The term ‘healthcare assistant’ (HCA), ‘support worker’, nursing assistant and ‘care worker’ (and others) are used to describe staff would work to meet the care needs of patients in health and social care settings such as hospitals and residential homes. The job does not usually require a qualification and involves tasks such as assisting with washing, dressing, toileting and feeding, as well as sometimes engaging in other activities and daily tasks with service-users. It’s not a well-paid job, the hours are long and the work often tiring and repetitive Sometimes agencies may provide staff, meaning that different staff will work in a setting each day, although many sites also have permanent staff.
Care-workers have had some bad press in recent years. Winterbourne View shed some light on how staff caring for vulnerable adults are often lacking in training and supervision, and how in some cases these enables abuse to go undetected. Following the Stafford Inquiry, it was recommended that nurses spend additional time working as healthcare assistants to help them to be more compassionate and in touch with the ‘fundamentals of patient care’. Nurses have been very critical of this proposal but personally, I think all staff in healthcare would benefit from spending some time working ‘on the front-line’. Working in this kind of role can give you a greater understanding of the needs of the patients and a sense of the work of the people who provide the majority of the care for our country’s most disabled, unwell and vulnerable.
My first job out of university was was a healthcare assistant at a private hospital for adults with long-term and severe mental health problems, often with additional physical health needs and ‘challenging behaviour’. I was bright-eyed and interested in mental health, but I don’t think I had a clue about what the job might involve. I’d never cared for someone else before, unless you count babysitting and tending to hungover friends. It wasn’t long into my first day that I was filled with an over-powering urge to leave and never return. The building was over warm and was filled with a strong smell of cleaning product not quite masking that of human waste. I could hear yelling and residents walked the corridor slowly, giving me unnerving stares. The prospect of helping an aggressive man change his incontinence pad was somewhat terrifying.
The work was eye-opening and exhausting. I didn’t always like working there, but I still could my time at the hospital as one of my most valuable working experiences, and it has really shaped my perspective and professional identity today.
Getting to really know people. When you spend all day with someone, from helping them get out of bed and get washed, right through to the end of the day, you get a sense of their life that just isn’t possible in a once weekly session. I enjoyed the times I had a chance to sit and talk to residents about their lives, or to do activities with them. I liked the continuity I had with people, that I could get to know them, and them me. It was frustrating when other professionals would come in and talk as if they really know someone, when they’d barely spent any time with them.
Disgust, dignity and disability. As far as a first job went, there was far more contact with bodily fluids than I was expecting. But I think it significantly raised my threshold for disgust. It stopped really bothering me. And I hope that if I need it, there’s someone around to help clean me up too! What I found far harder was having so much exposure to how disabled and narrow the lives of the residents could be. Often there wasn’t a plan for residents to get better or leave, and many had deteriorating conditions such as dementia. One of the worst jobs I had was assisting a woman with Huntington’s who was progressively losing control of the muscles of her body, to smoke a cigarette. She wasn’t really able to suck and inhale, so she had the cigarette attached to a tube-like device, the inside of which was coated in a black tarry substance, saliva and dirt from where she had dropped it. This device frustrated her, so she’d try and hold the cigarette, but her fingers were too weak and she’d drop it, burning herself. When I tried to take the cigarette and return it to the tube she’d yell and swipe at me. She was slowly dying but all she wanted was a smoke, and my job was to help her do it. It felt really harrowing, and it made me think about how small all of the things in my life that bother me are.
Lack of support. I had very little relevant experience, other than a psychology degree (which doesn’t prepare you much for working with a real-life person) and I received minimal training. I had a few days learning how to restrain someone and other staff quickly showed me how to wash, feed and transfer particular residents. And then they left me to it. Getting everyone out of bed, washed and breakfasted took me pretty much up to lunch, when it was almost time to start all over again. Nurses tended to stick in the office or the pharmacy (I know not all nurses do this, but it was mostly the case where I worked) and weren’t around when I needed their help, I was often left on my own or with other HCAs who on the whole had pretty low morale. The treatment I received from other professionals was often condescending and dismissive, I felt like the lowest rung in the site. I received minimal supervision, and when difficult or upsetting things happened at work there was no one to talk to about the experience. Apparently there’s a high-turnover for staff in these roles and I’m not surprised, though it must be very difficult for residents to see staff they get close to continually leaving and being replaced with new faces. The high demands placed on me to support basic needs such as washing and toileting left little time to go beyond this and engage in more personal and creative work with residents. I rarely even had time to look at people’s files, even when they had a substantial risk history, as if it wasn’t important for me to know much about the person I engaged so intimately with.
Many care-workers probably have better experiences than I did, the hospital I worked for definitely had some problems, but having talked to others I don’t think my experiences were all that unusual. HCAs and similar staff do the jobs that the rest of us are glad we don’t have to do, and receive little recognition for it. It’s a tough job and not everyone can do it. I’ve met staff who were truly brilliant, but the lack of respect (not to mention pay) you receive on the job does limit how likely it is that skilled staff will stay in a post. These people need to be celebrated and given further training so they can develop in the role. The residents and patients deserve better. Though I found the job a useful experience and it helped me get further posts, I probably wasn’t the right person to be providing that sort of care to people with such particular needs. I tried to do my best, but I wasn’t experienced.
Now I’ve moved up a few pay-bands and I don’t have to clean up anyone’s vomit and it’s been a long time since anyone hit me at work. But my experience on the ward is still with me, and I often find myself drawing on it and using it in examples at work. It’s definitely impacted on how I think about healthcare, other staff and my own professional responsibilities. Though the work was tough, I definitely don’t regret doing it. Sometimes I even miss being in that community environment and having more time with patients (it seems as I develop more skills I get less and less time with the people I’m learning to support). I don’t think being a healthcare assistant/support worker/similar should be seen as a ‘lowly’ job that’s beneath the other professions. It’s not a job just anyone could do, and it takes a special kind of person to do it well. Unfortunately this isn’t reflected in the pay and training attention that people in this roles often receive. For someone thinking of starting a career in healthcare I think you couldn’t have a better starting point, and you’d actually be at a disadvantage for skipping over it. It’s an enriching and insightful experience that I know I come back to again and again.