As demands on healthcare services increase, so too do the number of personal care assistants (PCAs) and assistants in nursing (AINs) employed to support their registered colleagues.
Care assistants are now well established as valuable team members within a wide variety of clinical specialities. But their relative lack of access to continuing education is starting to become a cause for concern, both for organisations and for clients.
McCready and MacDonald (2002) for example, report that the provision of continuing education for support workers has typically been at the discretion of individual employers. But there is a growing consensus of opinion that healthcare assistants need easy access to professional development, education and support, in just the same way as their fully trained colleagues.
As Arblaster et al. (2004) suggests, the fact that healthcare support workers often find themselves on the front line of patient care makes it essential that they are appropriately trained and competent to deliver the fundamentals of care.
Beyond this, many would argue they also need access to appropriate continuing professional development (CPD), that opens up a viable career pathway leading to professional qualifications (Field and Smith 2003).
Non-professionally qualified workers have traditionally provided a substantial and often under recognised contribution to healthcare services. As Skills for Health (2018) point out, care assistants often spend more direct time with patients than professionally qualified carers, sometimes even substituting for qualified members of staff.
Historically the wide variety of care assistant roles that now exist have all originated from the need to ‘fill the gaps’ created by staff shortages, along with the drive for increased productivity and the need for totally new roles to take on specific tasks.
Does Training the Care Assistants Make a Difference?
Many health authorities are reluctant to finance training events for care assistants because this is viewed as non-essential funding. However, results from a recent research review suggest that providing education for the wider workforce helps improve the productivity, quality and safety of services (Skills for Health 2018).
Opponents to this idea point out that the quality of this research is often problematic.
Even so, there is still a clear indication that training and development for the wider workforce has a direct relationship to improved quality of care. For example, researchers found that healthcare assistants play a key role in care homes and that pivotal to their effective performance is preparation, training and support (Skills for Health 2018).
Demonstrating the Need for Further Training
For the past fifteen years or more, research studies have been advocating the need for CPD for care assistants.
For example, the work of Fowler (2003) supports the findings of McCready and MacDonald (2002), highlighting a growing consensus that health care assistants need to have access to professional development, education and support.
The following statistics from their research clearly indicate a workforce group that is highly motivated to pursue further training, skill-building and career development:
86 % recognised that they could formally learn other ‘more advanced skills and competencies’
72 % reported wanting ‘increased responsibility and challenge at work’.
These findings from over a decade ago, are still relevant today, indicating that little has changed, and that care assistants are still struggling to gain access to high quality continuing education.
Lack of Understanding, Lack of Research and Lack of Resources
In the view of Munn et al. (2011), the majority of care assistants would welcome the opportunity for further training, a fact that is clearly demonstrated by the oversubscription of many courses. They also suggest that employers have both moral and practical obligations to enable staff who have the potential, or talents to progress, to do so.
It’s a controversial point that not everyone agrees with, but it’s another indicator of the growing pressures on employers to provide for the ongoing educational needs of all staff members, regardless of qualifications.
That said, Munn et al. (2011) also flagged up the need for uniformity, suggesting that a common concern within the literature is the need to standardise the training provided to care assistants.
One of the acknowledged challenges in providing ongoing education for health care assistants is embracing their diversity of roles and professional titles. This diversity is also reflected in the wide variety of award titles that accompany further training, making it difficult to transfer between employers and clinical areas.
Skills for Health (2013) neatly summarise these challenges, suggesting the following broad areas for improvement:
Improved flexibility and further modernisation of models of delivery in response to changing service pressures.
Further educational resources for healthcare support workers employed in the community.
Greater consistency in award titles, so that support workers can move more easily between different employers.
The development of a sustainable funding model and recognition that these programmes are resource intensive.
Further work on the interface between support worker education programmes and pre-registration programmes.
Further research into the effectiveness of this workforce from both a service user and carer perspective.
(Skills for Health 2013)
Munn et al. (2011) suggest that training for care assistants should be mostly of a practical nature, use a variety of adult learning styles and be as relevant as possible to the associated profession of the learner.
It’s a conclusion echoed by Webb (2011) who points out that in a continually evolving health service, care assistants in particular, need to be able to work to their full potential.
Why is this so important? Because without relevant ongoing education, there is a real risk that care assistants can be left with insufficient knowledge and competence to carry out their duties. This means that employers must be seen to advocate, support and implement education and training programmes for healthcare assistants as well as other support workers (Skills for Health 2018).
Fowler (2003) also provides a useful overview of the key action steps care assistants feel they need to update their training opportunities. These include:
Equity of access to learning opportunities
Meaningful recognition of the completion of further training
The use of assessed competencies in the workplace
A structured, standardised approach to the provision of training opportunities
Yet in spite of this consensus of views amongst care assistants themselves, the relative lack of robust research evidence in this area remains a stumbling block for many employers.
In particular, Skills for Health (2003) suggests that further research outside of the hospital setting is urgently needed along with further detailed studies on the return of investment. Healthcare assistants are after all, key players in the frontline workforce and even though they have the least access to formal training they often have the most contact with patients.
For many employers, the lack of current research is often cited as a valid reason for not upskilling their care assistant workforce. Yet evidence suggests that for the past decade at least, relevant research has been side-lined in favour of offering CPD for registered members of staff.
Arblaster, G., Streather, C., Hugill, L., McKenzie, M. and Missenden J. (2004) ‘A training programme for healthcare support workers.’, Nurs Standard, 18(43), pp. 33-37 [Online]. Available at: https://www.ncbi.nlm.nih.gov/pubmed/15318650(Accessed: 01.03.19).
Field, L. and Smith, B. (2003) ‘AN essential care course for healthcare assistants’, Nursing Standard, 17(44), pp. 33-35 [Online]. Available at: https://www.researchgate.net/publication/10638052_AN_essential_care_course_for_healthcare_assistants(Accessed: 3.3.19).
McCready, T. and MacDonald, J. (2002) ‘Development of an accredited cancer course for health care assistants. ‘, Nursing standard, 16(16), pp. 41-42 [Online]. Available at: https://www.researchgate.net/publication/285056235_Development_of_an_accredited_cancer_course_for_health_care_assistants_Nursing_standard_1616_41_42_Mc_Cready_T_MacDonald_J(Accessed: 3.3.19).
Skills for Health (2018) Does training the wider workforce make a difference?, Available at: http://www.skillsforhealth.org.uk/index.php?option=com_mtree&task=att_download&link_id=99&cf_id=24(Accessed: 3.3.19).
Skills For Health (2013) The Higher Education Contribution To Education and Training for healthcare Assistants For Healthcare Support Worker Roles, Available at: good bmj article here https://bmjopen.bmj.com/content/bmjopen/4/5/e005356.full.pdf (Accessed: 3.3.19).
Webb, S.C. (2011) ‘Education for healthcare assistants working in acute NHS hospitals’, Nursing Standard, 25(41), pp. 41-46 [Online]. Available at: https://www.brief-encounters.org/wp-content/uploads/2014/01/Art-and-science-education-Education-for-healthcare-assistants-in-acute-NHS-hospitals.pdf(Accessed: 3.3.19).