In the modern era of evolutionary changes, there is an immense requirement for bringing clarification to the roles of unlicensed and registered nursing professionals in their professional lives while catering to patient care tasks. The registered nurses provide medical diagnosis, treatment, and assistive counseling to the patients in a health care system. The registered nurses have to ensure many steps while delegating the medical care tasks to other care providers (especially unlicensed assistive personnel). The unlicensed assistive personnel provides assistance facilities in the health care system by observing and documenting the medical records of the patients. Furthermore, they have to report these documented medical records to higher professionals such as registered professional nurses and doctors. The 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 the registered nurse in medical facilities and unlicensed assistive personnel in the intensive care unit and general surgical units.
The Unlicensed Assistive Personnel
Unlicensed assistive personnel (UAP) are known as paraprofessionals because they assist different professionals of different fields. According to the health worker classification by the World Health Organization, unlicensed assistive personnel is defined as “personal care workers in health services” (Health_workers_classification.Pdf, n.d.). As understandable by the term “unlicensed assistive personnel” the 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. The unlicensed assistive personnel provides different assistance facilities to patients in hospitals and private homes. The unlicensed assistive personnel provide facilities to patients in private homes. These private home patients include old age people and patients with serious health problems, and people with physical/ psychological disabilities.
The Unlicensed Assistive Personnel: Intensive Care Unit (ICU)
The economic imperative has given rise to the inculcation 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 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 to only complement rather than provide a substitute for nursing care. This unlicensed personnel is only allowed to maintain the critical care environment in which nursing care is provided. To maintain the environment in the intensive care unit, the 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 facilities to registered nurses. They are strictly not allowed to provide any other medical care which is out of their scope of practice. They are only allowed to perform their delegated tasks by the registered nurses. The duties of a UAP in an intensive care unit include:
- Taking care of the personal hygiene of the patient
- To assist in the transportation and mobilization of the patient (for bed changing, CT scans, etc.)
- To help in 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. The unlicensed assistive personnel also assist residents of nursing facilities. The responsibilities and duties of unlicensed assistive personnel are given below:
- To observe, document, and report clinical treatment information to higher professionals (licensed practical nurses, registered nurses, etc.)
- To report the patient’s behavioral changes to a registered nurse
- To assist in motion exercises (physical therapies) and other recuperation procedures
- To record the vitals of a patient (temperature, pulse, respiration, blood pressure, and body weight)
- To assist with ambulatory services and transportation of patients
- To collect specimens and samples for required medical tests from the patients
- To provide emotional support services to patients and their family members
- To assist in maintaining the personal hygiene of the patient (personal hygiene includes bathing, changing of clothes, oral hygiene, nail care, and grooming)
- To help the patient with dressing, repositioning, shifting, feeding, and toileting of patients
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 (RN) are ascribed 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 the different responses to the diagnosed health issues of the patient under treatment. The registered nurse is supposed to provide counseling and teach the 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 the unlicensed assistive personnel. Conferring to New York State Education Law, the registered nurses are required:
- To administer physical exams and medical assessments of the patients to recognize and address health problems and patient care necessities.
- To improve and develop complete nursing care plans and execute nursing involvements 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 the patients who have chronic injury or illness and their families to help the patient to face these medical issues
- To administer care delivered by other health care professionals
- To efficiently delegate tasks to the UAPs
- To work with specialized doctors to ensure that patients receive effective and timely medical care 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 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 the medical care tasks to the 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 very well know the Nurse Practice Act 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 take an alternate 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 their UAP in carrying out the delegated tasks efficiently. The praise from the registered nurse will give immense motivation for the UAP to carry out their delegated tasks competently. Therefore, a registered nurse should examine the condition of the patient and the skills of the UAP to delegate the medical care tasks.
In a nutshell, effective communication between registered nurses (RN) and unlicensed assistive personnel (UAP) is the key to providing efficient medical care and the fulfillment of their prescribed responsibilities. In contemporary society, the inclusion of unlicensed medical workers and registered nurses is propagating 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 concerning their medical setting.
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