A question of competence? Re-evaluating the roles of the nursing auxiliary and health care assistant in the NHS.

This article draws from the first national sample survey evidence and detailed case studies of both the long-standing grade of Nursing Auxiliary/Assistant and of the new grade of 'Health Care Assistant/Support Worker' in the NHS. It argues for a fundamental re-evaluation of the real competencies of non-registered caregivers, and of their potential to progress into registered nurse training. The study demonstrates their real maturity, experience, competencies, roles and responsibilities, along with the extent to which they perceive themselves as 'substituting' for registered nursing staff. It is shown that many have been blocked from entering registered nurse training due to domestic and financial constraints. The rise of NVQ accreditation has now provided both the potential for a formal recognition of their experimental learning and also the means by which they might progress into registered nurse training or even along parallel--and more practice-orientated--lines. It is argued that registered nurses should welcome a more fluid and progressive role for these team members, since, failing such a welcome, managers will otherwise continue to 'undercut' registered staff with their 'cheaper' non-registered caregiving colleagues.