The role of patient care workers in private hospitals in the Cape Metropole, South Africa.
Louise A Aylward, Talitha Crowley, Ethelwynn L Stellenberg
PMID 28828868WHAT IT FOUND
Unregulated patient care workers in South African hospitals performed tasks identical to trained auxiliary nurses, including hygiene and monitoring.
Staff reported these workers often operated unsupervised and expanded their role beyond basic care, raising concerns about patient safety and legal accountability.
Key findings
01Participants reported that unregulated patient care workers performed activities indistinguishable from enrolled nurse auxiliaries, such as basic hygiene and comfort care, despite lacking formal nursing training or regulation.
02Although policy required supervision, participants acknowledged that patient care workers frequently worked alone with patients, and nurses relied on them to identify and report clinical abnormalities like pain or deterioration.
03Unit managers and nurses expressed concern that these workers were increasingly performing tasks beyond their authorized scope, such as monitoring vital signs and diagnostic tests, due to workload pressures and financial constraints.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was conducted only in medical and surgical wards of private hospitals, excluding critical care, paediatric, and public sector settings, so findings may not apply elsewhere. The sample was small (15 interviews) and drawn from three specific hospital groups in one region, limiting transferability. Data saturation was reached after 12 interviews, but the researchers continued to 15 to include all categories, which may have introduced redundancy. The study relied on self-reported perceptions of staff and did not observe actual patient outcomes or safety incidents.
Declared interests
The authors declared no competing interests. The study received ethical approval from the Health Research Ethics Committee of the University of Stellenbosch and the research boards of the three hospital groups.
The easy way to misread this
Do not interpret the high value placed on these workers' observations as evidence that they are safe to delegate clinical monitoring to. The study explicitly notes they are unregulated, lack formal nursing training, and often work unsupervised, creating significant legal and safety risks.