Health Care Support Worker (HCSW) development within NHS Scotland, and indeed the United Kingdom, has been a central component of service redesign (NES 2010). As Registered Nurses (RNs) adopted new roles different responsibilities were delegated to the HCSW. Within the context of long term ventilation for children with complex needs, services have been established to provide direct care to children in the out of hour’s period, who require respiratory mechanical ventilation. These services are staffed by HCSWs and RNs. Challenges of recruiting RNs (Jardine et al 1999) has resulted in more HCSWs working within these services and providing this care.

Although these HCSWs have a training programme to prepare them to undertake their role, little is known about the decision making processes that they use when caring for these children, or if this differs from those of the Registered Nurse.

Using a multiple case study approach, decision making processes were identified through the mapping of data obtained through a combination of a ‘Think Aloud’ interview, immediately followed by a retrospective interview against the Carroll and Johnston (1990) decision making framework and Heuristic principles (Tversky and Kaheman 1974) respectively. HCSWs and RNs were invited to participate in the study from two NHS Scotland children’s long term ventilation services. Using a purposive sampling technique five HCSWs and five RNs were recruited.

This study identified that there were similarities and differences between the HCSWs and RNs, who worked within these services. HCSWs demonstrated an algorithmic approach to their decision making processes, reflecting their training for the role. In contrast the RNs were more holistic in their approach adopting a wider view of the needs of the child. HCSWs used available care planning and pathways to direct their decision making, whereas RNs used care plans and pathways to inform, rather than direct, their decision making. The influence of being a parent within the HCSW group affected the decision making process of participants, but not the outcome.

This study has provided new insights into decision processes used by both groups, which have relevance to children’s services, as it is an area which has received minimal research.