Low paid care workers - should unqualified workers not be allowed to enter the profes

As a Student Nurse who works as a Healthcare Support Worker on an internal 'bank' system I think that there should definately be alot more training for 'unqualified staff' but not to a higher education level. Most Healthcare Assistants complete NVQ's (Level 2's & 3's but there's still some areas that isn't included which they should know more about. For instance; when joining as a Healthcare Assistant, bearing in mind I am a Student Nurse too, I received training regarding - Moving & Handling, Hand Hygiene, Fire and Infection Control which in my opinion isn't nearly enough! I know there is also e-learning to complete, but most of it is optional. There should definately more indepth training regarding basic care needs that falls mainly to the Healthcare Assistant like; Pressure Area care, Nutrition and Fluid Balance, Completing Observations and Personal Hygiene - at the very least. I know most of this should be covered during practial induction days/week but there should be theory sessions around it so that people know the importance of it .. It would benefit all sides!

Really? But the job is basically brainless - you follow the protocol for all of those things

I have to strongly disagree with you there! Following 'protocol' it may be but people NEED to understand the theory/rationale behind the protocol in order to fully appreciate and follow it .. Nutrition - may seem a 'brainless' task of feeding someone to you but people need to understand other things surrounding it such as; modified diets and additional needs that some people may need. Stroke patients for example; shouldn't use a 'beaker' to drink with because physically the swallowing process starts with the sensation on the lips and beakers bypass this. Most 'brainless' people as you put it would proberly get a stroke patient, who can't handle the drink well, a beaker to prevent them spilling their drink down themselves. That's just one example of why people need such training!

Surely that's what care plans are for?

Certainly in the care home I worked in, each resident had a care plan specifying their individual needs. Ranging from nutritional - including feeding methods - to mobility.

I would not say that the job as a carer is 'brainless', but I wouldn't say it takes anything more than common sense and the ability to read.

I agree - but the time constrictions within some areas/roles often mean that you just don't have a chance. In a Care Home, you have no excuse - the residents are often long term and you get to know each individual. I work in a Hospital meaning I go to different wards almost every shift I have - I often don't have time to read through each persons care plans in detail (and remember them all). I have to go by a short handover and my own knowledge and experience and generally only refer to the care plans if needing to .. If people aren't trainned to a standard where they can understand and impliment the necessary basics they shouldn't be in care.

The agencies are regulated by the CQC (who usually manage to do far more harm than good) and all nurses are required to hold a recognised nursing qualification (which is a degree now in the UK) and are responsible to the NMC (they have to revalidate every year and maintain fitness to practice standards etc).

I don't think that carers necessarily need to be 'smarter' (care homes which cater for people with complex medical needs are required to employ nurses) as given the choice I would prefer to be cared for by someone less educated but more caring. What I do think needs to happen is that all HCAs (particularly those in hospital environments) be provided with minimum training standards, clearly defined skill levels (and make this universal rather than varying from trust to trust) and registration with the NMC. Professional accountability, clearly defined skill levels and protected training would I think address many of the problems that you are suggesting and go a long way to improving patient safety.

As a suggestion I would like to see all HCAs trained in (and required to annually revalidate on):

* Basic life support (more than just the 2 hours once a year that you currently get)
* Observations and basic non-invasive monitoring (to include BMs, manual BP, ECGs and heart monitors).
* Patient hygiene
* Management of pressure areas
* Patient handling
* Non-complex dressings
* Management of patiets with dementia/mental health needs
* Fluid balance and nutrition
* Infection control

** optional = venepuncture and cannulation

I would also really like to see HCAs receive basic instruction on chronic illnesses (particularly COPD, heart disease, renal failure and diabetes) and common medications - but I doubt that will happen.

Do you think HCA's working in nursing or residential homes require knowledge on ECG's, manual BP, venepuncture and cannulation? As a nurse I'd be uncomfortable with a HCA carrying out wound care without me seeing the wound as well.