title: The role and accountability of senior health care support workers in intensive care units.
abstract: BACKGROUND
  Nurses have always looked to support their activities through the presence of unregistered co-workers. In the later part of the 20th century this workforce has evolved from a predominance of students to increasing use of variously prepared second level nurses, nursing assistants and Health Care Support Workers.
  
  
  METHODS
  The study evaluated the development of 'advanced' support workers for intensive care settings, examining the views of the multi-disciplinary team, the support workers, and making observations of the work undertaken. Ethical approval was gained via a multi-centre committee. Individual interviews, focus groups and fieldwork provided rich qualitative data. It is this, and the views of support workers themselves on which we focus in this report.
  
  
  RESULTS
  Senior support workers have a potentially important, but as yet insufficiently clear role to play. Key tasks such as taking arterial blood gas symbolise their rite of passage into the role. Expectations vary by locality and by person and there is great concern over accountability for work done. Delegation of work depends as much on experience as training and individuals are reluctant to delegate to staff they have not personally assessed and come to know as 'competent'.
  
  
  CONCLUSIONS
  These workers should have clear and adequately remunerated career pathways open to them, in particular into nursing and allied health disciplines, and should probably be licensed to practice.
authors.affiliation: Salford Centre for Nursing, Midwifery and Collaborative Research, University of Salford, C717 Allerton Building, Frederick Road, Manchester, UK. m.johnson2@salford.ac.uk
authors.forename: Martin
authors.initials: M
authors.lastname: Johnson
authors.forename: Paula
authors.initials: P
authors.lastname: Ormandy
authors.forename: Andrew
authors.initials: A
authors.lastname: Long
authors.forename: Claire
authors.initials: C
authors.lastname: Hulme
mesh_terms: D002983:Clinical Competence; D004739:England; D006801:Humans; D007318:Inservice Training; D007362:Intensive Care Units / Q000592:standards; D024802:Nurse's Role; D009728:Nursing Assistants / Q000193:education / Q000592:standards*; D009936:Organizational Innovation; D015397:Program Evaluation; D011787:Quality of Health Care; D012308:Risk Management; D000078329:Workforce