Delegation of tasks to unlicensed assistive personnel in nursing

Delegation of tasks to unlicensed assistive personnel in nursing

Delegation of tasks to unlicensed assistive personnel in nursing is a subject that has drawn debate in recent years. The term unlicensed assistive personnel includes but is not limited to technicians, attendants, assistants, orderlies, and nurse aides. Unlicensed assistive personnel have been used in various capacities including serving in nursing homes, cancer screening, inpatient handoff, diabetes-related tasks, and the provision of infusion therapy. Unlicensed assistive personnel have mostly been assigned to medical-surgical units. However, in recent times, the use of unlicensed assistive personnel in the critical care setting has steadily increased. However, the use of unlicensed assistive personnel in the critical care setting is problematic because of patient safety concerns and issues with monitoring their level of competence. While some scholars consider unlicensed assistive personnel essential, others find their use to represent an increased risk to patients.

In the state of California, the role of the registered nurse is defined under the Nursing Practice Act Business and Professionals Chapter 6. According to section 1443.5 of the Standards of Competent Performance California Code of Regulations Title 16, the registered nurse is expected to be consistent in displaying the capacity to apply scientific knowledge from physical, biological, and social sciences in providing health care services. Therefore, the registered nurse is expected to formulate nursing diagnoses after a keen observation of the patient’s behavior, physical condition, and interpretation of patient data from the patient and other members of the health team. Section 70215 of the California Code of Regulations Title 22 also states that the registered nurse shall offer the patient continuous patient assessments and document the findings in the patient’s file.

Such ongoing assessment is expected to be conducted in all shifts the registered burse is involved in, when he or she receives new clients, and when he or she is moved to another area of patient care. Furthermore, the registered nurse is expected to provide direction for multidisciplinary patient care by assessing all patients in each shift. The registered nurse is also expected to perform his or her functions interdependently, dependently, and independently and to have an adequate understanding of when each of these functions is to be applied. In addition, the registered nurse is also expected to initiate and implement complex thinking strategies in every aspect of healthcare provision. Therefore, the registered nurse should have the capacity to come up with a patient-centered plan when there is conflicting, unique, inconsistent, and uncertain patient information.

Regarding delegation, the registered nurse, according to Title 16 of the California Code of Regulations, should be able to demonstrate competence in the delegation of tasks to unlicensed assistive personnel. In this context, the registered nurse is expected to observe laws that govern the practice of the subordinates. The demands of the task, and the ability of the subordinates, are also crucial factors that have to be considered. In addition, the registered nurse is expected to apply adequate supervision for healthcare services provided by the unlicensed assistive personnel. The delegation of tasks plays a crucial role in the ability of the registered nurse to make independent and collaborative judgments based on the effectiveness of the care plan and to modify it when necessary based on changes in treatment orders, response to therapy, and patient condition. If there is a need for any revisions to be done in any aspect of the nursing plan, the registered nurse is expected to make sure that the interventions are adequate and appropriate for the client. However, the registered nurse cannot, under California law, delegate the direction and scope of practice for the nursing process to the unlicensed nursing personnel. Additionally, the registered nurse must ensure that unlicensed registered nurses have the proper experience, skills, and education to perform the required activity.

In addition, the registered nurse is expected to ensure that potential delegates have documented evidence of their skillset before having tasks delegated to them. Furthermore, the registered nurse is expected to intervene where delegated tasks are poorly performed, and to have all delegated tasks carefully documented. The relationship between the registered nurse and the delegate is also supposed to be governed by the “Five Rights of Delegation”: right supervision provided, right communication, right person, right circumstances, and right task. Concerning supervising the unlicensed assistive personnel, the registered nurse is expected to clarify expectations and provide directions on how a delegated task is to be performed. In addition, the registered nurse is expected to monitor performance to ensure compliance with established procedures, policies, and practice standards.

In the medical-surgical environment, unlicensed assistive personnel mostly provide supportive care –they provide for clients’ comfort and help in the functions of daily living. These activities form the bulk of their operations. In these tasks, clinical observations involved in these tasks included observations for confusion, fatigue, and weakness, weighing clients, and measuring input-out of fluids. However, in the critical care environment, the tasks to be performed are more professional. For instance, all health care practitioners working in the critical care setting are required to demonstrate quick response, seeing the whole picture, and continuous vigilant assessment. Thus, unlicensed assistive personnel are also expected to do many observations and performing multiple reassessments. Just like the registered nurse is required to note changes in patient conditions and act promptly in response. Furthermore, other than helping to monitor patient conditions, and in helping to respond to the patient’s condition, unlicensed assistive personnel are also expected to perform tasks that are not linked to the performance of bedside tasks. These include the retrieval of equipment and stock, the cleaning of spaces and equipment, and the answering of phones. Another difference arises in the role of unlicensed assistive nurses between the critical care and medical-surgeon setting in that the specialized nurses in the intensive care unit have a more significant challenge in role identification. In addition, while the medical-surgical unit requires unlicensed assistive personnel to perform necessary patient care activities that are mostly non-invasive. These activities include stocking tasks, chores services, range of motion exercises, client transport, specimen collection, ambulation, maintenance activities, housekeeping, companion care, grooming, bathing, and positioning. On the other hand, the tasks performed by unlicensed assistive personnel are more specialized and require more skill and precision. Therefore, they may administer controlled drugs, administer insulin under nurse delegation regulations, a document that the required dosage was taken or refused, and confirm that medication was taken. As a result of the critical care environment requiring more documentation, they are required to verify that patients took their pills, may deliver only pre-packaged medications to the patient, may release medications to patients and assist them to take them and may prepare new medication orders.