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Evaluating the role
of enhanced care workers

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Q. There are lots of new roles developing in social care at the moment. What is the emerging role of enhanced care worker and what role will they play?

A. George Holley-Moore, Research and Policy Manager, International Longevity Centre – UK


The challenges facing the adult social care sector are well known. Chronic long-term underfunding, challenges around staff recruitment and retention as well as an ageing population, often with high support needs, mean that the sector needs to innovate to survive.

The International Longevity Centre-UK (ILC-UK), a think-tank addressing the challenges of demographic change and population ageing, were commissioned by the Department of Health to scope an emerging role in the social care sector where a care worker is upskilled to provide enhanced clinical support to registered nurses.

The new report, Innovate to Alleviate: Exploring how the role of an enhanced care worker could address skills shortages in the social care sector, provides, for the first time, an analysis of the emerging role of the enhanced care worker, with a focus on the characteristics of the job, any challenges faced, and what lessons can be learned if providers were to implement the enhanced care worker role. We found that the new role has been given different titles in different care homes, including senior care lead and care practitioner; for clarity we reference all these roles as an enhanced care worker, as they all share certain characteristics.

The report was informed by a series of interviews with care home managers, nurses and enhanced care workers from a range of different care homes.

The characteristics of this emerging role

While the role is not homogeneous across the sector, the research found that there are certain similarities that run across the job description.

Enhanced clinical support

Enhanced care workers undertake a variety of clinical tasks, either independently or in assisting the nurse, including the administration of medication and simple wound care. Other clinical tasks cited as part of the job description included: ensuring care profiles are up to date; assisting in developing care plans; taking blood pressure; helping with nutrition plans; managing vital signs; and conducting blood sugar analysis.

Softer skills

As well as qualifications such as NVQs and training in clinical skills, all interviewees noted that staff members for the enhanced care worker role needed ‘softer’ skills, such as learning quickly, a desire to advance their career and a willingness to ‘go the extra mile’.

Leadership and management

Leadership and management skills were another defining element of the emerging role. Enhanced care workers need the ability to cope well with stress, natural leadership skills, an ability to cope well under pressure, and a willingness to take the initiative – all important characteristics to look out for.

Implementing the role

As well as gaining an understanding of how the enhanced care worker role is developing across the sector, in compiling the report we also identified some key themes associated with the role in practice.

These themes offer insights into the current feeling of how the role is working in individual care homes, incorporating the views of managers, nurses and care workers. They also provide an understanding of what is working in the role, whether there have been any challenges in implementing the role and how these barriers were addressed and overcome.

Training and qualifications

There is training and a need to develop qualifications and skills for enhanced care workers that are specific to working in a care home setting. The research found that crucial to the new role was the need to acknowledge that nursing in a care setting can often require a different skill set to nursing in a hospital setting. In gathering evidence for the evaluation of the role, it was emphasised that there is a need for enhanced care workers to be personally motivated and able to emotionally connect with the role, as well as the people they are caring for. This is crucial to the success of the role and integration of the enhanced care worker within a care home setting.

Relationship with registered nurse

A strong working relationship between the registered nurse and the enhanced care worker is vital in ensuring that the new role is a success. Many of the interviewees highlighted that there were initial tensions between the two roles; this is understandable as the registered nurses may feel threatened.

the overwhelming response from staff at all levels was that the enhanced care worker role makes a real difference to their organisation and the people they support.

However, these tensions almost always eased over time. Reasons for this included regular meetings between registered nurses and enhanced care workers to voice any concerns, as well as registered nurses seeing, over time, the benefit of the support provided by the new enhanced care worker role.

Concerns over accountability

Often the most significant concern from registered nurses was found to be issues of accountability. To resolve these concerns organisations developed their own strategies and these varied depending on the organisation.

Some organisations stated that enhanced care workers were fully accountable for their actions. Whereas others stated that the line of accountability ultimately lay with the registered nurses. This led to some registered nurses feeling particularly wary about the situation. However, accountability appeared less of an issue where the registered nurse was actively involved in developing the enhanced care worker role.

Making a difference

Whilst the scope of the research did not allow for a full evaluation of the enhanced care worker role, the overwhelming response from staff at all levels was that the enhanced care worker role makes a real difference to their organisation and the people they support. Not only did it address staffing issues and allow nurses to spend more time providing more complex care, it was also reported that residents were often more comfortable discussing their specific needs with the enhanced care workers who spent more time with the residents on a daily basis.

Lessons learned

To assist with the potential roll out of the enhanced care worker role, we evaluated the key ‘lessons learned’ by the participating organisations. These are of particular importance to providers who are considering implementing the role. There are a number of experiences that could contribute towards successful implementation.

Clearly define roles and accountability

It is important to establish clear communication on the lines of accountability and the delegation of tasks to ensure smoother integration of the role into the organisation. When evaluating the role, it was found that whilst accountability can be troubling to nurses, concerns can be mitigated by clearly establishing accountability lines to give both parties clear definition of responsibilities.

Training

The enhanced care worker needs a full and rigorous training programme to give them the knowledge, understanding and training necessary to work alongside registered nurses. Ideally, the training programme should involve nurses as well. This can foster good working relationships and alleviate nurses’ fears around allowing enhanced care workers to undertake clinical tasks, such as administering medication.

Minister of State for Community and Social Care, Rt Hon. Alistair Burt MP said of the Enhanced Care Worker role, ‘The adult social care sector is facing unprecedented challenges, and this newly developed “Enhanced Care Worker” role has the potential to provide much needed clinical support in care homes.

‘I welcome this report, and its analysis of the challenges and opportunities of this emerging role. It will provide valuable insight for care homes when considering how best to implement it.’

Communication

An environment which allows for open communication between all levels of staff was also found to be beneficial; it was highlighted that this is crucial to create an environment where enhanced care workers can speak up if they are not confident in undertaking a clinical task.

Involvement in planning

It’s important to involve both registered nurses and enhanced care workers in regular planning meetings. Transferring greater responsibilities in terms of care delivery to enhanced care workers should be accompanied by greater involvement of them in planning meetings. This can improve care by giving them a voice on residents’ potential needs, as well as fostering a sense of inclusivity that can strengthen the relationship between the registered nurses and enhanced care workers.

Importance of softer skills

There needs to be a focus on, or recognition of, the softer skills mentioned previously. The kind of nursing undertaken in care homes relies on a strong set of softer skills that foster an understanding of residents’ emotional and psycho-social needs. Developing the enhanced care worker role may be boosted by looking beyond clinical training and qualifications to actively recognise the importance of such softer skills.

Growing pains

All organisations should recognise that there will be growing pains in the process. The potential benefits of the enhanced care worker role must be seen in the long-term, and care homes interested in implementing the enhanced care worker role should prepare for some short-term disruptions. While the short-term challenges may be mitigated through proper preparation and clear communication, care homes should nonetheless be aware that the initial phasing in of the role is likely to be something of a bumpy ride.

Further work

The analysis of the role and accompanying report makes clear that there is still the need for greater research on the impact of the enhanced care workers. The scope of the research did not allow for a full evaluation. However, this report, the first to provide a scope of this emerging role in the adult social care sector, provides an analysis of how this new role is emerging in care homes, from the point of view of frontline staff and management.

The full report, Innovate to Alleviate: Exploring how the role of an enhanced care worker could address skills shortages in the social care sector is available to download from the ILC-UK’s website www.ilcuk.org.uk

George Holley-Moore is Research and Policy Manager at International Longevity Centre – UK. Email: GeorgeHolley-Moore@ilcuk.org.uk Twitter: @ILCUK

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