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Understanding the roles of registered general nurses and care assistants in UK nursing homes


  • Michelle Perry MSc,

    1. Research Assistant, Centre for Health Services Studies, University of Kent, Canterbury, Kent, UK
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  • Iain Carpenter MD FRCP,

    1. Associate Director and Reader in Health Care of Older People, Centre for Health Services Studies, University of Kent and East Kent Hospitals NHS Trust, Canterbury; and Senior Lecturer, GKT School of Medicine and Dentistry, London, UK
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  • David Challis PhD,

    1. Professor of Community Care Research, and Director, Personal Social Services Research Unit, University of Manchester, Manchester, UK
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  • Kevin Hope PhD

    1. Lecturer in Nursing, School of Nursing, Midwifery and Health Visiting, University of Manchester, Manchester, UK
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Michelle Perry,
Centre for Health Services Studies,
George Allen Wing,
University of Kent at Canterbury,
Kent CT2 7NF,


Background. The recent government decision to fund the costs of Registered nursing time in long-term care facilities in England through the Registered Nurse Contribution to Care renders the need to distinguish the role of Registered General Nurses (RGNs) from that of Care Assistants (CAs) in nursing homes increasingly important.

Aim. The objective of this qualitative study was to obtain an in-depth understanding of the main differences between the roles and functions of RGNs and CAs working in nursing homes in the United Kingdom (UK).

Design. Data were collected through interviews with nine RGNs and 12 CAs employed in four different nursing homes across England.

Findings. Our findings suggest that RGNs have difficulty defining and limiting their roles because they have all-embracing roles, doing everything and anything within the home. By contrast, CAs define their role in terms of what they are not allowed to do. This difficulty in limiting their role, in addition to their sense of professional accountability for residents' care, leads RGNs to experience difficulty in delegating tasks to CAs. Both RGNs and CAs agreed that an increase in the number of assistive staff is needed to provide residents with good quality care and suggested that a measure of resident dependency would be a good method by which to determine staffing levels.

Conclusions. We recommend that job descriptions that clearly define the roles and responsibilities of both RGNs and CAs are developed so that caregivers at all levels understand each others' roles and work together to co-ordinate, plan and provide residents' care.