Essay Example on UAP: An Essential Part of Nursing Care in Changing Healthcare

Introduction

Due to changes witnessed in the healthcare environment in recent years, the utilization of unlicensed assistive personnel (UAP) has become necessary in the provision of safe, affordable, and accessible nursing care. UAP refers to unlicensed individuals who are trained to assist licensed nurses in particular roles. According to the Academy of Medical-Surgical-Nurses (AMSN), the UAP must be appropriately trained and demonstrate competence in their roles before assuming any new or expanded responsibilities (AMSN, 2009). Mechanisms must also be established to regulate and monitor UAP in clinical settings. Such mechanisms include state of boards of nursing which clarify the delegation process as well as any restrictions. This paper seeks to discuss the role and responsibilities of the UAP, according to the Texas Board of Nursing. The responsibilities of the registered nurse in the delegation of roles will also be explored. Finally, the differences of UAP responsibilities between the ICU environment and the general-medical-surgical unit will be discussed.

Is your time best spent reading someone else’s essay? Get a 100% original essay FROM A CERTIFIED WRITER!

Save 25%

Role of UAP and Registered Nurses

As mentioned earlier, the use of UAP in nursing has been informed by the shortage of nurses in the United States (Daniel & Smith, 2018). To bridge the gap, more hospitals around the country are hiring UAPs. Cost-cutting is also one of the primary reasons why hospitals are increasingly hiring UAPs instead of registered nurses. Recent regulations such as the Affordable Care Act lead to an increase in costs, and hence hospital executives must develop ways of cutting costs (Henke, et al., 2018). UAPs include orderlies, nursing aides, attendants, assistants, and technicians. While UAPs are hugely helpful in improving the accessibility, affordability, and quality of care, their roles differ from those of registered nurses. In Texas, UAPs are trained to offer an assistive or supportive role to the registered nurses. Basically, UAPs engage in patient supportive duties which do not require any form of specialized training or specialized knowledge. Their roles can be broadly divided into indirect and direct care activities. None of these categories requires specialized knowledge. The roles that fall under the direct care activities are feeding and grooming of the patients. Indirect care activities include housekeeping and transportation. By taking up these roles, the UAPs free up registered nurses to engage in tasks that require specialized training and knowledge such as the administration of medication. Other roles that fall within the scope of the registered nurse according to the Texas Nursing Practice Act include observation, evaluation, assessment, and rehabilitation of the patient as well as the maintenance of health and prevention of illness. They are also supposed to develop nursing care plan (Texas Board of Nursing, 2013).

Delegation of Tasks to UAPs

The Texas Board of Nursing has also established rules and regulations to guide delegation of tasks to UAP. According to the body, delegation is a critical nursing skill used by registered nurses to optimize the care given to the patients. The general criteria for delegation, according to the board's regulations, are based on the needs as well as the stability of the patient. The patient must also be assessed for any potential harm, and the complexity of the task to be delegated must also be considered. Moreover, the predictability of the outcomes, as well as the capabilities of the UAP to perform the tasks, are also essential considerations. It should be noted that the delegation process is usually multifaceted (Bertolino LLP, 2019). It starts with decisions made at the administrative level and flows to the staff responsible for the delegation and supervision of the delegated tasks such as the registered nurses. While the Medical Practice Act gives physicians broad delegation authority, the Nursing Practice Act does not give similar authority. Therefore, though registered nurses work with UAP in different practice settings, their authority to delegate is restricted to particular tasks as laid down by the Texas Board of Nursing Delegation Rule, found in chapters 224 and 225 (Bertolino LLP, 2019).

Some of the tasks that a registered nurse can delegate to UAP include non-sterile and non-invasive treatments, as well as the collection, reporting, and documentation of specific data. The UAPs are also allowed to transport clients within the facilities, feed them, and also tasks involving ambulation, turning, and positioning of the clients. Other roles that can be delegated to UAP include socialization and daily living activities, as well as the reinforcement of health teaching given by the registered nurse (Bertolino LLP, 2019). According to the delegation rules, there are some tasks that a registered nurse cannot delegate to UAP, especially those that require professional nursing judgement, referral, intervention, or follow-up. Some of these tasks include psychological, physical, and social assessment of patients, formulation of a nursing care plan, as well as the evaluation of the patient's response to the care given. Administration of most medications, including intravenous fluids, can also not be delegated.

Differences between ICU Environment and General Medical-Surgical Unit regarding Assigned Responsibilities for UAP

In the ICU, the patients are usually critically ill and hence require closer monitoring and care. These tasks require specialized knowledge and training, and hence the responsibilities of UAPs in the ICU are limited. Registered nurses perform most of the tasks in this environment, and fewer roles are delegated to the UAPs, as compared to other units (Jenkins & Joyner, 2013). Moreover, due to the sensitivity of the tasks performed in this environment, various boards of nursing around the country have developed their own role definitions, educational standards, as well as the scope of practice for UAPs in the ICU environment (Jenkins & Joyner, 2013).

As compared to the ICU environment, the general medical-surgical unit has more patients. Therefore, most hospitals find it necessary to bring in UAPs to help care for the high number of patients (Lavander, Merilainen, & Turkki, 2016). Moreover, some of the nursing tasks carried out in the general medical-surgical units do not require specialized knowledge hence the registered nurses can delegate more responsibilities to the UAPs. However, since the unit may require coordination, organization, and prioritization of complex and multiple patients assignments, supervision must be provided whenever any task is delegated to the UAPs.

Conclusion

Informed by a shortage of nurses and the need to cut costs, hospitals across the country are increasingly hiring UAPs to perform tasks that do not require specialized training and knowledge. By doing so, the UAPs free up the registered nurses to perform tasks that require more specialized knowledge and specialization. In Texas, the Texas Board of Nursing dictates the scope of practice for both UAPs and registered nurses, as well as the educational standards to be met by both. While physicians have broad authority to delegate, the Texas Nursing Practice Act limits the registered nurses' authority to delegate. The board outlines the roles that the registered nurse can delegate to UAPs, as well as those that cannot be delegated. The board also emphasizes that supervision for the delegated roles must be provided. The responsibilities of the UAPs also depend on the unit. For instance, the tasks that they can perform in the ICU are fewer compared to those that they can perform in the general medical-surgical unit.

References

AMSN. (2009). Unlicensed Assistive Personnel (UAP). Retrieved from AMSN: https://www.amsn.org/practice-resources/position-statements/archive/unlicensed-assistive-personnel-uap

Bertolino LLP. (2019, July 26). RN Delegation of Nursing Tasks to Unlicensed Personnel, Texas Rules. Retrieved from Bertolino LLP: https://www.belolaw.com/posts/delegation-of-nursing-tasks-to-unlicensed-personnel/

Daniel, K. M., & Smith, C. Y. (2018). Present and future needs for nurses. Journal of Applied Biobehavioral Research, 23(1), e12122. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/jabr.12122

Henke, R. M., Karaca, Z., Gibson, T. B., Cutler, E., White, C., & Wong, H. S. (2018). Medicare advantage penetration and hospital costs before and after the Affordable Care Act. Medical care, 56(4), 321-328. Retrieved from https://www.ingentaconnect.com/content/wk/mcar/2018/00000056/00000004/art00008

Jenkins, B., & Joyner, J. (2013). Preparation, Roles, and Perceived Effectiveness of Unlicensed Assistive Personnel. Journal of Nursing regulation, 4(3), 33-40. Retrieved from https://www.sciencedirect.com/science/article/pii/S2155825615301289

Lavander, P., Merilainen, M., & Turkki, L. (2016). Working time use and division of labour among nurses and healthcare workers in hospitals-a systematic review. Journal of nursing management, 24(8), 1027-1040. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/jonm.12423

Texas Board of Nursing. (2013). Practice - Registered Nurse Scope of Practice. Retrieved from Texas Board of Nursing: https://www.bon.texas.gov/practice_scope_of_practice_rn.asp