Introduction
In the modern era of evolutionary changes, there is an immense need for clarification of the roles of unlicensed and registered nursing professionals in their professional lives while carrying out patient care tasks. Registered nurses provide medical diagnosis, treatment, and assistive counseling to patients in a health care system. Registered nurses have to ensure many steps while delegating medical care tasks to other care providers, especially unlicensed assistive personnel. Unlicensed assistive personnel provide assistance in the health care system by observing and documenting the medical records of patients. Furthermore, they have to report these documented medical records to higher-level professionals such as registered professional nurses and doctors. Unlicensed assistive personnel face different environmental circumstances in the intensive care unit and general medical-surgical unit. This essay tends to explicate the roles and responsibilities of registered nurses in medical facilities and unlicensed assistive personnel in intensive care units and general surgical units.
The Unlicensed Assistive Personnel
Unlicensed assistive personnel (UAP) are known as paraprofessionals because they assist different professionals in different fields. According to the health worker classification by the World Health Organization, unlicensed assistive personnel are defined as “personal care workers in health services” (Health_workers_classification.Pdf, n.d.). As is understandable from the term “unlicensed assistive personnel,” people with this designation do not have or require any legal license or professional degree for their job. They do not require any compulsory professional degrees for their practice. However, many unlicensed assistive personnel have professional certifications that give them access to prestigious hospitals and medical care centers. Unlicensed assistive personnel provide different assistance services to patients in hospitals and private homes. Unlicensed assistive personnel provide services to patients in private homes. These private-home patients include elderly people, patients with serious health problems, and people with physical or psychological disabilities.
The Unlicensed Assistive Personnel: Intensive Care Unit (ICU)
The economic imperative has given rise to the inclusion of unlicensed assistive personnel in the intensive care unit. In this way, the use of expensive registered nurses is reduced in intensive care units. However, the practice of using unlicensed assistive personnel in the intensive care unit has always been a debated issue in the medical health care system. According to the “New York State Board of Nursing,” nursing care cannot be separated from the personal care of a patient. This is why the responsibility of unlicensed assistive personnel is only to complement rather than provide a substitute for nursing care. These unlicensed personnel are only allowed to maintain the critical care environment in which nursing care is provided. To maintain the environment in the intensive care unit, unlicensed personnel are only allowed to provide “indirect patient care activities” (Use of Unlicensed Personnel in Hospitals, n.d.). The New York State Board does not permit unlicensed assistive personnel to administer or alter the medication of any patient. They are trained to provide assistance to registered nurses. They are strictly not allowed to provide any other medical care that is outside their scope of practice. They are only allowed to perform tasks delegated by registered nurses. The duties of a UAP in an intensive care unit include:
- Taking care of the personal hygiene of the patient.
- Assisting in the transportation and mobilization of the patient (for bed changing, CT scans, etc.).
- Helping with the physical movements of the patient (side changing or repositioning of the patient).
The Unlicensed Assistive Personnel: General Medical-Surgical Unit.
The environment of a critical care unit for a UAP is a bit different from the environment in a general medical-surgical unit. However, the tasks and responsibilities of a UAP remain the same in these two domains. In the United States, a surgical technologist is considered unlicensed assistive personnel. Unlicensed assistive personnel also assist residents of nursing facilities. The responsibilities and duties of unlicensed assistive personnel are given below:
- Observing, documenting, and reporting clinical treatment information to higher-level professionals (licensed practical nurses, registered nurses, etc.).
- Reporting the patient’s behavioral changes to a registered nurse.
- Assisting in motion exercises (physical therapies) and other recuperation procedures.
- Recording the vitals of a patient (temperature, pulse, respiration, blood pressure, and body weight).
- Assisting with ambulatory services and transportation of patients.
- Collecting specimens and samples from patients for required medical tests.
- Providing emotional support services to patients and their family members.
- Assisting in maintaining the personal hygiene of the patient (personal hygiene includes bathing, changing clothes, oral hygiene, nail care, and grooming).
- Helping the patient with dressing, repositioning, shifting, feeding, and toileting.
Registered Nurses
In the nursing profession, there are different professional roles provided to nurses to carry out patient care tasks. There are four different nursing professions in New York State that include “Registered Professional Nurse, Clinical Nurse Specialist, Licensed Practical Nurse, and Nurse Practitioner” (NYS Nursing, n.d.). Registered nurses (RNs) are assigned their specific roles by the New York Medical Health Board. A registered nurse can perform medical health assessments to provide the diagnosis of a patient’s health problem. The registered nurse can diagnose and treat different responses to the diagnosed health issues of the patient under treatment. The registered nurse is supposed to provide counseling and teach patients about their health problems and status. Furthermore, the registered nurse has to implement medical treatment as recommended by the licensed physician, pulmonologist, nurse practitioner, podiatrist, etc. Additionally, registered nurses can participate in interdisciplinary healthcare committees. They have to manage and oversee the delegated tasks given to unlicensed assistive personnel. According to New York State Education Law, registered nurses are required:
- To administer physical exams and medical assessments of patients to recognize and address health problems and patient care necessities.
- To improve and develop complete nursing care plans and execute nursing interventions to provide nursing care to the patient (nursing interventions include emotional counseling, diagnosis, medical treatment, etc.).
- To provide medical intervention (i.e., wound care, medicine administration) as prescribed by a doctor, specialist assistant, podiatrist, dentist, physician assistant, or specialist assistant.
- To provide health counseling and emotional support to patients who have chronic injury or illness and their families to help patients face these medical issues.
- To administer care delivered by other health care professionals.
- To efficiently delegate tasks to UAPs
- To work with specialized doctors to ensure that patients receive effective and timely medical care and treatment.
- To provide health counseling or make arrangements, as suitable, for further medical treatment (NYS Nursing: Practice Information: FAQ, n.d.).
According to the Nurse Practice Act (State Education Law, Article 139) in New York State, “A nurse is not legally allowed to provide nursing services that they are not personally competent to perform, even if New York law generally allows a nurse to provide the service.” A registered nurse should be responsible for providing medical care within the limits of their professional abilities and assigned responsibilities. According to New York State law, if a nurse performs any medical procedure that is outside her/his assigned role, the nurse will be charged with “professional misconduct” (NYS Nursing: Consumer Information, n.d.).
Registered Nurses: Delegation of Patient Care Tasks
There are certain responsibilities of registered nurses when delegating patient care tasks to different healthcare providers. The registered nurse is ultimately responsible for the medical treatment and health status of his/her patient while delegating medical care tasks to unlicensed assistive personnel. The registered nurse should know the medical policies and state laws regarding the delegation of medical treatment. They should know the written policies of the medical facilities in which they are practicing. A registered nurse should know the Nurse Practice Act very well while providing medical services and delegating medical services to unlicensed assistive personnel. To provide efficient and safe delegation of health care tasks, a registered nurse should examine the skills of his/her unlicensed assistive personnel. For instance, if a patient is medically unstable, it is unethical and illegal for the nurse to ask the UAP to take the patient to the washroom all by himself. The registered nurse should find an alternative solution for the movement of such a patient or be there to monitor the task while the UAP takes the patient to the washroom. The registered nurse should also have leadership qualities to assist the UAP in carrying out delegated tasks efficiently. Praise from the registered nurse will give immense motivation to the UAP to carry out delegated tasks competently. Therefore, a registered nurse should examine the condition of the patient and the skills of the UAP before delegating medical care tasks.
Conclusion
In a nutshell, effective communication between registered nurses (RNs) and unlicensed assistive personnel (UAP) is the key to providing efficient medical care and fulfilling their prescribed responsibilities. In contemporary society, the inclusion of unlicensed medical workers and registered nurses is increasing due to economic obligations. To provide quality health care and efficient medical treatment, roles and responsibilities are assigned to medical professionals such as registered nurses and unlicensed assistive personnel according to their medical setting.
References
Chaboyer, W., McMurray, A., & Patterson, E. (1998). Unlicensed assistive personnel in the critical care unit: What is their role? International journal of nursing practice, 4(4), 240-246.
Furåker, C. (2008). Registered Nurses’ views on their professional role. Journal of Nursing Management, 16(8), 933-941.
Hartman’s nursing assistant care: the basics. Fuzy, Jetta Lee., Hedman, Susan Alvare., Hartman Publishing. (4th ed.). Albuquerque, N.M.: Hartman Pub. 2014
NYS Nursing. (n.d.). Retrieved June 29, 2021, from https://www.op.nysed.gov/prof/nurse/#
Spencer, S. A. (2001). Education, training, and use of unlicensed assistive personnel in critical care. Critical Care Nursing Clinics, 13(1), 105-118.
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