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HCAs must have nurse supervision under new Wales staffing law

Tagged In:  Nursing

Draft guidance from the Welsh Government says that healthcare assistants (HCAs) must be supervised by an appropriate number of registered nurses.

In 2015 the Royal College of Nursing (RCN) surveyed over 1000 nurses in Wales. Their main concern was safe staffing levels. Working closely with the RCN, the Welsh Assembly introduced new legislation to ensure nurses are deployed in sufficient numbers.

Now the Welsh Government has issued guidance and a consultation document on the new law. It encourages the recruitment of HCAs, but also states that their numbers must be balanced with the right number of registered nurses to provide effective supervision. RCN Wales Director Tina Donnelly said, "When calculating staffing, people often don't take into consideration that when you are designating a registered nurse to look after patients, they have additional duties of supervising non-registered care workers."

Currently only applying to adult acute medical and surgical inpatient wards, the Nurse Staffing Levels (Wales) Act 2016 became law on 21 March last year. The draft statutory guidance advises on how staffing levels should be calculated and maintained. It says that a designated person, usually a senior nurse, should 'calculate the number of nurses appropriate to provide patient centred care', as assessed by the ward nursing team.

In 2015 the Welsh Minister for Health and Social Services, Mark Drakeford, issued new strengthened training standards for healthcare support workers in nursing, midwifery and allied health roles in the Welsh NHS. The framework set out three levels of support work with varying degrees of autonomy. However, it made clear that all three depended on appropriate supervision by a registered practitioner.

The Welsh Government has also published a Code of Conduct for Healthcare Support Workers to provide them with guidance and support to ensure they meet the standards expected of them. One of the key topics in the document is accountability. It says that healthcare support workers must always seek guidance from their supervisor if they do not feel able or adequately prepared to carry out any aspect of their work, or are unsure how to effectively deliver a given task. It also instructs them to be aware of their own limitations: "If you do not feel competent to undertake an activity, you must report this to your supervisor." 

The consultation on the draft nurse staffing law guidance is due to be completed in April and may result in further clarification. The Welsh Government's All Wales Nursing Principles for Nursing Staff, issued in 2013, has already established that staffing level ratios should be 60% registered nurses to 40% HCAs.

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