Chapter 8 Unlicensed Assistive Personnel and the Registere.docx

Chapter 8
Unlicensed Assistive Personnel
and the Registered Nurse
Copyright © 2016 Wolters Kluwer Health | Lippincott Williams
& Wilkins
Copyright © 2020 Wolters Kluwer • All Rights Reserved
Terminology
Unlicensed assistive personnel (UAP) includes
Nurse aides, nurse extenders
Health care aides
Technicians
Patient care technicians
Orderlies
Assistants or attendants
Nursing assistive personnel (NAP): replacement term by ANA
in 2007
Motivation to Use UAP
Arguments
Maximize human resources: free professional nurses from tasks
and assignments not requiring independent thinking and
professional judgment (nonnursing tasks and functions)

Cost savings: conflicting findings in research
Controversy
UAP are not supplements but replacements of professional RN
staff
Variation in scope of practice and lack of minimum educational
and training requirements
Top Reasons for Being Pulled Away from Patient Care
Documenting information in multiple locations
Completing logs, checklists, and other unnecessary
paperwork/data collection
Filling out regulatory documentation
Entering/reviewing orders
Walking to equipment/supply areas, utility rooms, etc.
Educational Requirements
OBRA regulations for certified nurse’s aides
Minimum of 75 hours of state-approved theory and practice
Successful completion of competency exam in both areas
Most UAP training in employing facility with no formal
certification
Formal training at vocational schools and community colleges;
focus on long-term care; certification only to meet state
requirements
Education for acute care settings facility-based; no required
educational standards or guidelines

Question #1
Is the following statement true or false?
Currently, strict standards related to the educational
requirements are in place for UAP.
Answer to Question #1
False
Wide variations exist in the educational requirements for UAP.
For example, OBRA regulations require a minimum of 75 hours
of theory and practice, and successful completion of an exam in
both areas, while in other cases, training occurs in a facility
with no formal certification.
Certified Medicine Aides
Have worked in licensed nursing home settings, residential care
settings, and adult day services in this country for almost four
decades
RNs reported feeling pressured to delegate medication
administration to UAPs because of inadequate organizational
personnel and finances
“Handing over a crucial nursing responsibility under
jeopardizing circumstances” (see Research Fuels the
Controversy 8.1)
UAP Scope of Practice #1
ANA: 6 actions necessary to create a national and/or state

policy agenda for education of UAP or NAP and competencies
for safe practice (see Box 8.1)
No universally accepted scope of practice for UAP
Some states with task lists
Most facilities allowing a broader scope of practice than
advocated by professional nursing organizations or state boards
of nursing
UAPs completing tasks traditionally reserved for licensed
practitioners, that is, medication administration
UAP Scope of Practice #2
In many settings, UAPs perform functions within the legal
scope of nursing
Certain activities NEVER to be delegated to UAP
RN ultimately responsible for:
Analyzing information using highly developed critical thinking
skills
Then using the nursing process to achieve desired patient
outcomes
Regulatory oversight: regulation varied by state and jurisdiction
UAP and Patient Outcomes
Effect of increased use of UAP not fully known
Studies show direct link between decreased RN staffing and
decline in patient outcomes.
Increased incidence of falls
Increased incidence of nosocomial infections
Increased physical restraint use
Higher medication errors

Question #2
Which of the following would be appropriate for a nurse to
delegate to a UAP?
A. Vital sign measurements
B. Care planning
C. Patient assessment
D. Patient teaching
A
A UAP may perform vital sign measurements because this task
does not require independent thinking or professional judgment.
Activities that should never be delegated include those that
require the RN to analyze information using highly developed
critical thinking skills and then use the nursing process to
achieve desired patient outcomes.
RN Liability for Supervision and Delegation of UAP #1
RN responsible for adequate supervision of person to whom
assignment has been delegated
RN liable if negligent in supervision of employee at the time the
employee committed negligent act
Supervisor’s failure to determine which patient needs could be
safely assigned to a subordinate
Failure to closely monitor subordinate requiring supervision

RN awareness of UAP’s job description, knowledge base,
demonstrated skills
“Mindful” communication between the RN–UAP dyad
RN is always:
Accountable for care given
Responsible for instructing UAP as to who needs care and when
UAP accountable for knowing:
How to perform care properly
When others need to be called in for tasks beyond limits of
knowledge and training
Marquis and Huston (2017)
Bottom line: RNs are always accountable for care given and
instructing NAPs to perform care properly
ANA general principles for delegating to NAP (see Box 8.2)
RNs Working as UAP: Liability
New graduates being hired as UPAs
Issues of legality
RN not able to provide care to level of expertise—violation of
statues
Possible charges of negligence or malpractice if providing care
only to the level of the assumed position

Role discrepancy
Creating a Safe Work Environment
Health care organization activities to increase likelihood that
UAP used effectively and appropriately
Clearly defined organizational structure
RN recognized as leader of health care team
Clear job descriptions defining roles and responsibilities
Uniform training and orientation programs for UAPs
Adequate program development in leadership and delegation for
RNs
Question #3
Is the following statement true or false?
The RN is responsible for instructing UAP in how to properly
perform the assigned care.
False
The RN is responsible for instructing UAP as to who needs care
and when. The UAP is accountable for knowing how to properly
perform the assigned care and when to call in others for tasks
beyond limits of knowledge and training. The RN must know if
UAP has knowledge and skills to perform assigned task. If not,
then the RN should not delegate the task.

UAP Shortage #1
Demand for UAP growing; persons typically filling these
positions declining
Graham (2017): Acute shortages occurring across the United
States, but in some states, the problem is worse than others
Current nationwide shortage of well-trained UAP in all
settings—high turnover rate
Long hours, inadequate staffing, physical and emotional job
demands, low pay
Negative messages from managers, supervisors, coworkers
UAP Shortage #2
Current nationwide shortage (cont.)
Lack of employer-paid benefits
Limited career paths
Less-than-ideal working conditions; high turnover rate leaving
others short-handed
Outdated federal regulations for minimum standards for staffing
in nursing homes
Hazards related to exposure to infectious diseases and drug-
resistant infections
Emotional exhaustion brought on by occupational fatigue
UAP Shortage #3
Possible solutions
Financial incentives
Addressing the barriers to incorporating UAP into modes of

care
Making sure UAP is successfully recognized as a delegated
clinical role
Doing more to recruit and retain UAPs
End of Presentation

Chapter 8 Unlicensed Assistive Personnel and the Registere.docx

Recommended

Recommended

More Related Content

Similar to Chapter 8 Unlicensed Assistive Personnel and the Registere.docx

Similar to Chapter 8 Unlicensed Assistive Personnel and the Registere.docx (20)

More from tiffanyd4

More from tiffanyd4 (20)

Recently uploaded

Recently uploaded (20)

Chapter 8 Unlicensed Assistive Personnel and the Registere.docx