Roles of Assistant In Nursing
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To qualify as a registered nurse, one needs to complete their undergraduate nursing course and register to be licensed to practice. For specialist nurse, then one is expected to take graduate studies. However, recent studies indicate that there have shortages in the number of the registered nurses (RN) and Advance nurse practitioners (APN). Therefore, there is a need to establish an effective strategy that will address the shortages of the nurses (Unruh & Zhang, 2012).
One of the strategies suggested by the evidence-based practice is the use of assistant in nursing to help in the healthcare setting. The issue of the integration of the AIN is highly debatable, with many studies highlighting their advantages as well as the disadvantages. This paper aims at defining the role of AIN, and the impact of their utilization in the healthcare settings. This aims at identifying their role in helping the RN achieve the set competencies and nursing practice goals.
Roles of Assistant In Nursing
The AIN is the word used to describe nurses who have completed nursing certificate at level III in a healthcare service. The Nursing and Midwifery board of Australia (NMBA) indicates that AIN are supervised and delegated duties by the RN. In some cases, AIN are also referred to as multi-skilled worker, technician, personal care assistants, and nurse extenders. Traditionally, AIN have been employed in aged care sector and in midwifery. The NMBA indicates that midwife have vital roles in counseling, education of the community especially during antenatal education and reproductive health. However, there have been changes in the recent past where AIN are increasingly being used to support RN in broad range of healthcare settings. The AIN roles and responsibilities include helping the patient during meals where they prepare table over the patient’s bed and help the patient position safely to feed (Unruh & Zhang, 2012).
Where necessary, AIN are required to feed the patients physically who cannot feed themselves but rather require the assistance when feeding. The AIN are also required to help the patient perform their daily living activities. These include activities such as bathing, bed washes and oral hygiene, brushing and the cleaning of dentures. They are required to make observations on changes on the patient’s physical appearances and report them to the RN. The AIN are also required to help the patients with mobility such as moving patients from bed to chairs, re-application of the ant-embolic stockings and bed positioning. They are also supposed to help the patients with voiding, including helping the patient go to the toilet or provide bedpan, and recording the urine collected in the drainage bags (Weiss, Yakusheva, & Bobay, 2011).
The AIN are expected to communicate any abnormalities to the RN. During this step, they are expected to uphold the key nursing principles and to maintain patient privacy, dignity and demonstrate empathy towards the patients. The AIN are expected to ne diplomatic and report any disputes to the RN. AIN are also used to relay patient educative information regarding the disease management especially on matters that regards hygiene (Heale, 2010). The AIN are required to maintain a stable environment that will facilitate quick recovery. These includes making up of post operative beds, implementation standards that reduce infection control such as hand hygiene, moping the spills and notify the RN if specific cleaning procedures such as use of radioactive procedures is required (Richer, Ritchie, & Marchionni, 2010).
According to the Nursing and Midwifery board of Australia (NMBA) registered nurses have various roles. Their roles as a coordinator imply that they are expected to coordinate plans. This is through piecing together of the fragmented care includes preparation of discharge with the liaison with other healthcare team. RN roles as communicators include establishing a good rapport between the healthcare providers and service users. This helps in their establishment of therapeutic care through analysis of verbal and non-verbal communication (Unruh & Zhang, 2012).
RN roles as teachers include the educating the patient to empower them with the benefits of self-care abilities. They are also responsible in affecting knowledge to the patients to enable them make informed decisions. This include training them with the relevant skills that will help the patients promote health, restore health, promote coping and prevention of further complication (Fitzpatrick, Campo, & Lavandero, 2011). They strategize the teaching learning process by identifying the specific teaching domains. These include cognitive learning, psychomotor learning, and affective learning. The RN is also counselors and is expected to provide emotional support to the patients to enable them handle the challenges they face with positivity. It is important, the RN are expected to know that they are team player. They are expected to collaborate and should not work in isolation when promoting patient healthcare. (Van Walraven et al., 2015).
RN responsibilities when working with the AIN
Some of aforementioned responsibilities of RN can be assigned to the AIN. The AIN can help the RN on duties such as teaching, assisting patients to feed, bath, and mobility as described above. This way, the RN can concentrate on leadership, by supervising the RN. This is because RNs are trained to have visions to energize other medical staff through motivation to work as team players and encourage them to achieve goals (Unruh & Zhang, 2012). As leaders, RN are expected to encourage AIN to work their best and collaboratively. The RN roles as managers are wider than that of managers. They are equipped with leadership skills during training, which includes cognitive skills, interpersonal skills, legal skill, ethical skill, management skills, problem solving skills and communication skills (Tyler, 2010).
With the help of AIN, the RN is supposed to note the barriers as well as challenges that hinder effective delivery of care. This includes barriers such as language barriers, cultural barriers, cognitive barriers, health literacy levels, and stress levels (Wayhlin & Idvall, 2010). Then, develop strategies to overcome these barriers. This is done using the nursing process, which includes assessment, planning, implementation and evaluation processes. RN is also advocate and is expected to support all patients by being assertive and promoting self-determination (Aubry, Etheridge, & Couturier, 2012).
Impact of utilization of Assistant in nursing (AIN)
As mentioned above, the role of Registered nurses are varied and very complex. Quality delivery of care requires the nurses to take different roles during different phases of care. They are expected to fulfill all their roles to the best of their abilities. However, nurse shortage and poor working environments have led to nurse shortages (Hebert, Moore, & Rooney, 2015). This has led to numerous challenges in the delivery of care in the healthcare settings, especially in patient safety concerns such as medication errors, diagnostic errors, hospital acquired infections, and patient hospital falls. This calls for a rapid measure to ensure that patient’s outcomes are positive and care delivered is safe and of quality (Van Walraven et al., 2015).
One of the strategies suggested by the Department of healthcare and supported by evidence-based practice is the utilization of AIN in healthcare settings. The benefits of integrating the AIN in health settings are that they will be a viable solution to the micro-political health issue (Taylor-Ford, 2013). The utilization of AIN will address the shortages of RN. This is because the AIN can aid the RN with some of the clinical settings chores under their supervision, as the RN works focuses on other responsibility (McHugh, Berez, & Small, 2013).
A typical nurse day begins with the analysis of the reports from the nurses in the previous shift and end with the filling of their own reports. In between these two responsibilities, the RN is expected to perform all other aforementioned tasks including administering of medication, wound care, physical assessments, and coordinate care with the other healthcare professionals. Lunch breaks and tea breaks are usually nonexistent. This sometimes leads to nurse burn out, which increases the risk of medical error, poor hand hygiene, and poor patient outcome (Tyler, 2010).
One study has indicated that the utilization of AIN in the health care settings found an association between the proportions of total hours the RN with the assistant with the AIN improved six outcomes in patients under care. These included reduction of hospital stays and well as the reduction of hospital acquired infections (Richer, Ritchie, & Marchionni, 2010).
Other studies indicate that nurse shortages leads to working for log hours with high nurse to patient ratio. This had been associated high increase of mortality, reduced patient empowerment. The patients are discharged too soon before their medical complication has established (Armmer & Ball, 2015). Consequently, the readmission rates are higher and in most cases, the patients report with more complications. With the integration of AIN in the healthcare settings, their patient ratio is lower, and the RN in collaboration with the AIN, they are able to deliver patient centered care and the patient are empowered such that they are able to manage their healthcare complications. Additionally, these nurses are able to notice and intercept medical errors. They also get ample time to advocate for the patients to the medical care in insurance companies to ensure that the patient get all their demands (Castle & Anderson, 2011).
One research associates nurse burnout with increase of infections. The aforementioned RN responsibilities lead to nurse burnout with extra patient assigned or extra overtime assigned to nurse. The study has indicated increase in the rate of catheter infection of one person for every 1,000 (Heale & Butcher, 2010). One study that integrated that utilization of AIN reduced burnout from 30% to 10%, and would reduce about 4,160 infections. The mortality rates would reduce to 11% with reduced burnout (Tyler, 2010).
Another study indicated that the utilization of AIN to help the RN with some of the nursing practices reduced the RN’s overtime hours. This was correlated with better care, fewer emergency departments within the first month of hospital discharge. This translated to reduced cost of care. This study also found correlation between utilization of AIN with the staffing ratios and with the patient satisfaction (Castle & Anderson, 2011).
A study that conducted cost benefit analysis study indicated that increased overtime hours increased patient cost of care by $197.92 per hospitalized patient. With the utilization of AIN, approximately $607.51 taxpayer’s money is saved (Heale & Pilon, 2012). Studies indicated that reduction of overtime work by 0.07 hours saved hospital cost by $8.18 per patient and $10.98 in savings of the taxpayer’s money. The annual net savings reported by this article was $11.64 (Weiss, Yakusheva, & Bobay, 2011).
From this analysis, the body of research indicates that utilization of AIN translates into quality care, low mortality rates, shorter hospitalization stay, and fewer health complications. However, the main disadvantages is that healthcare productivity could decline if the RN are replaced with AIN (Ulrich et al., 2010). This is because RNs are all encompassed. There are concerns that this approach could increase the risk of “failure to rescue” in departments with less RNs. This refers to cases where the situation requires further treatment due to the deterioration of the patient status. The AIN may not fully identify such situations early enough. There is need to conduct more further research to identify the most effective nursing staffing mix is effective to sustain quality care.
The study concluded that to manage effective delivery of care, the healthcare facilities should invest in reducing RN workloads strategies such as the utilization of AIN. This results to improved quality of care, reductions of readmissions, HAIs, patient falls, and emergency visits. This strategy is cost effective and improves quality of care.
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