Assistant in Nursing (AIN)

The utilization of an Assistant in Nursing (AIN) in the provision of patient care
The utilization of an Assistant in Nursing (AIN) in the provision of patient care
To qualify as a registered nurse, one needs to complete their undergraduate nursing course and
register to be licensed to practice. For specialist nurse, then one is expected to take graduate
studies. However, recent studies indicate that there have shortages in the number of the
registered nurses (RN) and Advance nurse practitioners (APN). Therefore, there is a need to
establish an effective strategy that will address the shortages of the nurses (Unruh & Zhang,
One of the strategies suggested by the evidence-based practice is the use of assistant in nursing to
help in the healthcare setting. The issue of the integration of the AIN is highly debatable, with
many studies highlighting their advantages as well as the disadvantages. This paper aims at
defining the role of AIN, and the impact of their utilization in the healthcare settings. This aims
at identifying their role in helping the RN achieve the set competencies and nursing practice
Roles of AIN
The AIN is the word used to describe nurses who have completed nursing certificate at level III
in a healthcare service. The Nursing and Midwifery board of Australia (NMBA) indicates that
AIN are supervised and delegated duties by the RN. In some cases, AIN are also referred to as
multi-skilled worker, technician, personal care assistants, and nurse extenders. Traditionally,
AIN have been employed in aged care sector and in midwifery. The NMBA indicates that
midwife have vital roles in counseling, education of the community especially during antenatal
education and reproductive health. However, there have been changes in the recent past where
AIN are increasingly being used to support RN in broad range of healthcare settings. The AIN

The utilization of an Assistant in Nursing (AIN) in the provision of patient care
roles and responsibilities include helping the patient during meals where they prepare table over
the patient’s bed and help the patient position safely to feed (Unruh & Zhang, 2012).
Where necessary, AIN are required to feed the patients physically who cannot feed themselves
but rather require the assistance when feeding. The AIN are also required to help the patient
perform their daily living activities. These include activities such as bathing, bed washes and oral
hygiene, brushing and the cleaning of dentures. They are required to make observations on
changes on the patient’s physical appearances and report them to the RN. The AIN are also
required to help the patients with mobility such as moving patients from bed to chairs, re-
application of the ant-embolic stockings and bed positioning. They are also supposed to help the
patients with voiding, including helping the patient go to the toilet or provide bedpan, and
recording the urine collected in the drainage bags (Weiss, Yakusheva, & Bobay, 2011).
The AIN are expected to communicate any abnormalities to the RN. During this step, they are
expected to uphold the key nursing principles and to maintain patient privacy, dignity and
demonstrate empathy towards the patients. The AIN are expected to ne diplomatic and report any
disputes to the RN. AIN are also used to relay patient educative information regarding the
disease management especially on matters that regards hygiene (Heale, 2010). The AIN are
required to maintain a stable environment that will facilitate quick recovery. These includes
making up of post operative beds, implementation standards that reduce infection control such
as hand hygiene, moping the spills and notify the RN if specific cleaning procedures such as use
of radioactive procedures is required (Richer, Ritchie, & Marchionni, 2010).
RN roles
According to the Nursing and Midwifery board of Australia (NMBA) registered nurses have
various roles. Their roles as a coordinator imply that they are expected to coordinate plans. This

The utilization of an Assistant in Nursing (AIN) in the provision of patient care
is through piecing together of the fragmented care includes preparation of discharge with the
liaison with other healthcare team. RN roles as communicators include establishing a good
rapport between the healthcare providers and service users. This helps in their establishment of
therapeutic care through analysis of verbal and non-verbal communication (Unruh & Zhang,
RN roles as teachers include the educating the patient to empower them with the benefits of self-
care abilities. They are also responsible in affecting knowledge to the patients to enable them
make informed decisions. This include training them with the relevant skills that will help the
patients promote health, restore health, promote coping and prevention of further complication
(Fitzpatrick, Campo, & Lavandero, 2011). They strategize the teaching learning process by
identifying the specific teaching domains. These include cognitive learning, psychomotor
learning, and affective learning. The RN is also counselors and is expected to provide emotional
support to the patients to enable them handle the challenges they face with positivity. It is
important, the RN are expected to know that they are team player. They are expected to
collaborate and should not work in isolation when promoting patient healthcare. (Van Walraven
et al., 2015).
RN responsibilities when working with the AIN
Some of aforementioned responsibilities of RN can be assigned to the AIN. The AIN can help
the RN on duties such as teaching, assisting patients to feed, bath, and mobility as described
above. This way, the RN can concentrate on leadership, by supervising the RN. This is because
RNs are trained to have visions to energize other medical staff through motivation to work as
team players and encourage them to achieve goals (Unruh & Zhang, 2012). As leaders, RN are
expected to encourage AIN to work their best and collaboratively. The RN roles as managers are

The utilization of an Assistant in Nursing (AIN) in the provision of patient care
wider than that of managers. They are equipped with leadership skills during training, which
includes cognitive skills, interpersonal skills, legal skill, ethical skill, management skills,
problem solving skills and communication skills (Tyler, 2010).
With the help of AIN, the RN is supposed to note the barriers as well as challenges that hinder
effective delivery of care. This includes barriers such as language barriers, cultural barriers,
cognitive barriers, health literacy levels, and stress levels (Wayhlin & Idvall, 2010). Then,
develop strategies to overcome these barriers. This is done using the nursing process, which
includes assessment, planning, implementation and evaluation processes. RN is also advocate
and is expected to support all patients by being assertive and promoting self-determination
(Aubry, Etheridge, & Couturier, 2012).
Impact of utilization of Assistant in nursing (AIN)
As mentioned above, the role of Registered nurses are varied and very complex. Quality
delivery of care requires the nurses to take different roles during different phases of care. They
are expected to fulfill all their roles to the best of their abilities. However, nurse shortage and
poor working environments have led to nurse shortages (Hebert, Moore, & Rooney, 2015). This
has led to numerous challenges in the delivery of care in the healthcare settings, especially in
patient safety concerns such as medication errors, diagnostic errors, hospital acquired infections,
and patient hospital falls. This calls for a rapid measure to ensure that patient’s outcomes are
positive and care delivered is safe and of quality (Van Walraven et al., 2015).
One of the strategies suggested by the Department of healthcare and supported by evidence-
based practice is the utilization of AIN in healthcare settings. The benefits of integrating the AIN
in health settings are that they will be a viable solution to the micro-political health issue
(Taylor-Ford, 2013). The utilization of AIN will address the shortages of RN. This is because the

The utilization of an Assistant in Nursing (AIN) in the provision of patient care
AIN can aid the RN with some of the clinical settings chores under their supervision, as the RN
works focuses on other responsibility (McHugh, Berez, & Small, 2013).
A typical nurse day begins with the analysis of the reports from the nurses in the previous shift
and end with the filling of their own reports. In between these two responsibilities, the RN is
expected to perform all other aforementioned tasks including administering of medication,
wound care, physical assessments, and coordinate care with the other healthcare professionals.
Lunch breaks and tea breaks are usually nonexistent. This sometimes leads to nurse burn out,
which increases the risk of medical error, poor hand hygiene, and poor patient outcome (Tyler,
One study has indicated that the utilization of AIN in the health care settings found an
association between the proportions of total hours the RN with the assistant with the AIN
improved six outcomes in patients under care. These included reduction of hospital stays and
well as the reduction of hospital acquired infections (Richer, Ritchie, & Marchionni, 2010).
Other studies indicate that nurse shortages leads to working for log hours with high nurse to
patient ratio. This had been associated high increase of mortality, reduced patient empowerment.
The patients are discharged too soon before their medical complication has established (Armmer
& Ball, 2015). Consequently, the readmission rates are higher and in most cases, the patients
report with more complications. With the integration of AIN in the healthcare settings, their
patient ratio is lower, and the RN in collaboration with the AIN, they are able to deliver patient
centered care and the patient are empowered such that they are able to manage their healthcare
complications. Additionally, these nurses are able to notice and intercept medical errors. They
also get ample time to advocate for the patients to the medical care in insurance companies to
ensure that the patient get all their demands (Castle & Anderson, 2011).

The utilization of an Assistant in Nursing (AIN) in the provision of patient care
One research associates nurse burnout with increase of infections. The aforementioned RN
responsibilities lead to nurse burnout with extra patient assigned or extra overtime assigned to
nurse. The study has indicated increase in the rate of catheter infection of one person for every
1,000 (Heale & Butcher, 2010). One study that integrated that utilization of AIN reduced burnout
from 30% to 10%, and would reduce about 4,160 infections. The mortality rates would reduce to
11% with reduced burnout (Tyler, 2010).
Another study indicated that the utilization of AIN to help the RN with some of the nursing
practices reduced the RN’s overtime hours. This was correlated with better care, fewer
emergency departments within the first month of hospital discharge. This translated to reduced
cost of care. This study also found correlation between utilization of AIN with the staffing ratios
and with the patient satisfaction (Castle & Anderson, 2011).
A study that conducted cost benefit analysis study indicated that increased overtime hours
increased patient cost of care by $197.92 per hospitalized patient. With the utilization of AIN,
approximately $607.51 taxpayer’s money is saved (Heale & Pilon, 2012). Studies indicated that
reduction of overtime work by 0.07 hours saved hospital cost by $8.18 per patient and $10.98 in
savings of the taxpayer’s money. The annual net savings reported by this article was $11.64
(Weiss, Yakusheva, & Bobay, 2011).
From this analysis, the body of research indicates that utilization of AIN translates into quality
care, low mortality rates, shorter hospitalization stay, and fewer health complications. However,
the main disadvantages is that healthcare productivity could decline if the RN are replaced with
AIN (Ulrich et al., 2010). This is because RNs are all encompassed. There are concerns that this
approach could increase the risk of “failure to rescue” in departments with less RNs. This refers
to cases where the situation requires further treatment due to the deterioration of the patient

The utilization of an Assistant in Nursing (AIN) in the provision of patient care
status. The AIN may not fully identify such situations early enough. There is need to conduct
more further research to identify the most effective nursing staffing mix is effective to sustain
quality care.
The study concluded that to manage effective delivery of care, the healthcare facilities should
invest in reducing RN workloads strategies such as the utilization of AIN. This results to
improved quality of care, reductions of readmissions, HAIs, patient falls, and emergency visits.
This strategy is cost effective and improves quality of care.

The utilization of an Assistant in Nursing (AIN) in the provision of patient care
Armmer, F., & Ball, C. (2015). Perceptions of horizontal violence in staff nurses and intent to
leave. Work, 51(1), 91-97.
Aubry,, F., Etheridge, F., & Couturier, Y.,(2012). Facilitating Change Among Nursing
Assistants in Long Term Care. The Online Journal Of Issues In Nursing, 18(6).

Castle, N. G., & Anderson, R. A. (2011). Caregiver staffing in nursing homes and their influence
on quality of care, Medical Care, 49(6), 545-552.

Fitzpatrick, J., Campo, T., & Lavandero, R. (2011). Critical Care Staff Nurses: Empowerment,
Certification, and Intent to Leave. Critical Care Nurse, 31(6), e12-e17.

Heale, P. (2010). Nurse-Perceived Barriers to the Implementation of Nondirected Pushing.
Journal Of Obstetric, Gynecologic, & Neonatal Nursing, 39, S103-S103.

Heale, R., & Butcher, M. (2010). Canada’s First Nurse Practitioner’s “Led Clinic: A Case Study
in Healthcare Innovation. Nursing Leadership, 23(3), 21-29.

Heale, R., & Pilon, R. (2012). An Exploration of Patient Satisfaction in a Nurse
Practitionerâ’s“Led Clinic. Nursing Leadership, 25(3), 43-55.

Hebert, K., Moore, H., & Rooney, J. (2015). The Nurse Advocate in End-of-Life Care. The
Oschnoerjournal, 11(4), 325-329.
McHugh, M., Berez, J., & Small, D. (2013). Hospitals With Higher Nurse Staffing Had Lower
Odds Of Readmissions Penalties Than Hospitals With Lower Staffing. Health Affairs,
32(10), 1740-1747.

The utilization of an Assistant in Nursing (AIN) in the provision of patient care
Richer, M., Ritchie, J., & Marchionni, C. (2010). Appreciative inquiry in healthcare. British
Journal of Healthcare Management, 16(4), 164-172.

Tyler, D. A. (2010). Nursing home culture, teamwork and culture change, Journal of Research in
Nursing, 16(1), 37-49.
Taylor-Ford, R. (2013). Moral Distress in End-of-Life Care: Promoting Ethical Standards of
Executive Nursing Practice. Nurse Leader, 11(3), 51-54.

Ulrich, C., Taylor, C., Soeken, K., O’Donnell, P., Farrar, A., Danis, M., & Grady, C. (2010).
Everyday ethics: ethical issues and stress in nursing practice. Journal Of Advanced Nursing,
66(11), 2510-2519.Nursing
Research, 61(1), 3-12.
Van Walraven, C., Dhalla, I., Bell, C., Etchells, E., Stiell, I., & Zarnke, K. et al. (2010).
Derivation and validation of an index to predict early death or unplanned readmission after
discharge from hospital to the community. Canadian Medical Association Journal, 182(6),
Wayhlin, I., Ek, A., & Idvall, E. (2010). Staff empowerment in intensive care: Nurses’s and
physicians’ lived experiences. Intensive And Critical Care Nursing, 26(5), 262-269.

Weiss, M., Yakusheva, O., & Bobay, K. (2011). Quality and Cost Analysis of Nurse Staffing,
Discharge Preparation, and Postdischarge Utilization. Health Services Research, 46(5),

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