What does your State Board of Nursing say about Unlicensed Assistive Personnel and their role, and the role of the Registered Nurse?
What does your State Board of Nursing say about Unlicensed Assistive Personnel and their role, and the role of the Registered Nurse? Describe the responsibilities of the Registered Nurse when delegating patient care tasks.
How does the ICU environment differ from a general medical-surgical unit as far as assigned responsibilities for Unlicensed Assistive Personnel?
Expert Answer and Explanation
Delegation in Practice
To ensure high-quality patient care, every state has a board that oversees the roles of nurses and ensures that they are able and well prepared to handle their roles. Colorado's State Board of Nursing ensures that nursing standards and policies are well implemented. The board oversees the license issuance and further stipulates the roles of different nursing professionals in the state (Board of Nursing, n.d).
As a result of their intervention, it is easy to understand the roles of different nurses and to ensure further that there is discipline among the nurses. There are varying nursing professionals, and the board has effectively covered the scope of their practice.
Role of the Unlicensed Assistive Personnel
According to the State of Colorado, unlicensed assistive personnel are people without any recognized knowledge in the medical field and, therefore, cannot be given complicated tasks involved in the field. The roles of the unlicensed assistive personnel are greatly limited, and a registered nurse only directs them. These can include caregivers, parents, and other personnel (Colorado Association of School Nurses 2015).
Notably, in many situations, the roles are only carried out when the nurse is unavailable, and the duties are easy to train and will not have devastating outcomes if done incorrectly.
The following are roles that can be delegated to unlicensed assistive personnel. Notably, for all the roles, the unlicensed assistive personnel must be well trained by the registered nurse. It is also important to ensure that the assistant is always available to monitor the patient's progress and has access to 24/7 communication in case the patient's conditions change abruptly (Colorado Association of School Nurses 2015).
- Applying preventative diaper cream
- Naso-gastric feeding
- Emergency preservation of gastrostomy stoma
- Clean intermittent catheter
- Indwelling catheter care
- Continuous positive airway pressure
- Continuous monitoring of the oxygen supply
- Subcutaneous continuous glucose monitoring
- Administration of prescribed medications and emergency medications such as injections. It is paramount that the registered nurse prepare the unit dose
- Pressure ulcer care
- Collecting blood glucose Ketone
Role Of The Registered Nurse In Delegating Patient Care Task
The registered nurse is responsible for delegating and supervising the delegating tasks and can be considered to be responsible for the tasks that are not well performed. This means the nurse has legal implications for the tasks delegated to the unlicensed assistive personnel. To ensure that the task is well performed, the nurse must ensure the following:
- That the instructions for the procedure being delegated be specific and broken down into easy individual components
- The steps for the task being delegated must be well documented
- The documentation of each document must be made accompanied by the signs of the delegator and the delegatee
- The nursing procedure can be delegated after the delegate has shown competence through the training process
- The registered nurse must determine the frequency of evaluation
- It is also the role of the registered nurse to document all the errors committed to carrying out the tasks and further note that all the corrective actions are taken.
- It is also important to ensure that the task delegated is within the nurse's knowledge, skills, and abilities.
- It is also the nurse's role to ensure that the unlicensed assistive personnel is competent and can safely perform the task.
- The nurse must ensure that the roles do not require nursing judgment.
How The ICU Environment Differ From The General Medical-Surgical Unit As Far As Assigning Responsibilities For The Unlicensed Assistive Personnel
There is no information about the ICU environment and the general medical surgical unit when considering the responsibilities or the unlicensed assistive personnel. However, when considering the general practice of nurses in states, it is clear that there is no unlicensed assistive personnel allowed in the ICU environment as the patients are high risks and can only be taken care of by licensed personnel.
However, some hospital environments have allowed nursing assistants in the general medical-surgical unit. According to Twigg et al. (2016), it is important to understand the role of assistants in the nursing wards through the study, and there were adverse outcomes in matters such as increased urinary tract infections, failure to rescue, and falls with injury.
This shows the adverse consequences of having the assistants working directly on patients' care. However, there is an observed decrease in mortality in the wards (Griffiths et al. 2019). The authors noted that with a perfect address of the roles of the assistant and clearly describing their role while working under the direct supervision of the nurses, it could be possible to ensure that there are no adverse consequences to the patients.
Unlicensed assistive personnel is integral to patient care, especially when a registered nurse is not always available to perform the procedure. However, it is also notable that it is paramount for the registered nurse to give instructions on how the procedure should be carried out, as the legal responsibility of caring for the patient is still with the registered nurse.
In the hospital setup, unlicensed assistive personnel is not advocated for as the patients are in less stable conditions, and a small mess-up can cost the life of the patients.
References
Board of Nursing. (n.d). Title 12 Division of Professions and Occupations Article 25 Nurses and Nurse Aides. Board of Nursing. Practice Act and Laws. . https://dpo.colorado.gov/Nursing/Laws
Colorado Association of School Nurses. (2015). Guidance on Delegation for Colorado School Nurses & Child Care Consultants. https://www.cde.state.co.us/healthandwellness/guidanceondelegationforschoolnurses
Griffiths, P., Maruotti, A., Saucedo, A. R., Redfern, O. C., Ball, J. E., Briggs, J., ... & Smith, G. B. (2019). Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal cohort study. BMJ quality & safety, 28(8), 609-617.
Twigg, D. E., Myers, H., Duffield, C., Pugh, J. D., Gelder, L., & Roche, M. (2016). The impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes: An analysis of administrative health data. International Journal of Nursing Studies, 63, 189-200.
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