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Researchers recommend clearer national guidance on the role of community nursing assistants

Posted on 10 June 2013

A pioneering study led by researchers from the University of York highlights the role and contribution of community nursing assistants and their potential impact on patient experience.

The study published today, which was funded by the National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR) Programme, concludes that while assistants provide flexibility to community nursing teams, allowing them to respond to changing demands, the development of the assistant role has been relatively neglected.

Based on their findings, the researchers recommend clearer national guidance on assistants’ roles and responsibilities, which they say will reduce local confusion and highlight areas where assistants can benefit organisations and patient care.

The results of the study, which researchers believe is the first to explore the roles of assistants in community nursing, are published in Health Services and Delivery Research, part of the NIHR Journals Library.

Community nursing is nursing care delivered in locations such as a patient’s home, a residential care home or health centre. Assistants work alongside and under the guidance of registered nurses and other healthcare professionals.

Over the last decade there has been a significant increase in the number of assistants working in community nursing teams, yet there appears to be a lack of consistency in their roles and responsibilities.

Professor Karen Spilsbury

Lead researcher Professor Karen Spilsbury from York’s Department of Health Sciences, said: “As the disease burden shifts from acute to chronic conditions, community nursing services face the growing challenge of caring for increasingly dependent patients with complex care needs. This is further exacerbated by the emphasis on providing care and services closer to patients’ homes rather than in hospitals.

“The skills of the entire nursing workforce need to be deployed and used appropriately and efficiently. Over the last decade there has been a significant increase in the number of assistants working in community nursing teams, yet there appears to be a lack of consistency in their roles and responsibilities.”

The study looked at the delivery of care to adult patients by community nursing services and the potential impacts of assistants working at levels 2, 3 and 4. It was based on interviews with senior managers.

The researchers found that assistants are especially valuable in supporting routine care and enabling registered nurses to focus on the more complex cases. They also provide opportunities for a more efficient skill mix, promoting better use of resources and providing stability to the workforce.

Professor Spilsbury said: “There is general enthusiasm among managers about the contribution of assistants and their employment is regarded as fundamental to the ability of community nursing teams to deliver an acceptable and appropriate service. Assistants are also valued for the maturity and life experiences they frequently bring to the role.

“However, there is a lack of consensus in defining the role of community nursing assistants which has created inconsistency in the ways these roles are deployed and are developing nationally. Roles appear to be strongly influenced by local factors such as staff shortages, organisational changes or rurality. This lack of consensus about the appropriate role and responsibilities for assistants is leading to a lack of consistency, not just across different organisations, but within services in an organisation.”  

The findings also highlight a lack of clear structure for career development and progression for community nursing assistants, as well as challenges in terms of line management when trying to balance the management of risk while promoting innovation in service delivery.

Notes to editors:

Notes to editors:

  • National Institute for Health Research:
  1. The National Institute of Health Research Health Services and Delivery Research (NIHR HS&DR) Programme was established to fund a broad range of research. It builds on the strengths and contributions of two NIHR research programmes: the Health Services Research (HSR) programme and the Service Delivery and Organisation (SDO) programme, which merged in January 2012. The programme aims to produce rigorous and relevant evidence on the quality, access and organisation of health services, including costs and outcomes. The programme will enhance the strategic focus on research that matters to the NHS. The HS&DR Programme is funded by the NIHR with specific contributions from the CSO in Scotland, NISCHR in Wales and the HSC R&D Division, Public Health Agency in Northern Ireland. 
  2. The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website.
  • The report ‘Support matters: a mixed methods scoping study on the use of assistant staff in the delivery of community nursing services in England’ is published in NIHR Health Services and Delivery Research, part of the NIHR Journals Library: or
  • The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR Programme, NIHR, NHS or the Department of Health.
  • The authors are: Karen Spilsbury, Karen Bloor, Karl Atkin, Dorothy McCaughan, Ian Watt, Department of Health Sciences, University of York; Sue Pender, City Health Care Partnership Community Interest Company, Hull; Rachel Borthwick, Firefly Research and Evaluation; Una Adderley, School of Healthcare, University of Leeds; Ann Wakefield, School of Nursing, Midwifery and Social Work, University of Manchester; Hugh Mckenna, Institute of Nursing Research, University of Ulster.
  • Further information on the University of York’s Department of Health Sciences is available at
  • More information on the NIHR Health Services and Delivery Research (HS&DR) Programme is available at


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Caron Lett
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