THE UNSUNG HEROES Susan Hopkins: RCN Practice Education/VQ Adviser susan.hopkins@rcn.uk

1. THE UNSUNG HEROES Susan Hopkins: RCN Practice Education/VQ Adviser susan.hopkins@rcn.org.uk

2. Ch’ch’ch’CHANGES… • Different healthcare needs • Ageing population/of nurses too! • Increasing expectations • Rise of ‘Consumerism’ philosophy • Rapid improvements in (healthcare) technology • Recruitment and retention • European Working Hours Directives • Leading to …changing roles • Public protection is vital…

3. LEGAL ISSUES • Will I be held responsible by a court for my actions? • Is it legal for me to be doing this? • Who is accountable? • Will I need separate insurance/indemnity for this role? • …the law does not generally prescribe who may perform a particular health care task • …it does insist there is a standard of care whoever is performing it • …you must therefore have the knowledge, skills and experience to perform it

4. CIVIL LAW/PROFESSIONAL NEGLIGENCE • Duty of care • Breach • Damage • ‘Labels’ don’t • guarantee competency!

5. REGULATION… • Registered professionals are regulated within statute and are accountable to their regulatory body- i.e. Nursing and Midwifery Council (NMC) for nurses, midwives and health visitors and, Health Professions Council (HPC) for physiotherapists, dietitians and so on. • Although HCAs are not currently regulated by statute they are accountable for their actions:

6. ACCOUNTABILITY AND HEALTH CARE STAFF… • The patient - civil law (The duty of care) • The public – criminal law • The employer – contract law • Additionally registered nurses are accountable to the regulatory body - NMC (Dimond 2005)

7. You remain accountable for the delegation of the work, for ensuring that the person who does the work is able to do it… “. . .Such delegation must not compromise existing care but must be directed to meeting the needs and serving the interests of patients and clients”. New draft B3 Delegate effectively B3.1 You must establish that anyone you delegate to is competent to carry out your instructions B3.2 You must confirm that the outcome of any delegated task meets required standards B3.3 You must make sure that everyone you are responsible for is properly supervised NMC CODE OF CONDUCT (2004)…UNDER REVIEW

8. HCAs AND ACCOUNTABILITY A HCA is accountable e.g. for the hygiene of patient if they… • Have the Ability- knowledge of hygiene needs- skill to carry it out- values, such as dignity, comfort and the feelings of the patient • Have Responsibility for assisting in the hygiene needs of the patient • Is given the Authority to do the job- delegation and job description

9. DELEGATION AND ACCOUNTABILITY • A Registered Nurse can transfer accountability if the HCA has the ability to do the task, has the responsibility because they are adequately prepared and are working within Trust Guidelines or protocols and have the authority delegated by the Registered Nurse. • The Registered Nurse is responsible for ensuring that the criteria for delegating are met. • The Registered Nurse would be accountable if delegation was inappropriate

10. QUESTION… Who is accountable for the care received by a patient when the RN delegates procedures to a HCA? 1) The HCA 2) The Registered Nurse 3) Both

11. ANSWER… The RN is accountable for delegating to a competent individual and ensuring the task is completed to a satisfactory level. If the HCA fails to deliver care to a level for which they have been prepared and assessed as competent then the HCA is accountable.

12. VICARIOUS LIABILITY AND INDEMNITY INSURANCE • NMC recommends that all nurses consider indemnity insurance but it is not a recommendation of registration • Organisations must have indemnity insurance against negligence by their staff (NHS organisation all have this, CNST) • vicarious liability is not optional and is important when developing or extending roles • where an employee was acting ‘in connection with’ her employment when she caused harm to the patient, the employer is vicariously liable for her actions.

13. INDEMNITY INSURANCE “It is unacceptable practice for an employing organisation to expect that an employee, whether registered nurse or health care support worker, who is enhancing his or her role, should take out their own insurance to cover any risks associated with that role. This is particularly unethical where the new role is likely to save the employer costs and enhance the quality of service provided for the patients. That is, and should remain, the responsibility of the employer.” (Chris Cox, RCN)

14. PRINCIPLES • The patient has the right to expect the same standard of care, and outcome of care, whoever is delivering it, and to know the qualifications of that person. • Practice must be based on legislation and employment policies, e.g. Care Standards Act 2000. • The Registered Nurse is accountable for their actions and for any delegation of duties • If the Registered Nurse is not confident that the HCA is competent they must not delegate the duty

15. PRINCIPLES HCAs must : • Be trained • assessed as competent • ensure that they maintain and update their competence • It is incumbent upon the employer to ensure that their staff are competent. Vicarious liability must be properly discharged • The NMC Code of Professional Conduct underpins these principles.

16. ISSUES

17. REGULATION: THINGS TO CONSIDER • RNs struck off register, become HCAs • No register for support workers • No one oversees their conduct. • NMC should regulate HCAs? Or HPC, or independent? • Scottish model, employers responsible for monitoring conduct and training of HCAs locally. • Centralised list of HCAs • National codes of practice • Employers and HCAs • Employers not obliged to place HCAs on the list

18. FINALLY… • Nurses remain accountable for planning of care and for determining the activity of their support staff • HCAs must not be allowed to work beyond their level of competence • HCAs should be integral members of the caring team • HCAs should be supported with their professional development • Career pathways?

19. FINALLY… • Nurses and HCAs have a duty of care to patients. • Inexperience is no defence to a claim of negligence. • When things go wrong, you are judged against the standard that would reasonably be expected from an ordinarily competent practitioner. • There is no excuse for getting basics wrong, such as poor handwriting in a patient record or failing to read relevant patient notes. • Employers must ensure staff are trained and supervised to provide care to a legal standard.

20. WELCOME TO THE RCN FAMILY Support • Over 390,000 members • Voice of nursing in the UK • Resources you need to deliver high quality patient care • Clinical information to back up your S/NVQ work

21. ADVICE • Range of publications available online • Specialist advisers and networking opportunities • Dedicated adviser leading on recognising and supporting the interests and needs of HCAs

22. PROTECT • £3m indemnity insurance • Personal injury insurance • Free 30 minute legal advice session

23. MORE THAN JUST A UNION… • Personal counselling • Careers information and guidance • Support and advice if you become ill, injured or disabled • Advice on welfare rights • Discounts on products and financial services • Personal loans • Discount shopping on the high street

24. WHO CAN JOIN? • If your work is delegated to you by a registered nurse or midwife – or you have a qualification (or are working towards a qualification) in health and care level one of the National Qualifications Framework in England or level three of the Scottish Credit and Qualifications Framework in Scotland.

25. HOW CAN YOU JOIN? • Ask me for an application form today! • To join online, or for more information, visit www.rcn.org.uk or call RCN Direct on 0845 772 6100

26. Stop press! • National RCN conference for health care support workers - 29th November 2007 at RCN headquarters in London. • Bring together HCSWs and those involved with their employment, education and support • Covers the latest developments and views on issues around regulation, roles and responsibilities, career pathways and education. • Visit our website at www.rcn.org.uk/events for more information or contact Mirka at mirka.ferdosian@rcn.org.uk or on 020 7647 3583 to register for the event.