Tasks performance by registered nurses and care assistants in nursing homes: a quantitative comparison of survey data

OBJECTIVES: To examine the care tasks performed for residents of Belgian care institutions for older people and the association between the performance of care tasks by persons of different staffing categories (registered nurses (RN) and care assistants (CA)) and the characteristics (the dependency level and the diagnosis of dementia) of the residents. STUDY DESIGN AND SETTING: Survey on the care for residents, aged 65 or over, living in 26 care institutions for aged people. MAIN OUTCOME MEASURES: Separate bivariate comparisons of care time spent on residents with and without dementia and bivariate comparisons of care time spent on six task categories on residents of different dependency levels were performed. The median number of minutes over seven days (mosd) and the inter quartile range (IQR) are presented as summary measures. The proportion of the time spent by RNs and CAs per resident and per task category was calculated. RESULTS: Time spent was highest on primary care tasks (34,554 mosd; 48.7%), followed by in order of time spent, supportive tasks (10,845 mosd; 15.3%), logistic tasks (10,697 mosd; 15.1%), practical nursing procedures (8,689 mosd; 12.2%), administrative tasks (3,357 mosd; 4.7%) and communication tasks (2,814 mosd; 4.0%). Overall there was no significant difference between the total time spent by RNs (median=190 mosd; IQR 105-334) and the total time spent by CAs (median=196 mosd; IQR 91-331; p=0.89). RNs were spending significantly more time than CAs in practical nursing procedures, communication tasks and administrative tasks. CONCLUSIONS: There was a sharp task demarcation between RNs and CAs in the three less frequent task categories. There was no indication that RNs were delegating tasks to CAs.