The contribution of the Patient Support Assistant to direct patient care: an exploration of nursing and PSA role perceptions.

Health care systems have seen the introduction of the unregulated worker into patient care areas to assist Registered Nurses (RNs) in the provision of health care. A study was undertaken to identify the perceptions of both nurses and unregulated workers of the unregulated worker role in direct patient care in a regional hospital in New South Wales, Australia. The nomenclature used for a non regulated worker in the workplace in which this study occurred is Patient Support Assistant (PSA). Separate surveys were designed for PSA and nursing staff. Twenty seven per cent of PSAs (n=21) and 36% of nursing staff surveyed (n=120) responded. Results identified that both groups identified the main role of PSAs were attending to general cleaning and providing physical assistance to nurses, medical and physiotherapy staff, primarily for manual handling of heavy or difficult patients. Some activities of the role identified in the job description, such as pre-operative shaves on male patients and assisting with the application of traction, appeared no longer to be relevant for current practices. Both groups identified a positive team working relationship between nurses and PSAs. However, there was evidence to suggest that not all RNs had a clear understanding of the role of the PSA and the PSAs believed that they did not receive adequate feedback about their work. There was a mixed view as to whom the PSA should report. A high percentage of RNs felt they should be responsible for the supervision of the PSA. This was in contrast to a high percentage also believing that RNs should not be accountable either for PSA work or for delegating tasks to PSAs. Challenges voiced by PSAs included being expected to achieve both allocated cleaning tasks and provide patient support, being requested to assist with aggressive patients and working with other PSAs. A major recommendation of the study is that employment of Assistants in Nursing may provide enhanced scope and role clarity for unregulated workers to assist nurses in providing nursing care.