Concerns that nursing staff numbers are being diluted by the widespread hiring of healthcare assistants (HCA) has prompted calls for an urgent review of all skill mix arrangements in workplaces, to ensure that patient safety and the role of the registered nurse and midwife are not compromised.

The national review would investigate how HCAs are utilised at ward and unit level, amid fears that they are becoming a substitute for a registered nurse or midwife, according to Jean Armitage, treasurer of the North Tipperary Branch, whose motion to seek the review was unanimously supported at the ADC.

Jean Armitage, North Tipperary Branch

“While we welcome and appreciate the role of healthcare attendants, they must never be used as a substitute for a registered nurse or registered midwife in the delivery and overseeing of care to patients,” she stressed.

“We need to be properly staffed at all times. As patient advocates, we have a duty of care not only to our patients but to ourselves and the organisations that we work for.”

She noted that nursing levels are currently 20% lower than in 2004, as confirmed in the Department of Health document ‘Health in Ireland 2013’. However, the number of hospital consultants, NCHDs and dentists has risen by 20% during the same period.

“HIQA requires of us that we give efficient, effective patient-centred care and we adhere to guidelines to the best of our ability but how can we do this if we’re not properly staffed?” said Jean, adding that “safe staffing equals safe care, equals safe patients, equals safe nurses”.

Seconding the motion, Mary Butler reiterated the importance of having a skill mix but not if HCAs are used as a replacement for nurses.

“The HCA can’t replace a qualified nurse, midwife, or theatre nurse, enough is enough. We want nurses to be replaced with nurses; like with like. If we don’t, we will have more nurses leaving the system through stress and overload, but also we will have a system failure. We should have a safe environment for ourselves as well as for our patients.”

Mary Cotter pointed out that the ratio of nurses to HCAs has shifted significantly in the 40-bed community hospital in West Cork where she works as a staff nurse. “Only recently, in spite of the recruitment moratorium, five HCAs have been hired. Our nursing hours are going to be replaced by these HCA hours. Once we had a 50:50 mix but we’re very quickly going down the route of a 40:60 staff nurse/HCA mix,” she said.

A number of other supporters from the floor emphasised the essential role of directors of nursing (DON) and assistant directors of nursing (ADON) in safeguarding staffing levels and an appropriate skill mix.

“As a nurse manager in an ED, I’m grasping with my fingernails to hold onto any semblance of what is normal practice anymore,” said Ann Burke, INMO Executive Council.

Geraldine Talty, first vice president, added: “I’m a clinical nurse manager and it is the role of every clinical nurse manager to support their nurses and to stop this creeping practice of registered nurses and midwives being replaced by a HCA or anybody else. They have to be supported by the ADON and the DON, and I do know that this is not happening in every hospital.”

“At the same time, nurses need to support their DON and ADON, and stand behind them and don’t give in because that’s what’s happening, we are actually allowing everybody else to replace us with somebody who is not capable or not qualified, educated professionals. We all have to stand together on this very important issue,” she said.

ADC - Staff numbers must not be diluted by HCA posts