Researchers recommend clearer national guidance on the role of community nursing assistants

A pioneering study led by researchers from the University of York highlights the role and contribution of community nursing assistants and their potential impact on patient experience.

The study published today, which was funded by the National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR) Programme, concludes that while assistants provide flexibility to community nursing teams, allowing them to respond to changing demands, the development of the assistant role has been relatively neglected.

Based on their findings, the researchers recommend clearer national guidance on assistants' roles and responsibilities, which they say will reduce local confusion and highlight areas where assistants can benefit organisations and patient care.

The results of the study, which researchers believe is the first to explore the roles of assistants in community nursing, are published in Health Services and Delivery Research, part of the NIHR Journals Library.

Community nursing is nursing care delivered in locations such as a patient's home, a residential care home or health centre. Assistants work alongside and under the guidance of registered nurses and other healthcare professionals.

Lead researcher Professor Karen Spilsbury from York's Department of Health Sciences, said: "As the disease burden shifts from acute to chronic conditions, community nursing services face the growing challenge of caring for increasingly dependent patients with complex care needs. This is further exacerbated by the emphasis on providing care and services closer to patients' homes rather than in hospitals.

"The skills of the entire nursing workforce need to be deployed and used appropriately and efficiently. Over the last decade there has been a significant increase in the number of assistants working in community nursing teams, yet there appears to be a lack of consistency in their roles and responsibilities."

The study looked at the delivery of care to adult patients by community nursing services and the potential impacts of assistants working at levels 2, 3 and 4. It was based on interviews with senior managers.

The researchers found that assistants are especially valuable in supporting routine care and enabling registered nurses to focus on the more complex cases. They also provide opportunities for a more efficient skill mix, promoting better use of resources and providing stability to the workforce.

Professor Spilsbury said: "There is general enthusiasm among managers about the contribution of assistants and their employment is regarded as fundamental to the ability of community nursing teams to deliver an acceptable and appropriate service. Assistants are also valued for the maturity and life experiences they frequently bring to the role.

"However, there is a lack of consensus in defining the role of community nursing assistants which has created inconsistency in the ways these roles are deployed and are developing nationally. Roles appear to be strongly influenced by local factors such as staff shortages, organisational changes or rurality. This lack of consensus about the appropriate role and responsibilities for assistants is leading to a lack of consistency, not just across different organisations, but within services in an organisation."

The findings also highlight a lack of clear structure for career development and progression for community nursing assistants, as well as challenges in terms of line management when trying to balance the management of risk while promoting innovation in service delivery.