Practice Guideline Show
. 2007 May-Jul;76(2):17-8.
Practice Guideline Registered nurse utilization of nursing assistive personnel statement for adoptionCenter for American Nurses. Prairie Rose. 2007 May-Jul. AbstractThe Center for American Nurses (the Center) recognizes that in today's health care environment the NAP will be utilized to provide support to Registered Nurses in providing patient care. In delegating, it is the Registered Nurse who uses professional judgment to determine the appropriate activities to delegate. The determination is based on the concept of protection of the public (patient safety) and includes consideration of the needs of the patients, the education and training of the nursing assistive staff, the extent of supervision required, and the staff workload. Assessment, planning, evaluation and nursing judgment cannot be delegated. Any nursing implementation or intervention that requires independent, specialized, nursing knowledge, skill or judgment cannot be delegated. "The Registered Nurse is accountable for the delegation decision, the process and the ongoing monitoring of the outcomes of nursing care." Similar articles
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Nurses increasingly rely on unlicensed assistive personnel (UAP) to effectively treat and care for all their patients. While UAP can be vital to a facility’s care delivery strategy, their responsibilities — including what they’re authorized to do — are vastly different from those of a nurse. Nurse leaders need to understand these differences so they can provide the best possible care. To learn more, check out the infographic below, created by Ohio University’s online Master of Science in Nursing program.  Add This Infographic to Your SiteNurses Are Crucial — and Also in CrisisNurses are the linchpin of the healthcare system, relied on to provide quality patient care. The Benefits of an Adequately Staffed Nursing UnitBuilding and maintaining an adequately staffed nursing unit yields many advantages that have a positive impact on patients. These benefits include reduced mortality rates; shortened patient stays; and fewer preventable issues, such as falls and infections. An adequately staffed nursing unit can also lead to better staff retention, as a poorly staffed unit could potentially lead to nurse attrition and high turnover. The impact of these negative outcomes is further exacerbated by an ongoing nursing shortage. Nursing ShortageThe U.S. Bureau of Labor Statistics (BLS) estimates that, by 2030, 276,800 more registered nurses (RNs) and 121,400 more advanced practice registered nurses (APRNs) will be needed. An aging population, projected nurse retirement, and nurse burnout are among the many reasons for this forecast. The effects of the COVID-19 pandemic have further contributed to the issue. A September 2021 survey from the American Nurses Association Enterprise reports that 68% of nurses experienced direct exposure to a patient with COVID-19. The survey also reported 42% of nurses have had “an extremely disturbing, stressful, or traumatic experience” because of the pandemic. Furthermore, 31% of nurses surveyed have sought mental health support since March 2020, and 21% of nurses intended to leave the profession within six months. Why UAP Are Integral to Better Health OutcomesThe unsung heroes of the healthcare system, unlicensed assistive personnel (UAP) are generalist care providers who help make daily living achievable for people with physical or cognitive disabilities. They ease the workload for nurses by taking on more basic nursing tasks. The Role of UAPUAP are trained to aid nurses in patient care situations. They work under nursing professionals, who delegate and supervise this level of aid. UAP typically works in assisted living facilities, nursing homes, schools, and rehabilitation facilities. UAP vs. NursesUAP executes basic supportive tasks to improve patients’ comfort. This is different from the role of nurses, who coordinate care designed to improve patients’ health and wellness, including treatment strategies or medication delivery. UAP typically do not need a license to practice, whereas nurses must be licensed. Also, the fact that nursing professionals delegate duties to UAP further differentiates the two roles from each other. Another differentiator between UAP and nurses is salary. BLS reports the 2021 median annual salaries for RNs and UAP were $77,600 and $30,310, respectively. Because of the salary difference, healthcare facilities may find hiring UAP to support their current staff to be more cost-effective than hiring more RNs. Making the Most of Nurse-UAP PartnershipsIn a healthcare setting, there must be enough nurses and UAP so each role can focus on their care specialties and be confident that their patients’ other needs are being met. Nursing professionals must understand how to delegate tasks to achieve optimal patient care. Typical UAP TasksSome of the common tasks executed by UAP include taking vital signs, providing minor first aid, and assisting in rehabilitative or therapeutic services. They are also typically tasked with aiding in activities for daily living, or ADLs. Common ADLs include bathing and grooming, feeding, dressing, toileting, ambulating, and continence. Five Rights of DelegationThe Five Rights of Delegation — a joint statement from the National Council of State Boards of Nursing (NCSBN) and the American Nurses Association (ANA) — seeks to standardize the delegation of tasks to UAP via five core “rights.” The first in this series is establishing the “right task,” which seeks to ensure the activity aligns with the person’s job description or expected process. “Right circumstance” involves making sure the patient’s health is stable enough to allow for delegation. “Right person” seeks to confirm that UAP has the appropriate skills for the task. “Right direction and communication” dictates that the delegation must be patient-specific and clearly communicated; it also states that the UAP must ask clarifying questions if necessary. Finally, the “right supervision and evaluation” establishes the need for the delegator to monitor the delegated activity, which includes following up with UAP upon completion. How Nurses Can Optimize a Nurse-UAP Partnership</h3>Nurses can take several steps to ensure their collaborative efforts with UAP remain strong. The first entails building a plan around which tasks to delegate. Communication is another key element because it’s important to communicate task expectations clearly and concisely, carefully listening to a UAP’s questions and asking them to restate expectations. Additionally, nurses should address performance problems as they occur and give appropriate feedback. Stronger Partnerships, Better CareBy forging strong partnerships and proper task delegation, collaborations between nurses and UAP can help improve patient care amid a dire nursing shortage. The nurse-UAP partnership makes it easier for a healthcare facility to deliver high-quality patient care. SourcesAmerican Association of Critical-Care Nurses, “Nurse Staffing: A Reason to Leave and a Reason to Stay” American Nurses Association, Nurse Staffing Crisis ANA Enterprise, Mental Health and Wellness Survey 3 Daily Nurse, “A Nursing Shortage and More: Three Ways the Aging Population Is Affecting the Profession” Houston Chronicle, “Nurses vs. Paraprofessionals” Law Insider, Unlicensed Assistive Personnel (UAP Definition) National Council of State Boards of Nursing, Board of Professional Licensure Requirements National Council of State Boards of Nursing, National Guidelines for Nursing Delegation National Library of Medicine, “Activities of Daily Living” National Library of Medicine, “Five Rights of Nursing Delegation” Relias, “Delegating Effectively to Nursing Assistants in Post-Acute Care” U.S. Bureau of Labor Statistics, Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners U.S. Bureau of Labor Statistics, Nursing Assistants and Orderlies, Pay U.S. Bureau of Labor Statistics, Registered Nurses What is the role of the UAP?Typical UAP Tasks
Some of the common tasks executed by UAP include taking vital signs, providing minor first aid, and assisting in rehabilitative or therapeutic services. They are also typically tasked with aiding in activities for daily living, or ADLs.
What are the roles and responsibilities of the unlicensed assistive personnel?UAP (nursing assistants, certified nursing assistants, patient-care technicians, and orderlies) play a vital role in patient care. UAP provide direct care to patients related to personal hygiene, vital signs, feeding, ambulation, and toileting, and monitor patients' blood glucose and cognition.
What are three tasks that a registered nurse may assign to an assistive personnel?Three tasks that a registered nurse may assign other assistive personnel include assisting the client with activities of daily living, measuring and recording vital signs, and observing and reporting any changes in the patient's current status and reaction to care (RegisteredNursing, 2016).
What can a nurse delegate to assistive personnel?In general, simple, routine tasks such as making unoccupied beds, supervising patient ambulation, assisting with hygiene, and feeding meals can be delegated. But if the patient is morbidly obese, recovering from surgery, or frail, work closely with the UAP or perform the care yourself.
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