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American Nurses Association defines the Unlicensed assistive personnel (UAP) as individuals who are trained to function as assistants to registered and professional nurses in providing of patient care activities. Their duties are delegated and supervised by the registered nurses. In practice unlicensed assistive personnel includes the following individuals: certified nurses aide, certified phlebotomist, orderlies or attendants, clinical assistant, home health aide, nursing assistant and personal care assistants (Fitzpatric, & Green, 1995).
Unlicensed Assistive personnel have been for many years been used in various settings to offer assistance to healthcare providers and often to the registered nurses in offering care to their patients. Unlicensed assistive personnel have in the recent past increased dramatically and this is partially attributed to the reduced reimbursement in Medicare as well as managed care. This prompted health acre providers to consider employing unlicensed assistive personnel in their health care settings for instance in acute care hospitals which in the past their use was very limited.
In addition to providing health care service unlicensed assistive personnel are nowadays performing even more complex tasks hence the increased concern that registered nurses should as well increase their supervision responsibilities as it regards to tasks that are performed by the unlicensed assistive personnel. The recent increase in the use of unlicensed assistive personnel has increased a concern by many health care professionals especially in regards to safety and the quality of care to patients and the issues of professional liability to the supervising nurses. The concern has led to introduction of legislations that are intended to regulate some of the aspects relating to use of unlicensed assistive personnel in the health care sector (Fitzpatric, & Green, 1995). Moreover, these concerns have even made organizations to study their use as well as the impacts of their services to its operations thus their adoption of position statements regarding their use.
The main problem faced by the nursing personnel especially the registered nurses is the negative effects that arise as a result of delegation and these include their increased risks of being exposed to professional liabilities resulting from supervising the unlicensed assistive personnel and the concern of reduced quality in care given to the patients as a result of involvement of unlicensed personnel in the provision of the health care services.
The values and ethics
The nursing profession involves working under strict code of ethics which the unlicensed assistive personnel might not be familiar with. The ethics of nursing include respect for humanity and the order not to participate in activities that conflict with caring and healing principles. The delegation of unlicensed assistive personnel might compromise with the observation of such ethic especially considering the fact that they are not held accountable by the management they may be tempted to ignore the seriousness of the ethically acceptable standards of nursing profession.
The concerns related to the quality of care that unlicensed assistive personnel’s provide for the patients as well as the risks of professional liabilities that supervising nurses face; there are various approaches that can be applied to solve them. Some of the approaches recommended include: improving the communication between the supervising nurses and the unlicensed assistive personnel, involving the management and the members of staff in the process of decision making , improved communication mechanisms and finally through specific job allocation for the unlicensed assistive personnel.
According to me I think the stated models of solving the problem of nurse’s liabilities due to unlicensed personally as well as achieving the nursing objective of providing a quality care to patients follows the order: involvement of the management and the staff in decision making process, work allocation and improved communication skills as the last model to solving the problem.
Research as shown that the increasing shortage of nurses has led to increased delegation of patient care activities which have led to nurses carrying out delegation duties despite the fact that they often don’t get full managerial support or a control over their work environments. So in order for nurses to manage challenging situations in their work, like being able to supervise unlicensed assistive personnel without being exposed to professional liabilities; the nursing organization should be able to involve them in decision making process.
Therefore the management should play its role in ensuring that all the team members involved in offering the nursing within their institutions are provided with a definite and specific definition of their roles and that they are provided with the essential communication skills that they require to deliver their designated duties. This ensures that care is not fragmented which often serve to reduce job satisfaction and thus decreased quality of care. It as also been proofed that high–level working teams working together towards a common goal and a focused mission experience an increased job satisfaction. Therefore the management plays a critical role in alleviating the concerns stated above if it contributes to promoting team work between the nurses and the unlicensed assistive personnel while keeping them satisfied and motivated (Fitzpatric, & Green, 1995).
The second model of minimizing the stated concerns is by promoting extensive communication skills between the nurse and the unlicensed assistive personnel’s. The current shortage of nurses and high turnover among the unlicensed assistive personnel make communication a challenge especially to the ever changing team members. Research has shown that delegation results to registered nurse’s dissatisfaction with communication as far as communication and team work is concerned specifically when unlicensed assistive personnel are involved (Mahlmeister, 1999).
This model suggests that the problem of communication in the team can be mitigated if personnel duties are specifically described as well as assigning experienced registered nurses with good communication and leadership skills. Also by providing numerous formal and informal structures for communication to be used by the team members, writing of care plans, availing written assignment of responsibilities and finally availing of team conferences which encourage coordinated care can help curb the problem stated above.
The final model focuses on work allocation by the supervising nurse. The registered nurses should be in a position to plan for the patient’s care and delegate the care for time they are available as well as in their absence. The nurses should be accountable for the coordination of the delegated duties as well as the continuity of the care right from admission to discharge of the patient. Thus the associate caregiver, in this case the unlicensed assistive personnel should be in a position to follow the plan of care, communicate the pertinent information or any changes in the status of the patient to the supervising nurse and finally provide a direct patient care when the supervisor is not present (Mahlmeister, 1999).
The advantage of the involvement of the management in solving the concerns stated above is that any decision made is always final and the employees have to abide by it hence the effectiveness in its implementation. The provision of improved communication only works if the teams have been allocated their specific duties hence a staff considers using communication skills to ensure that the designated duties and responsibilities are delivered as per the organizations rules and regulations. Therefore the order of solving the issues of concern stated above can be rearranged as follows: involvement of the management and staff in decision making process, work allocation and finally improvement of communication skills.
If the order stated is followed in implementing the models then the goals and objectives of offering a quality care and mitigating professional responsibilities for the supervising nurses should be realized with immediate effect because failure to implement them results to a disciplinary action which may involve suspension from work or even termination of employment (Mahlmeister, 1999).
Model success measurement
Once the plan is implemented its success will be assessed through client and staff feed back regarding reported cases of low quality care and high numbers on reports concerning nurses being mentioned for professional liabilities. Low number of cases reported on both scenarios will be an indicator that the model is successful in its implementation.
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