No / There has been a significant rise in the number of applicants to nursing pre-registration courses at British universities. A large proportion of these will be healthcare assistants. This article aims to guide them through the process of applying for nurse training and preparing for a successful outcome at interview.

The NHS must increase productivity by 6% every year if it is to make projected efficiency savings of £21 billion by 2014. At the same time, it is expected to maintain or improve the quality of care. We know staff costs make up 60% of the NHS budget, so it is likely that both the number and composition of the 1.7 million-strong workforces will need to change in order to meet these targets. We argue that while substituting registered nurses with healthcare assistants (HCAs) is desirable in terms of financial benefits, there is not enough research evidence to identify the impact of changes or maximisation in skill mix upon efficiency (represented by the number of NHS cases treated) and the quality of care experienced by service users.

Bakgrund: Delegering av arbetsuppgifter till omsorgspersonal är inte unikt för svensk sjukvård utan förekommer både nationellt och internationellt. Den globala bristen på legitimerade sjuksköterskor medför ett ökat behov av personal som kan utföra rutinmässiga arbetsuppgifter under delegering. Sjuksköterskor behöver delegera arbetsuppgifter för att kunna leda, prioritera och planera patienternas omvårdnad. Delegeringen av arbetsuppgifter ingår även i sjuksköterskans yrkesroll, därmed betonas vikten av att sjuksköterskan erhåller kunskap om riktlinjer och lagar gällande delegeringen. Syfte: Syftet med studien var att sammanställa sjuksköterskors upplevelser av att delegera arbetsuppgifter till omsorgspersonal inom olika vårdkontexter. Metod: Litteraturstudien bygger på tolv studier av kvalitativ ansats. Samtliga studier inhämtades från databaserna Cinahl och Pubmed. Utvalda studier har analyserats utifrån Popenoes m.fl. guide avseende artikelmatris och dataanalystabell. Valda studier har genomgått kvalitetsgranskning enligt SBU: kvalitetsgranskningsmall. Resultat: Resultatet utgör sex kategorier som besvarar litteraturstudiens syfte. Kategorierna består av Delegeringen var förenad med stort ansvar, Delegeringen upplevdes påtvingad, Delegeringen påverkade arbetsbelastningen, Upplevelser av okunskap relaterat till delegeringen, Attityder från medarbetare påverkade delegeringen, Kommunikation och relationer påverkade delegeringen. Konklusion: När sjuksköterskan delegerar enbart på grund av påtryckning från chefer sätts sjuksköterskan i en position där hen inte alltid upplever att delegeringen sker på ett korrekt och patientsäkert sätt. Däremot bidrog delegeringen till tid för planering och prioritering av patientens omvårdnad. / Background: Delegation of tasks to healthcare assistants is not unique to Swedish healthcare but occurs both nationally and internationally. The global shortage of registered nurses’ results in an increased need of healthcare assistants who can perform routine tasks under delegation. Aim: The aim of the review was to compile registered nurses’ experiences of delegating tasks to healthcare assistants in different healthcare contexts. Registered nurses need to delegate tasks in order to lead, prioritize and plan patients' care. The delegation of tasks is also part of the registered nurse's professional role, thus emphasizing the importance of the registered nurse obtaining knowledge of guidelines and laws regarding the delegation. Method: The literature review is based on twelve studies of qualitative approach. All studies were obtained from the databases Cinahl and Pubmed. Selected studies have been analyzed based on Popenoes et al. guide regarding article matrix and data analysis table. Selected studies have undergone quality review according to SBU: quality review template. Result: The results constitute six categories that answer the purpose of the literature review. The categories consisting of The delegation was associated with great responsibility, The delegation was perceived as forced, The delegation affected the workload, Experiences of ignorance related to the delegation, Attitudes from employees affected the delegation, Communication and relationships affected the delegation. Conclusion: When the registered nurse delegates under pressure from their managers, the registered nurse is put in a position where they do not always feel that the delegation takes place in a correct and patient- safe way. However, the delegation contributed to time for planning and prioritizing the patient's care.

The recently commissioned review of international healthcare systems by the Centre for Workforce Intelligence has a profound significance for healthcare management and the delivery of nursing and medicine within the UK (Cookson, 2012). This review will analyse and compare contrasting international healthcare systems of different providers across the UK—identifying the key factors affecting the delivery of healthcare. This commission must be viewed in relation to the ‘Nicholson Challenge’ (Hawkes, 2012), which requires savings of £21 billion to fund increased demand over the next four years. These efficiency savings are required to be found through better ways of working within current NHS law and regulation (Department of Health (DoH), 2010a; DoH, 2010b; Hawkes, 2012). The main agenda will be staff substitution —substitution of a higher graded practitioner by a lower graded practitioner. However, the greater opportunity is for healthcare assistants (HCAs) to become more professionally empowered.