Our hospital is about to begin a trial of Assistants in Nursing (AIN’s).
AIN’s are currently being injected into the health system in response to the impending desiccation of the nursing workforce.
The Australian Health Workforce Institute published a paper titled “Australian Nursing Workforce Research October 2008“, in which they cited Schofield (2007) who predicted “that during 2006 – 2026, Australia is projected to lose almost 60% of the current nursing workforce … an average of 14% of the nursing workforce every 5 years, and a total of around 90,000 nurses”.
The fact is that Universities are hard pressed to educate and train enough new graduate nurses to replace this exodus. And even if they could, many of those leaving the workforce are in senior clinical and administrative positions who will be pulling the plug from a deep vessel of accumulated knowledge, skills and experience.
AINs may be recruited as a Certificate III unregistered health service assistant or a student enrolled as an undergraduate nurse.
It is a great opportunity to expose undergraduates to a clinical environment whilst allowing them to financially support themselves during their studies.
AIN’s work under the supervision of a registered nurse and are able to deliver patient care under a prescriptive duty statement.
The Australian Nurses Federation position statement on AIN’s states:
Assistants in nursing or midwifery and other unlicensed workers (however titled) assist nurses and midwives in the provision of nursing and midwifery care where clinically appropriate. All aspects of nursing and midwifery care undertaken by assistants in nursing or midwifery or other unlicensed workers (however titled) are determined, delegated and supervised by a registered nurse or midwife. Supervision may be direct or indirect.
AIN’s can assist with many patient centered tasks including: patient showering, assisting with mobility and toileting, feeding of patients, answering callbells, providing a patient escort, and even recording patient observations1.
All very helpful, and potentially freeing up nurses for other more complex duties2.
My big problem lays in two small letters: Assistants in Nursing.
Call them assistants TO nursing and all is well and welcome. Send us a bus load ASAP.
But call them assistants IN nursing and you are very close to calling them them nurses.
For example, take a look at this paragraph from the NSW nurses association policy on Assistants in Nursing relating to non-undergaduate AIN’s:
Nursing care is provided by registered nurses and enrolled nurses. Assistants in nursing assist registered nurses and enrolled nurses in the provision of nursing care. All persons who provide or assist in the provision of nursing care to any individual or group are performing nursing work.
To me this sounds pretty close to calling even non-undergraduate AIN’s nurses.
Once AIN’s are counted as nurses, you can use them to replace registered nurses and enrolled nurses to fill rostering shortfalls. They could be used to replace the existing nursing workforce rather than augmenting it.
“Well, all our wards are fully staffed with nurses.”
Nurses that are cheap to employ, and can be churned out onto the wards in a very short period of time (that is weeks rather than years). A very cost-effective proposition for staffing our over budget, understaffed hospitals.
This would put a tremendous clinical pressure, not to mention exceptional workloads on the registered nurses remaining on the wards.
The resulting long term effect on staff morale and patient care might also result in a very negative experience for the very undergraduaes we are trying to nurture.
What do you think?
Is this going to improve or degrade the provision of quality nursing care to our patients?
Are AIN’s the answer to some of our problems….or one giant leap backwards for the future of our profession?
I would love to hear of the experiences of anyone who currently works with AIN’s.
Or anyone who is working as one.
Lets get a bit of a conversation going about this one …….
- Appendix 1: Assistants in Nursing Report 2008-2009 [↩]
- Although Im not so sure about the recording of patient observations [↩]
Would you leave your car to be fixed by a mechanics’ assistant? Or fly in a plane where the pilot was only an assistant? Would you allow the vets assistant to operate on your dog? Or a legal assistant to run your court case? How about a brick layers labourer design and build your home? I dare say you wouldn’t. But when we talk about replacing qualified nurses with assistants in nursing people don’t seem to care because they tend to think about the impact on others rather than themselves. I wonder how they would feel if all the had were assistants running the hospitals and it was them or their loved one who needed emergency treatment, surgery and intensive care.
Christina,
You may have trained for 2 years, but I’ll bet it wasn’t 5 days a week. Therefore, it’s not the same thing.
And there does need to be a line drawn. It’s all about patient safety. Nursing Assistants (because that’s what they are, NOT nurses) should be differentiated from ENs and RNs in training. They do not have the clinical knowledge that trainee nurses have. A third year nursing student should have a great deal more clinical knowledge than someone who has been an AiN for 3 years.
I don’t think anyone has deemed AiNs incompetent. It is a simple fact that they do not have the same training or clinical knowledge. Student ENs and RNs mostly don’t get paid and yet do mostly the same unsupervised work as an AiN. Student ENs and RNs are also able to give medication under supervision, something AiNs are not allowed to do in an acute setting.
I have met many AiNs who can’t make sense of clinical observations and so they don’t know when to inform the RN if there’s a problem. If a trainee EN or RN did that, they should not be allowed to graduate. Massive differences!!
Please don’t assume that all AIN’s only train for 4 weeks. I am currently an AIN who trained at TAFE for 2 years as the course contributed to my HSC. The extra time in the course definitely benefited me in being able to work clinically and to also have much needed experience whilst studying my RN’s at University. I have seen fantastic AIN’s that are more intune with thier patients feelings and needs than their RN’s and thus should not be deemed incompetent. They too are quick to think on their feet during emergencies like RN’s.
I do not think there needs to be a difference in title between AIN’s and those training to do RNs or ENs. The differentiation will cause discrepancies between staff.
As a BNurs student, its sad to see fellow students working in restauraunts and supermarkets to get themselves through Uni. Its a win-win situation if they can actually work in the industry in which they are training – I believe it will make for a better RN in the long run.
Perhaps there needs to be a differentiation between those that are not training to be ENs or RNs and those that are. But please don’t call us Nurses in Training (NiTS)!! LOL.
Firstly, I love how this subject has been commented on for 2 years!
AIN: Assistant to Nurses
EN: Enrolled nurse, works under the direction of an RN within their own scope of practice
RN: Registered nurse, who all the shit lands on if it goes haywire!
What I don’t understand is why some AIN’s here are being all hoytie toytie about other staff that they work with.. you think you can do a better job at being a nurse than someone who has spend the required time at tafe or uni? I’d like to see that! You’d probably piss your pants the first time a patient coded or needed an IDC or you had to hold a patient down to insert a cannula because they are delirious due to a UTI..
Why would you piss your pants? Because in the 4 weeks of training that you have had, they didn’t train you to do these things!
Likewise if I had a patient in the ED who needed me to crack his chest and clamp a vessel, I’d probably piss my pants too! I’m not trained to do this!
I personally think AIN’s are a great idea, EN’s and RN’s work very hard, with high patient ratios and less time then ever, the care in nursing is unfortunately the first thing to go… because if we miss someones meds or forget to do some aspect of their ‘clincal’ welfare, the patient could die..
Having said that, an AIN could be worth their weight in gold, picking up all the slack from the non clincal stuff that at times gets pushed to the side.
It would be nice to know Ian, have your views on AIN’s have changed now that they have been implemented for over 2 years (?) at TCH
wow, generalise much? RN this and RN that seriously, its people that are this and people are that. Not RN’s EN’s and AIN’s. Ive met prats in every walk of life. If my mechanic is a Prat i say his behaving like a prat and go to someone else. I don’t say Mechanics are prats!!!! I’ve seen great carers and really bad ones. RN’s i have met seem to be a bit anal at times but that could be the crap they have to deal with all the time. These poor souls seemed over worked and stressed out. If crap hits the fan it usually lands on them too. Doctors close ranks the Nurse is hung out to dry. I’m not against any quality help but if my ass is on the line too I’d be watching the proposed developments with concerned interest. If you walk onto a ward and see a stressed out RN you might think they’re a prat too. However what you may not know is that poor Nurse is in charge of 6 patients just started their shift have 3 patients to prep and admit for theatre. Plus 2 patients that have just returned from theatre. The remaining patients is supposed to be going home. Any person working under these stressful conditions would struggle with the stress. Years of this will change a person.