A comparison of the work of qualified nurses and nursing auxiliaries in primary, team and functional nursing wards

Abstract

Despite the large scale utilisation of nursing auxiliaries (NAs) within the health service, there is a paucity of research evaluating their effectiveness. This study aimed to compare the contribution to patient care of NAs with that of qualified nurses (QNs) using a qualitative indicator, nurse-patient verbal interaction. Different grades were also compared in terms of activities performed and perceptions of their work environment. The organisation of nursing work also has major implications for the roles of QNs and NAs. The study therefore also sought to evaluate the effect of three organisational modes, primary, team and functional nursing, on the work and work perceptions of both grades. A questionnaire was developed which discriminated between organisational modes. This was used to select three wards from each mode (nine in total) for participation in the study. Within each ward, four QNs and four NAs were chosen randomly for inclusion. Data were collected by direct observation and semi-structured interviews. Each subject also completed a Work Environment Scale. The most important differences were found across organisational mode, with QNs and NAs within modes engaging in similar patterns of work, verbal interactions with patients and regarding their work environment similarly. This suggests a culture exists within each organisational mode which permeates the work of both grades of staff. Primary wards were generally found to differ from team and functional wards, with both QNs and NAs regarding their work more positively and working in more therapeutic ways. The study has important implications for the debate about which grade of staff is most suited to caring for elderly patients. It is argued NAs are capable of providing therapeutic care for elderly patients within a pattern of ward organisation which facilitates sustained nursing staff-patient allocation and appropriate supervision and direction in the form of QNs working with NAs.