The profession of nursing has origins in the Nightingale concept of education that has received credit for advancing nursing education as well as practice in several countries across the globe. The services offered by nurses are needed for twenty four hours a day, 7 days a week, and three sixty five days a year. Nonetheless, the rise in demands for acute care cannot be achieved only by registered nurses (RN), for the mere reason that they are not sufficient to fill the present nursing positions. This, therefore calls for a need to ascertain that the expertise of nursing staff are being utilized in the most efficient and effective way. Moreover, the incorporation of and improved use of Assistant in Nursing (AIN) needs to be researched while still ascertaining quality patient results. In the wake of the ever-dynamic health care systems, increased consumer participation and technological advancements in health care, the demands on this profession are changing. Simultaneously, changes are evident in the profile as well as expertise mix of nurses in various care wards (Carrigan, 2009). In the endeavor to offer effective and effective heath care to patients, various health care organizations are coming up with numerous changes to the conglomeration of staff, which offers patient care. Consequently, there has been a fast propagation in the number of care roles, a trend, which has the potential to go on in the future. The utilization of an Assistant in Nursing (AIN) in the provision of patient care, as delegated and directed by a registered nurse (RN), is an appropriate, safe, and resource efficient method of providing nursing care.
The role of the AIN is to reinforce the efforts of enrolled and registered nurses in the delivery of overall patient care. However, they are only supposed to work under strict supervision of a registered nurse. Health organizations utilizing the AIN either adopts the duties stipulated for the AIN under the operational directive outlines, or are also allowed coming up with their choice of duties that they would want the AIN to perform in the health service (Chandler, 2003). However, in the latter case, they are supposed to articulate the options of allowable AIN roles through a statement of local rule (CAN, 2014). Some of the most common roles played by AIN include: 1) preparing a table over bed and safe sitting of patients to eat meals, feeding patients cannot eat by themselves, and ensuring that a patient has adequate water for later use; 2) the AIN is also tasked with the role of ensuring that the patient is well groomed and taken care of, this involves cleaning up the patient and assisting him or her to dress up among other hygienic duties; 3) the AIN is also tasked with ensuring patient mobility for patients who cannot move from one place to the other, the AIN is supposed to help him or her to shift from bed to chair, changing his or her position, and help registered nurses with patient transfer as well as manual handling; 3) patient toileting the AIN is also tasked with the role of ensuring that patients are assisted in toileting by providing urinal or bedpan, emptying, measuring, and taking records of urine, reports abnormalities to the registered nurse, records the output of urine on fluid balance chart, and conducting routine urinalysis as well as reports finding to the registered nurse (Perry, 2003); 4) the AIN is also required to uphold confidentiality, show empathy towards the patient, act discreetly with sensitive scenarios, seek counsel with conflict from the registered nurse, communicate in an appropriate manner when reporting or getting clinical information and data, and ensure that there is no communication breakdown between the patient and RN; 5) the AIN is also tasked with the role of maintaining a safe environment executing infection control standards and ensuring that all the equipment and areas that a patient uses are clean and safe for use; 6) the AIN also ensures that he takes the general care of a patient such as helping in settling patients for rest periods and sleep, spreading the bed, and conducts assessments and records various vitals as instructed by the RN; 6) it is also the role of the AIN to maintain documentation of patients by getting the necessary data pertaining patients and recording them on appropriate charts and ensuring that organizational procedures and policies are followed by patients at all times (Perry, 2003).
In the United States and globally, the nursing workforce has transformed significantly owing to the multifactorial influences like budgetary constraints, ageing workforce, hospital restructuring, advanced practice for enrolled and registered nurses, skill mix and the incorporation of undergraduate nurses, increases in sophistication of care, employment and retention of staff, as well as alterations in the scope of practice (Shearer, 2013). In consequent, the utilization of an AIN has found increased use in various health systems across the word. It has been established that care models that greater RN skill mix with AIN have been correlated to enhanced outcomes such as a reduction in medical errors, and lower wound infection and patient mortality (Shearer, 2013). Workplace burnout and stress have implications for both registered nurses and the health care facility. For this reason, the incorporation of AIN working under the supervision of registered nurses eliminate such workplace burnout and stress since the roles that were previously done by registered nurses are now transferred to AIN, thus making work easier. Further, the use of AIN in the health care under the delegation or supervision of registered nurses also improves the nursing care service delivery. This is because AIN shoulder off the greater load from registered nurses issues to do with feeding, cleaning, and moving the patient about are transferred to the AIN. In consequence, registered nurses are now able to concentrate on major tasks that are executing skilled nursing care, which results in increased service delivery and patient outcome. The utilization of AIN also results in consumer satisfaction. As earlier, there is a worldwide shortage of registered nurse, which also translates in increased demand for quality nursing care in the general and acute wards (Government, 2010). The increased ratio of registered nurses to the number of patients seeking their intervention definitely means that patients will not attain maximum clinical attention from registered nurses. Therefore, the utilization of the AIN bridges this gap by reinforcing the efforts of registered nurses, which in turn translates to increased consumer satisfaction. For instance, it is through the utilization of the AIN that patients can now afford to be fed, groomed, escorted around, and settled to rest or sleep among others, services that were hitherto unheard off when registered nurses used to work on their own.
In contrast, registered nurses are supposed to perform the following roles when working with the AIN:
Supervision: RN has the duty of directly or indirectly supervising the AIN direct supervision could be continuous, frequent, or occasional.
Accountability: The RN is held accountable for the provision of patient care functions to AIN, he or she is also to determine on the basis of the specific practice setting, the AIN current competencies as well as patient demands as to the care duties allocated, the AIN is also supposed to guide as well as help the AIN in attaining the clinical practice objectives.
Evaluation: The RN is also tasked with the role of assessing whether the AIN has achieved the competencies stipulated by the heath care guideline.
Performance management: The RN is also responsible to tackle and manage performance concerns the AIN may experience in his line of duty (Perry, 2003).
The AIN goes a long way in helping the registered nurse to attain competencies. The AIN provides the opportunity for enhanced communication and comprehension of each individuals role. Through the utilization of AIN, registered nurses are able to put faces to names as well as exchange information regarding patients and services, hence creating an invaluable benefit to the registered nurse. Delegation of duties to the AIN also offers the registered nurse a chance to advance his nursing profession since he or she now has ample time to concentrate in the academic work. Moreover, registered nurses can also use the assistance of the AIN in steering research and development, therefore improving the knowledge base that he or she already has. The effectiveness of AIN could be proved by its influence on patient outcomes. There is enough evidence to demonstrate connections between registered nurse staffing and blend of AIN-RN skills as well as adverse patient outcomes (McGillis Hall, 1997). The lack of combining the skills of the AIN with RN increase risks to patients such as reduced quality of care and compromised safety; increased incidence of disease as well as mortality; and heightened occurrence of sentinel or adverse events death or injury culminating from a nursing care intervention (King, 2014). Nonetheless, utilization of the AIN can help eliminate the above factors that prolong the duration of stay for patients in hospitals, hence enabling the registered nurse to attain competencies.
The contribution of the AIN utilization in the provision of patient care, as delegated and directed by a RN to the health care system as well as wellbeing of any society, community, or nation is nearly incalculable. AIN has created both consumer satisfaction and registered nurse competency. AIN has promoted public health, reduced pain and suffering, comforted the weak and the susceptible, and showered relatives of sick patients with loads of love. It is through the utilization of the AIN that patients can now feel at ease while still being in the hospital since most of the needs, which were earlier unheard off can now be afforded to them. Moreover, registered nurses are now able to specialize in the nursing section, hence increasing the patient outcome while at the same time reducing the burnout and stress issues that had characterized the nursing profession for a long time. Further, registered nurses are able to advance their nursing profession because of the reduced workload. (Shearer, T 2013).Therefore, the model that advocates utilization of AIN in patient care in liaison with registered nurses goes a long way in tackling workload, scheduling, and offers safe, secure working environment needed to ascertain occupational health and healthcare provider and patient safety.
ACN. (2014). Assistants in Nursing. Position Statement, 1-2.
Carrigan, C (2009) Mixing it up: the future of assistants in nursing, Australian Nursing Journal vol. 17, no. 4, pp. 24-27
Chandler, M (2003), Assistants in nursing: their emergence, roles and utilization in aged c a r e, Geriaction, vol. 21, no. 4, pp. 17-21.
Government, N. (2010). Assistants in Nursing Working in the Acute Care Environment. Health Service Implementation Package, 1-40.
King, A. (2014). Effectiveness of team nursing compared with total patient care on staff wellbeing when organizing nursing work in acute care ward settings: a systematic review protocol. JBI Database of Systematic Reviews and Implementation of Reports, 1-1.
McGillis Hall L. (1997) Staff mix models: complementary or substitution roles for nurses. Nursing Administration Quarterly.;21(2):31-39
Perry, M, Carpenter, I, Challis, D & Hope, K 2003 Understanding the roles of registered general nurse and care assistants in UK nursing homes,Journal of Advanced Nursing vol. 42, no. 5, pp. 497-505
Shearer, T 2013 Getting the mix right: assistants in nursing and skill mix, Australian Nursing and Midwifery Journal vol. 21, no. 5, pp. 24-27
NSW Health Guideline GL 2005_034. Reports...
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