As part of efforts to alleviate the burden on patients’ families and better meet the demand for patient care services, many regions in China have initiated pilot programs for “No Companion Wards.”
With the advent of No Companion Wards, have the nursing staff kept pace?
After the implementation of the No Companion Wards pilot, specially trained nursing personnel are providing more professional support to patients. However, the workforce is struggling to meet the actual demand. Experts suggest enhancing recruitment and training efforts to create a comprehensive and standardized training program for these personnel.
“Help! We have emergency transfers coming in!” At midnight, the quiet halls of the Orthopedic Department at the People’s Hospital affiliated with Fujian University of Traditional Chinese Medicine erupted with commotion from the sound of hurried footsteps and gurneys.
“Nurse, do you know how I can contact a caregiver?” On his hospital bed, Bao Wei, who had suffered a leg fracture, anxiously inquired.
“Sir, we’re not nurses; we’re the nursing staff you need,” replied caregiver Wu Zenghui, pointing to the arm badge labeled “No Companion Ward.”
To prevent the scenario where “one person’s illness burdens the whole family,” numerous medical facilities across the country are now offering No Companion Ward services. These institutions can employ appropriately trained nursing aides to provide care services, allowing for patients to be cared for without family members present.
In Wu Zenghui’s ward, he and three other caregivers are responsible not just for Bao Wei, but also for nearly 30 other patients residing in the ward.
Are they caregivers or nursing staff? Can they really take care of so many patients? Wu Zenghui, who began his internship in the No Companion Ward just this April after graduating from a vocational school with a nursing degree, shared feelings of uncertainty about the job. Yet, as he learned more, clarity emerged.
From Hard Work to Technical Skills
“Bed 15 calling, Bed 15 calling…” After the night shift, the broadcast reminded Chen Xiaofeng, who was just finishing her handover with Wu Zenghui, that a busy day lay ahead.
“Good morning, Mr. Chen! Did you sleep well last night?” Upon entering the ward, Chen greeted the patients warmly. While chatting, she helped one elderly patient with mouthwash, face washing, hand washing, and shaving. That morning, she would repeat similar care routines for eight different patients.
With five years of experience in orthopedic nursing and four years as a caregiver, Chen Xiaofeng remarked, “When I was a caregiver, I thought looking after orthopedic patients was just hard work. But taking on the role of nursing staff has opened my eyes to the technical aspects of orthopedic care.”
Reflecting on her earlier days in nursing, she recalled how difficult it was to even help patients turn in bed—there was no one to teach her, so she learned by imitating the experienced caregivers.
Now, as a member of the No Companion Ward, she has standardized procedures for patient assistance. “Assisting orthopedic patients with positional changes involves careful techniques; we must raise the bed to turn the patient to prevent secondary injuries,” she explained. Monthly bedside training sessions led by nurses have become an essential part of learning for nursing aides, where they receive professional skills training.
Additionally, Chen Xiaofeng attends two monthly skills training sessions organized by her nursing company, where she learns to perform tasks such as inserting intravenous needles and recognizing postoperative drainage tubes.
Like Chen, 52-year-old Zheng Qingzhang, a former caregiver who transitioned to working in the orthopedic department at Fuzhou Second General Hospital, has donned new light blue uniforms and taken on the role of a “nursing newcomer.”
Every shift, he receives a “daily care prescription” prepared by the on-duty nurse. The nurse quizzes him, and his responses contribute to a performance assessment jointly managed by the nursing department and a third-party organization. Zheng admits, “The pressure has increased, and so has the learning!”
“No Companion doesn’t mean ‘no caregiver’.” According to Wu Zenghui, caregivers are typically employed by families, whereas nursing staff are mostly hired by hospitals or care institutions. Nursing personnel in No Companion Wards undergo stricter training. “Nursing staff are a crucial part of No Companion Wards!”
Recruitment Challenges and Limited Skill Development
“While nursing aides in No Companion Wards must become the ‘eyes’ and ‘hands’ for nurses, there are still many factors limiting their skill enhancement,” argued Zheng Liwei, a professor at Fujian University of Traditional Chinese Medicine. The nursing aides not only help to lighten the caregiving burden on families but also support nurses in basic care and rehabilitation.
However, a recent study by the Fujian Provincial Health Commission indicates that the average age of nursing aides currently employed in the province is 52, with 93.3% having only a junior high school education or lower. Such low educational levels combined with older ages restrict the overall technical competence within the industry.
At 58, Qiu Renpei switched to nursing from a plumbing career due to a back injury ten years ago. “There was no training when I switched careers, and now that I’m in the No Companion Ward, opportunities to learn remain limited,” he lamented. “Currently, there are far too few qualified nursing aides with professional training.”
According to Zheng Liwei, the introduction of No Companion Wards has necessitated an increase in the qualifications and training requirements for nursing aides. They are now required to participate in training organized by the health commission and obtain certification.
However, data from the Fujian Provincial Health Commission shows that from the launch of the training initiative in 2021 to the end of 2023, only 5,331 medical nursing aides received training certificates. This markedly limited workforce cannot meet the needs for nursing personnel across 132 No Companion pilot wards in 40 public hospitals throughout the province.
“Recruitment is already tough; let’s not even talk about skill enhancement,” said Lu Kai, a manager from a care company in Fujian. He noted that only one-third of their nursing staff currently comes from Fujian, necessitating recruitment from regions like Tianjin, Shanxi, and Jiangxi, where new recruits undergo unified training and certification.
Emphasizing Recruitment and Training
Zhang Guolan, supervisor of the Nursing Society of Xiamen City, believes the No Companion Ward model differs from traditional caregiver roles by adopting dynamic inspections and collaborative teamwork, offering nursing professionals a new career choice.
She recommends increasing recruitment and training efforts among vocational schools and third-party nursing institutions, devising training programs that meet the needs of hospitals and patients alike.
Several pilot hospital leaders have proposed using these facilities as training bases for nursing aides, focusing on comprehensive and standardized training in institutional design, clinical practice, and personnel management. This could help mitigate the awkward situation of nursing talent being shuffled around rather than being cultivated.
On the day of the interview, coinciding with a surgery schedule, Chen Xiaofeng’s step count exceeded 30,000 steps. Tasked with caring for an average of eight patients, she acknowledged that her workload has significantly increased compared to her previous one-on-one caregiver job.
However, unlike caregivers who work around the clock, nursing aides follow a shift system, which slightly reduces work hours. “While doing No Companion care is tiring, I work 12 hours a day and can finally get some sleep at night,” Chen said.
Similarly, Yang Jun, a nursing aide in the cardiothoracic department at Xiamen University Affiliated Cardiovascular Hospital, agreed with Chen’s view. “We work in three shifts—morning, afternoon, and evening—averaging about eight hours. There’s time after work for our personal lives.”
“Implementing No Companion care should benefit the nursing aides involved,” argued Lan Guihua, director of the No Companion Office at Ninghua County General Hospital in Sanming. She believes establishing a skill-oriented pay distribution mechanism linked to experience and productivity can increase nursing aides’ recognition, participation, and contribution to the No Companion model, an ongoing process of exploration and improvement. She hopes that “those who work hard in the wards will be valued by society.”
