The Use of Unregulated Staff: Time for Regulation?

Policy Polit Nurs Pract. 2014 Feb;15(1-2):42-48. doi: 10.1177/1527154414529337. Epub 2014 Apr 4.


Internationally, shortages in the nursing workforce, escalating patient demands, and financial constraints within the health system have led to the growth of unlicensed nursing support workers. Recently, in relation to the largest publicly funded health system (National Health Service), it was reported that extensive substitution of registered nurses with unskilled nursing support workers resulted in inadequate patient care, increased morbidity and mortality rates, and negative nurse outcomes. We argue that it is timely to consider regulation of nursing support workers with their role and scope of practice clearly defined. Further, the addition of these workers in a complementary model of care (rather than substitutive model) should also be explored in future research, in terms of impact on patient and nurse outcomes.

Keywords: nursing support worker; patient outcomes; registered nurse; regulation; scope of practice; skill mix.

MeSH terms

  • Clinical Competence / standards*
  • Humans
  • Licensure, Medical / standards*
  • Models, Nursing
  • Nurse's Role*
  • Nursing Assistants / standards*
  • Nursing Staff / standards*
  • United States