Findings of the evaluation of the Care Assistant Development Programme

Learning from early implementation – SCIE evaluation report for HC-One

Recruitment and retention

In April 2016, 459 candidates had been recruited to the CADP and the Programme had sustained a high level of retention (97 per cent). Of the nursing assistants surveyed, the vast majority (82 per cent) were recruited from HC-One’s existing workforce and were experienced in working in health and social care, with 93 per cent having worked in the industry for four years or more.

The most important factors motivating candidates to join the CADP were to develop their skills, progress their career, and to improve quality of care for residents. Care staff valued having a progression route within the care home that was an alternative to nursing.

The recruitment process for the nursing assistant post consisted of a competency-based interview and a written assessment. Home managers regarded this process as rigorous and felt confident that it was assessing applicants for the right skills for the role.

Communicating the CADP

Communicating the nursing assistant role effectively to care home staff was an important step in introducing the Programme into a home. Some nursing assistants and other staff felt unclear about the remit of the role at first, though it was widely recognised that understanding improves as the Programme is embedded.

Nurses expressed a number of concerns about the role initially which could be addressed through clear information and through engaging nurses early to make them feel valued and invested in the Programme’s success. HC-One has since built this learning into the Programme’s introduction to home managers.

Just over half of residents (56 per cent) and relatives (57 per cent) surveyed were aware of the nursing assistant role. The most common way that residents and relatives found out about the role was directly through home staff and carers/senior carers in particular. Where residents and relatives indicated they had received information regarding the role they rated the quality of this information highly.

The survey findings present a positive picture overall of residents’ and relatives’ perceptions of the nursing assistant role. A notable minority of relatives (17 per cent) and residents (8 per cent) expressed worries or concerns. Relatives with worries and concerns sought reassurance regarding the level of training provided for nursing assistants and clarification around the remit of the role.

In response to early learning, HC-One launched an Implementation Review document to enable quality assurance checks to be made at each home on the Programme including verification that the Programme has been communicated effectively.

Training and development

All aspects of the Programme were rated highly by surveyed nursing assistants as having prepared them for their role as a nursing assistant: training workshops (96 per cent); nurse mentoring (92 per cent) and online learning (84 per cent).

Evidence across the evaluation suggests that the nurse mentor role is a valuable Programme element – 89 per cent of nursing assistants surveyed said they had felt supported by their nurse mentor. In cases where nursing assistants have felt less well supported, they often requested more time to practice in their new role under the supervision of a designated mentor.

The surveys indicated an overall increase in nursing assistants’ confidence in nine out of ten training and development areas covered by the Programme. Most striking was the increase in being ‘very confident’ in applying ‘leadership’ (118 per cent increase); ‘nutrition and hydration’ (78 per cent increase); and ‘understanding what is a quality service’ (70 per cent increase).

Requests for further training and development were varied but included wound care, care planning and end of life care.

Implementing the nursing assistant role

The context of each home is important in shaping implementation of the role. The size of a home, the layout and the existing culture and relationships between staff can all influence how the role works in practice. It may be necessary for home managers to intervene to ensure that new nursing assistants are building experience across all areas of practice.

Nursing assistants were seen to be undertaking a wide range of new tasks across the case study homes. The biggest change indicated in the survey was in managing/ leading a team with 85 per cent of respondents increasing their time spent on this task.

Nursing assistants largely indicated they feel supported in their role with a minority feeling less supported. They most commonly experience challenges around managing their workload, particularly when in a period of adjustment to their new post.

Emerging impacts for residents

Residents and relatives we spoke to reflected that they were happy for the nursing assistants to deliver some care that was previously done by a nurse, subject to them being trained to do so. Their experience of care from nursing assistants was positive and their overall experience of care was unchanged. Analysis of the KPI data across the 16 sampled homes showed an overall 27 per cent reduction in complaints and a five per cent increase in compliments compared to the same period the year previously.

Staff interviewed largely perceived the Programme to be positively impacting on residents care, however in the context of some homes care was seen to be delivered in much the same way as before. Observed impacts included: residents receiving greater consistency of care because of reduced agency use; more person-centred care because nursing assistants know them and their needs; and, more timely and responsive care because of the increased capacity across the home.

Some argued that care is being delivered more safely overall because staff are consistent and have more time. Analysis of KPI data from the 16 sampled homes show some early indicators of success including a substantial reduction in medication errors, incidents and safeguarding.

Emerging impacts for staff

The Programme has had an immediate impact for the nursing assistants in role. Across the case studies, nursing assistants reported feeling more satisfied in their role as a consequence of feeling better recognised and rewarded, enjoying the content of their new work and having opportunities to progress.

Nurses across homes reported that the Programme was having a positive effect for them where it had increased their capacity to spend more time on their tasks and with residents in the confidence that nursing assistants were supporting them.

Surveyed nursing assistants indicated that they thought the Programme was having a positive impact on improving communication between colleagues and improving understanding between colleagues. The case studies also highlighted instances where the Programme was perceived to have improved communication channels across staff roles.

The KPI data from the sampled 16 homes shows that total agency nurse spend across the homes decreased by 11 per cent overall in the period August 2015 to January 2016 compared to the same period the year previous.

Future of the CADP

This research suggests that the majority of nursing assistants surveyed and interviewed are happy in their new role and plan to stay with HC-One for the foreseeable future. Nevertheless, retaining nursing assistants within a competitive health and care market is a high priority for home managers.

Nursing assistants expressed a desire to continue to train and develop in their role. In the follow-on survey, 92 per cent indicated that progressing towards an NVQ Level 5 in Leadership and Management or an internally delivered leadership and management Programme would be useful. HC-One plans to keep nursing assistants engaged through further qualifications including launching mentoring qualifications and development opportunities which will allow nursing assistants to explore career pathways into care home management.