Roles in health care support

Common goals, different roles

The RCN briefing paper The Nursing Team: common goals, different roles (PDF 79KB) [how to access PDF files] explains how the members of the nursing team work together.

It is important for both the registered nurses delegating to an HCA, and to HCAs who have work delegated to them, to have a clear understanding of the principles of accountability and delegation.

Please visit our pages on accountability and delegation to view a short film and access further resources.

Health care assistants

A health care assistant (HCA) is defined as 'someone who works under the guidance of a registered health professional’ (NHS Careers and NHS Education for Scotland HCSW toolkit).

HCAs:

have their nursing tasks delegated to them and are supervised by registered professionals
are guided by protocols and act within these protocols at all times
perform tasks according to their competence levels (Career Framework levels 2 and 3 – Skills for Health, 2008)
must demonstrate competence supported with the required level of knowledge before being delegated particular tasks. They have a duty to inform the delegating professional if they do not have competence to perform a task
should not be required to make ‘stand-alone’ clinical judgements and plan the care of patients based on those judgements.

If you are interested in working as an HCA please visit 'How to become an HCA'.

Assistant practitioners

An assistant practitioner (AP) is a support worker who has been educated to a level above that of the HCA. One definition of the AP has been documented by Skills for Health (2009):

An Assistant Practitioner is a worker who competently delivers health and social care to and for people. They have a required level of knowledge and skill beyond that of the traditional healthcare assistant or support worker. The Assistant Practitioner would be able to deliver elements of health and social care and undertake clinical work in domains that have previously only been within the remit of registered professionals. The Assistant Practitioner may transcend professional boundaries. They are accountable to themselves, their employer, and, more importantly, the people they serve.

APs:

have a level of knowledge and skill beyond that of the traditional HCA (Career Framework level 4 – Skills for Health 2008)
support the work of registered professionals and may transcend professional boundaries
make judgements requiring a comparison of options
plan straight forward tasks and work guided by standard operating procedures and protocols
may undertake the ongoing supervision of routine work of others.

The role of AP in nursing teams is becoming more popular across the UK and many pre-registration nurse training courses accept the foundation degree or equivalent to step into the second year of the course. For more information on the role please visit 'How to become an assistant practitioner'.