THE UNSUNG HEROES

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• THE UNSUNG HEROES
• Susan Hopkins
• RCN Practice Education/VQ Adviser
• susan.hopkins_at_rcn.org.uk

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ChchchCHANGES

• 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

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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

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CIVIL LAW/PROFESSIONAL NEGLIGENCE

• Duty of care
• Breach
• Damage
• Labels dont
• guarantee competency!

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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

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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)

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NMC CODE OF CONDUCT (2004)UNDER REVIEW

• 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

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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

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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

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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

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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.

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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.

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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)

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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

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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.

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ISSUES
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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

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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?

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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.

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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

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ADVICE

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

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PROTECT

• 3m indemnity insurance
• Personal injury insurance
• Free 30 minute legal advice session

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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

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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.

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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

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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_at_rcn.org.uk or on 020 7647 3583 to
  register for the event.