An investigation of the inter-relationship between the registered nurse and the healthcare assistant with reference to workforce policy implementation in the South-East of Ireland

There is a constant reconfiguration of the roles of healthcare personnel worldwide in relation to workload, practice responsibilities and reporting relationships. Within this context, the role of the registered nurse (RN) continues to expand whilst that of the healthcare assistant (HCA) is developing in terms of role identity and inter-relationships with other healthcare professionals. With this in mind, it is now timely to examine current practice and policy as they relate to role reconfiguration of both the RN and the HCA and the professional relationship that exists in terms of nature, extent and significance. This study therefore explored the ‘nature’ and ‘impact’ this role relationship has with regard to respective role identities of the RN and HCA. A qualitative descriptive approach was adopted. One ward where RNs and HCAs involved in a reciprocal role relationship was purposefully selected. Participants were observed and seven of those observed were interviewed using a semi-structured interview topic guide. Interview data was analysed using a thematic analytical framework. The findings of this study relate to the inter-professional relationship that exists between RNs and HCAs which makes collaborative working functional and effective. Findings are presented under four themes: (1) the time to care, (2) a knowing relationship, (3) routine of ward life, and (4) organisation of care. The healthcare organisation is viewed as impacting the dynamic of care causing tension and stress. Overall, this study suggests that RNs are consumed largely by documentation. RNs appreciate that having HCAs embedded within the skill mix and knowing that individual HCA’s are competent allows for informal delegation and supervision. However, HCAs are largely unaware of their work being supervised, seeing supervision as a negative concept. Both RNs and HCAs feel that the HCA role is expanding without support or guidance from the organisation with no career pathways identified. This study makes recommendations in relation to (1) workforce policy (2) practice and (3) future research initiatives.