Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

The Contribution of the Patient Support Assistant to Direct Patient Care: An Exploration of Nursing and PSA Role Perceptions

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

The Contribution of the Patient Support Assistant to Direct Patient Care: An Exploration of Nursing and PSA Role Perceptions

Article excerpt


It is widely acknowledged (Conway, McMillan & Becker 2006: 129) that managing the clinical workforce underpins quality health care delivery and that there is a 'need to respond to:

* demographic trends, most significantly the ageing of the population (both clientele and personnel);

* increased levels of acuity and chronicity among those who access health services;

* the shift from institutional to community care; and

* changing patterns of work and consumer expectations'.

In response to the global shortage of nurses, there has been a move in recent times to introduce unregulated personnel to the health care system to assist nurses. According to a Nurses Board of South Australia Discussion Paper (2002: 1):

... the term 'Unregulated Care Worker' encompasses a growing number of workers employed in a diverse range of settings who may undertake aspects of personal care, health care tasks, support for activities of daily living ....

In Australia, one type of unlicensed personnel is the Patient Support Assistant (PSA). This study aimed to examine the perceptions of both nurses and PSAs of the role undertaken by PSAs in direct care delivery in a public hospital in New South Wales, Australia.

According to their position description and industrial award PSAs at the health service examined in this study undertake duties within ward and inpatient units. They are responsible for general cleaning and housekeeping duties and provide assistance to nursing, medical and physiotherapy staff in the care of heavy or difficult to manage patients. Although they line report through the environmental services department, they are required to work in harmony with nurses to enhance direct patient care. However, there have been no formal studies in Australia of how PSAs contribute to patient care and the factors that enhance or inhibit that contribution.

In a climate of nurse workforce shortage and high patient acuity, this study sought to identify how PSAs contribute to patient experience when they undertake direct client contact at the direction of staff and/or when they fulfil their other responsibilities. The study aimed to identify:

1. how PSAs and nurses perceive the role of the PSA;

2. the factors that enhance or inhibit PSA contribution to patient care; and

3. the educational needs of PSAs regarding their role in direct patient care and the educational needs of nursing staff regarding the PSA role.


Literature review

A review of the literature related to unregulated care providers and nursing was under taken. This revealed that, despite relatively limited research investigating the role of support workers (Baldwin et al. 2003), one of the most frequently cited responses to the nursing workforce shortage has been the use of unlicensed assistants to undertake the 'non-professional tasks or duties... performed by scarce, highly trained professional nursing staff' (Tuttas 2005: 230). Factors leading to the use of unregulated personnel have included financial imperatives (Tuttas 2002), role creep in nursing (Johnson et al. 2002), shortages within both the regulated nursing workforce (Huston 1996) and a decrease in the number of personnel in apprenticeship models of training for nursing work (Buchan 1992).

There has been some attempt to suggest that the use of health care assistants are part of a long term solution to dwindling regulated health care workers numbers through providing career development opportunities that articulate to registration (Gould et al. 2004;Thornley 2000) and that in some cases, the use of health care assistants may enhance organisational and care effectiveness (Buchan and Dal Poz 2002; Hancock and Campbell 2006).

However, the use of such personnel is frequently reported to have amplified confusion among role responsibilities when providing direct patient care (Rogers 2002) and revealed that unlicensed personnel may be used to make clinical decisions beyond the scope of their role and educational preparation (Jack, Brown & Chapman 2004; Pearcy 2000). …

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