Top tips from Tanis
Published: 24 November 2011
The RCN’s HCA/AP Adviser gives advice on taking responsibility for your actions and knowing when to say “no”
The RCN’s Principles of Nursing Practice were launched last year and have been adopted by many employers as a way of promoting excellent nursing care and improving quality. I have decided to focus on each of the Principles in turn in our newsletters as they are such a fundamental part of good nursing care. Whether you’re a health care assistant (HCA) or assistant practitioner (AP), and whether you work in acute care, mental health, the independent sector or indeed anywhere, the Principles will apply to you and your colleagues.
Nurses and nursing staff take responsibility for the care they provide and answer for their own judgments and actions – they carry out these actions in a way that is agreed with their patients, and the families and carers of their patients, and in a way that meets the requirements of their professional bodies and the law.
This Principle is all about accountability - a subject that I believe all members of the health care team need to understand. Accountability is about knowing your boundaries, and as Cornock (2008) explains: "HCAs who accept responsibilities must ensure that they acknowledge their limitations...they should inform those who give them tasks when they are unable to undertake them competently and ask for advice or guidance."
This might sound negative – but it applies equally to every single member of the nursing team. As a registered nurse I was asked to catheterise a patient when I was working in general practice. I hadn’t done this since I was a student nurse (too many years ago to mention), but just because I was available and ‘trained’ (*see below) it was presumed that I could do it. So I was accountable to say that I was no longer competent to perform this and it certainly was not in the best interest of the patient for me to do it. We called in one of the community nursing team who was competent and, although the patient had to wait a little while, this was a far better scenario for him than had I been prepared to ‘have a go’. This would have been totally unacceptable.
A legal duty of care
It brings me to a point that is very well made by Chris Cox, Director of the RCN’s legal services (2010), that the law imposes a duty of care on all practitioners, whether they are registered nurses, HCAs or APs, whenever it is ‘reasonably foreseeable’ that they could cause harm to patients either through their actions or if they fail to act. And this of course applies not only to the more complex of tasks but even to the most fundamental aspects of care such as bathing a patient. So, once we assume responsibility for a care of patients, we owe them a legal duty of care.
It is useful to ask what standard of care is expected. From the patient’s perspective, they should expect a similar standard of care from any person providing that care. If a registered nurse has delegated a task to an HCA, the nurse is accountable for ensuring that the HCA will provide the care at a similar level to any other person who might provide it. Take for example, going to your surgery for a routine blood test. Who is the most appropriate person to take that blood? One of the GPs who does this perhaps once every month or so, the practice nurse who may take blood a few times a week, or the HCA who has undergone training and assessment and runs a phlebotomy clinic every day? Therefore the key is competence, and patients should expect to be treated by a person who is competent to perform the care they need. You can find a lot more about accountability and watch our short film on this at www.rcn.org.uk/hcaaccountability
*Registered nurses are frequently referred to as the ‘trained’ or ‘qualified’ nurses, and to me this infers that HCAs and APs are therefore untrained or unqualified, when of course you are often highly qualified in the skills that you practise. To a patient who really wants to know that a person is competent, these terms can make it sound as if an HCA or APs isn’t, and I believe we should all use the term registered nurse, and try to avoid the use of ‘trained’ or ‘qualified’ . What do you think? Let us know at firstname.lastname@example.org or start a debate on the RCN Discussion Zone.
Cornock M (2008) Where the Buck Stops; Nursing Standard December 17; Vol 23 no 15-17 p 64
Cox C (2010) Legal Responsibility and Accountability; Nursing Management June 2010; Vol 17 no 3 p 18-20