Using nursing assistants to fill coronavirus gaps brings risks if they're not up to the job

The number of people going to hospital with the coronavirus is expected to rise, putting a strain on our health and aged care services and their workforce.

Australian undergraduate student nurses and those health workers here on visas from overseas are being encouraged to work as nursing assistants during this COVID-19 pandemic.

This is in keeping with the worldwide trend of employing more nursing assistants in health and aged care services.

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But questions remain about the differences in training of nursing assistants compared to regulated nurses (registered and enrolled nurses) and the tasks they are able to undertake.

An unregulated workforce

As nursing assistants are unregulated, their training and clinical practice is not controlled by professional bodies or governments.

Training is certainly recommended, but it is not compulsory, and content between training organisations can be different. Therefore, nursing assistants working in hospitals and residential aged care facilities may have completed an on-line course, a Certificate III qualification, completed one year of undergraduate nursing studies or have a nursing qualification from overseas. They may have had no training at all.

Visa holders can work as a nursing assistant while their overseas nursing qualifications are being assessed by the Nursing and Midwifery Board of Australia.

It is these last two examples, undergraduate nursing students in Australia or overseas trained nurses, that the Prime Minister Scott Morrison recommends organisations seek to recruit.

What a nursing assistant can do

Nursing assistants can work under the supervision of a registered or enrolled nurse to help provide basic nursing care such as showering, hair, skin and mouth care. They can assist with activities essential for daily living including helping people with dressing and feeding.

They may also perform simple wound dressings, transport stable patients or residents between beds or wards, and undertake nursing observations such as pulse, temperature and respiratory rates.

Using student nurses and current visa holders seems like a potential solution to a possible staffing crisis. But is it?

For student nurses, there is considerable variation in the course structure offered by universities, who each write their own curricula within the boundaries of the Australian Nursing and Midwifery Accreditation Council.

This means not all students will have had the same clinical experience or completed the same content by a given point in their course. Therefore they may not have equivalent knowledge or skills before working as a nursing assistant.

Patients at risk?

This variation may be a problem and there is a lot of evidence that a higher number of unregulated nurses and a lower number of regulated nurses increases the risk of patient infections and other adverse events in hospitals) and the aged care sector.

For example, nursing people with an infectious disease requires scrupulous attention to detail and meticulous use of Personal Protective Equipment (PPE) to prevent further spread.

There are correct ways to apply and remove a mask and gown. A tiny slip-up can put the wearer and others at risk of contamination.

Working as nursing assistants can provide undergraduate students with valuable clinical experience. Our recent research shows most nursing activities performed by nursing assistants are those personal care activities described above.

But we found around one-third of tasks they performed require a higher level of skill and knowledge and should therefore be performed by regulated nurses.

This may explain why the rate of adverse events increases with more unregulated nurses. With the projected increase in patients who may need intensive care, experienced qualified nurses who can work without supervision will be needed.

Can retired nurses help?

Some have recommended recruiting retired nurses to help staff intensive care units. Again, this is fraught with problems.

Working nurses are ageing – the average age is about 45 – with two out of five aged 50 and over. So most retired nurses are likely in their 60s or older.

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The two age groups – the over 50s and the over 60s – are precisely those at risk of a severe response to the coronavirus, which could make staffing shortages and the demand for beds much worse.

Perhaps a more effective and sustainable solution would be to use Australian Defence Force nurses who are all regulated, presumably fit and who have been prepared to deal with emerging crises at short notice.

Australia is clearly going to need innovative ways to ease pressure on the health workforce over the coming months. If we’re going to recruit student nurses and current visa holders, we need to make sure all have been trained and assessed to the same standard.