Evaluation of lay health workers on quality of care in the inpatient setting.
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2023-01
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Abstract
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To evaluate the impact of a lay health worker support role in the inpatient setting.Background
Healthcare systems are facing critical nursing and nurse assistant staffing shortages. These disciplines can be challenging to recruit and retain, leading healthcare leaders to identify innovative staffing models. Whereas lay health workers have been used in the community and low-income setting, there is scant evidence of their use in the inpatient setting. We implemented a lay health worker role, called Patient Attendant Service Aides (PASAs), on two medical/surgical units at a community hospital.Methods
A pre/post-implementation design was used for this study. An online survey was provided to nurses, nursing assistants, and PASAs on the two medical/surgical units to assess their satisfaction and perceptions of the role. Nursing quality metrics, patient satisfaction, and nursing and nursing assistant turnover were evaluated before and after implementing the role.Results
The online survey showed that nurses and nursing assistants felt that PASAs helped offload their workload, allowing them to focus on nursing-related tasks. PASAs felt supported by the team and believed they were making a meaningful contribution to the unit. There were slight improvements in patient satisfaction, although not significant. There was a significant improvement in nursing turnover on Unit A, from 71.1% to 21.6% (p = 0.009).Conclusions
This is one of the first studies to evaluate the use of lay health workers in the inpatient setting; we found this role to be a feasible way to offload tasks from clinical staff. This role may serve as a pathway for workforce development, as several PASAs are now enrolled in nursing assistant training. Nurse managers may consider using lay health workers in the inpatient setting as they face severe clinical staff shortages.Type
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Basnight, Ramona, Peter Berry, Kellie Capes, Sherri Pearce, Julie Thompson, Deborah H Allen, Bradi B Granger, Staci S Reynolds, et al. (2023). Evaluation of lay health workers on quality of care in the inpatient setting. PloS one, 18(11). p. e0293068. 10.1371/journal.pone.0293068 Retrieved from https://hdl.handle.net/10161/29557.
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Scholars@Duke

Bradi Bartrug Granger
Dr. Bradi Granger is a Research Professor at Duke University School of Nursing, Director of the Duke Heart Center Nursing Research Program, and adjunct faculty at the University of Gothenburg, Sweden. She is also a core faculty at the Duke-Margolis Center for Health Policy. Dr. Granger received her doctorate in nursing from the University of North Carolina at Chapel Hill, her MSN from Duke University, and her BSN from the University of Tennessee at Knoxville.
Dr. Granger has extensive clinical experience in cardiovascular nursing, and her clinical work as a Clinical Nurse Specialist has been dedicated to overcoming barriers to the use and conduct of research in the service setting through the development of pragmatic tools that change the way nurses learn about, apply, and conduct nursing science. She has developed an innovative model for clinical inquiry and research in the hospital setting, which has been adopted in clinical settings across the U.S. and abroad. Dr. Granger is an active member of the Council for the Advancement of Nursing Science, the American Association of Critical Care Nurses, the American Heart Association, and the European Society for Patient Adherence, Compliance, and Persistence.

Staci Reynolds
Dr. Staci Reynolds is a Clinical Professor at Duke University School of Nursing (DUSON). At DUSON, Dr. Reynolds primarily teaches in the DNP program. Previously, she clinically served as a Clinical Nurse Specialist (CNS) at Duke University Hospital within the neuroscience inpatient units and Infection Prevention and Hospital Epidemiology department. In January 2023, Dr. Reynolds was appointed the Editor-in-Chief of the Journal of Nursing Care Quality. Before coming to DUSON, she was a neurocritical care nurse and a neuroscience CNS at Indiana University Health Methodist Hospital.
Dr. Reynolds received a baccalaureate degree in nursing science from Indiana University (IU) School of Nursing in Indianapolis, Indiana. She earned a Master’s degree as a Clinical Nurse Specialist at IU in 2011, and completed her PhD at IU in May 2016. Dr. Reynolds’ current scholarship interests include evidence-based practice implementation and evaluation, and she is an expert in quality improvement.
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