January 10th, 2018
Drawbacks of Use of Unregulated Care Providers
On the cons of using UCPs the safety and quality of care tops the list. It has for instance been advanced that a decrease in the ratio of professional care givers to other providers of care leads to an increase in mortality rate, average length of stay, and rate of re-hospitalization” (Gill, 1996, p. 1). Such observations have also been the based on the argument that the increasing outbreak of pandemics has brought home the need for safe staffing practices (ICN, 2006). What further buttresses this view is the observation that “adverse events such as falls, drug errors and inappropriate surgeries [are factors that increase] the morbidity and mortality of patients” (ICN, 2006, p. 9). Such would not however be a concern for UHWs were it not for the fact that these have been noted to have assumed roles that are increasing in complexity (CNO, 2009; CPNA, 2009; CAN, 2008). This then raises the a question as to whether UCPs have adequate skills so as not to compromise the standards of care needed.
With such an inquiry the training systems for UHWs would then be the context of evaluation. Without a uniform system of training, vetting and regulating the employment of these workers as has been noted to be the case (CNA, 2008); the level of care provided in different settings would fail to meet the minimal standards. Even with such training being there it is notable that technological and procedural trends with regard to care provision keep on changing (Gill, 1996; CNA, 2008). To be able to keep abreast with these advancements then the UCPs must be in an environment where continuous learning is provided (CNA, 2008). This then implies that were the organizations provide for such conditions; the gains for use of UCPs associated with cost reduction would not hold water since the lower salary benefit would be offset by the higher training costs (Gill, 1996). Similarly with such higher training the UCPs could expect increments in their income which when not accorded may affect their morale hence adversely affecting the level of care offered to clients and patients (CNA, 2008).
Secondly, in contrast to relieving nurses to concentrate on “more demanding duties”, use of UCPs could also blur the roles of various care providers thus compromising safety (CNA, 2008). With the suggestion that “there are no tasks that can always be delegated to a UCP safely because patient care is individualized and patient acuity changes rapidly”, the perception of UCPs helping nurses to perform their duties more effectively could be grounded on a false logic (Gill, 1996, p. 2). It has for instance been advanced that regulated nurses working with UCPs “spend more time in supervision, but less time in direct patient care” (Gill, 1996, p. 1). A study in dementia care settings reinforce such observations in its findings that UCPs practice in a “context of unpredictability, variability, and personal threat” hence their use of relevant knowledge to provide appropriate care would be influenced by the existence of a particular individual and diverse relational aspects (Janes, et al., 2008, p. 13). If such is the case, the least use of each health care provider required for attainment of minimum standard of care for each patient or client may be unachievable (CRNM, 2002). This then would mean that contrary to the view that UCPs help subjects to access requisite care, they actually preclude such access. However it has been noted that in some settings the use of UCPs have helped better the outcomes for populations where assess to health care professionals may be limited or absent (ICN, 2006; Ncama, 2005; Herron, 1996).