthedelegation)mustagreetothelevel
ofclinically-focussedsupervisionthatwillbeprovided.
Direct Supervisioniswhenthesupervisorisactually
presentandpersonallyobserves,workswith,guidesand
directsthepersonwhoisbeingsupervised.
Indirect Supervisioniswhenthesupervisorworksinthe
samefacilityororganisationasthesupervisedperson,but
doesnotconstantlyobservetheiractivities.Thesupervisor
mustbeavailableforreasonableaccess.Whatisreasonable
willdependonthecontext,theneedsoftheconsumerand
theneedsofthepersonwhoisbeingsupervised.
(AustralianNursingandMidwiferyCouncil2007)22
Indirect Remote Supervision
n Aregistered/regulatedhealthcareprofessionalis
availableforconsultationandguidancebutisnot
physicallypresentinthelocationwherethecareis
beingprovidedbutiseasilycontactablethrough
technicaldevices
(CollegeandAssociationofRegisteredNurses
ofAlberta2005)23
Tacit Knowledge
n ‘Knowhow’knowledgethatisembeddedinaction
orsocialpracticeandishardtoacquireoutsideofthe
contextoftheclinicalenvironment,itisseenasdeeply
rootedinindividualactionandexperienceaswellas
ideals,valuesand/oremotionsembraced
(BalogunandJenkins2003)24
Task
n Partofapatientcarefunctionwithclearlydefinedlimits
22 Australian Nursing and Midwifery Council. (2007). National framework for the development of decision-making tools for nursing and midwifery practice.
23 College and Association of Registered Nurses of Alberta, (2005). Standards for supervision of nursing students and undergraduate nursing employees providing client care. Edmonton.
24 Balogun and Jenkins. (2003). Re-conceiving change management: a knowledge-based perspective. European Management Journal, vol. 21, no. 2, pp. 247-257.
PAGE 36 NSW HEAltH Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package
Team
n Ateamisasmallnumberofcommonlyconsistent
peoplewitharelevant,sharedpurpose,common
performancegoals,complementaryandoverlapping
skills,andacommonapproachtoitscollectivework.
Teammembersholdthemselvesmutuallyaccountable
fortheteam’sresultsandoutcomes
(Manion1997)25
Team Based Nursing
n Nursingcaredeliveredtopatientsbyateamofnurses
withorwithoutassistantsinnursingmembershipn Nursingteamsmayormaynothaveconsistent
individualmembershipovertime.n Nursingteamsfacilitatethetransferenceofprofessional
and‘tacit’knowledgeacrossteammembersn Thereisnoidealconfigurationorcompositionofateam
asitisspecifictointernalandexternalcontextual
factors.Effectivenessandefficiencyofteamsresults
fromreducinggapsandduplicationinrequiredskills
acrossteammembersn Allteammembers,includingAINs,shouldactively
participateinqualityimprovementsthatcouldlead
tochangesinthedeliveryofcareandpatientcare
outcomesn NursingTeamsareintendedtomaximisetheskillsofall
teammembers,preventduplicationofservicedelivery
andenhancetheproductivityoftheworkforce.
Healthcareprofessionalsneedtomakejointdecisions
aboutwhowilldowhattoensurethatduplicationof
effortisreducedandfragmentationdoesnotoccur
(PanCanadianPlanningCommitteeonUnregulated
HealthWorkers2008)26
25 Manion, J. (1997). Teams 101: The manager’s role. Seminars for Nurse Manager’s. vol. 5, no. 1, pp31 – 38.
26 Pan Canadian Planning Committee on Unregulated Health Workers (2008). Valuing health-care team members, working with unregulated health workers. Ottawa.
Unstable
n Situationsinwhichapatient’shealthstatusis
fluctuating,withatypicalresponses,theplanofcare
iscomplex,requiringfrequentassessmentand
modificationandismanagedwithinterventionsthat
mayhaveunpredictableoutcomesand/orrisks
(CanadianNursesAssociation2003).27
27 Canadian Nurses Association (2003) in College of Registered Nurses Nova Scotia (2004) Delegation guidelines for registered nurses Nova Scotia
Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package NSW HEAltH PAGE 37
AustralianNursingandMidwiferyCouncil.(2007).
National framework for the development of decision-
making tools for nursing and midwifery practice.
AustralianNursingandMidwiferyCouncil.National
Competency Standards for Registered Nurses.
BalogunandJenkins.(2003).Re-conceivingchange
management:aknowledge-basedperspective.European
Management Journal, vol. 21, no. 2, pp. 247-257.
CollegeandAssociationofRegisteredNursesAlberta.
(2003).Decision making standards for nurses in the
supervision of health care aides: restricted activities and
activities of daily living. Edmonton.
CollegeandAssociationofRegisteredNursesofAlberta,
(2005).Standards for supervision of nursing students and
undergraduate nursing employees providing client care.
Edmonton.
CanadianNursesAssociation(2003)inCollegeof
RegisteredNursesNovaScotia(2004)Delegation guidelines
for registered nurses.NovaScotia
CollegeofRegisteredNursesBritishColumbia,(2002).
Practice Standard: Assigning and delegating to unregulated
care providers.Vancouver.
CollegeofRegisteredNursesNovaScotia,(2004).
Delegation guidelines for registered nurses.Halifax,
NovaScotia.
DepartmentofNursingandMidwifery,University
ofSterling.Informationformentors.accessedfrom
http//:www.nm.stir.ac.uk/mentorson10.11.09.
Kalliath.P.&Kalliath,T.(2003)Applying action learning
concepts to role transition in a dyadic group setting.
Accessedfromhpt//:www.education.up.ac.za/alarpm/PRP_
pdf/Kalliath&Kalliath.pdfon23.11.09
PanCanadianPlanningCommitteeonUnregulatedHealth
Workers,(2008).Valuing health-care team members,
working with unregulated health workers.Ottawa.
Manion,J.(1997).Teams101:Themanager’srole.
Seminars for Nurse Manager’s.vol.5,no.1,pp31–38.
Senge,P.(1990).The fifth discipline: The art and practice
of the learning organization.Doubleday,NewYork.
References
SECTION7