Registered Nurses and Unlicensed Assistive Personnel: An Uneasy Alliance

Abstract

To meet challenges of continuing change in the health care industry and maintain organizational viability in increasingly competitive markets, the use of the registered nurse--unlicensed assistive personnel model is an undeniable reality that fills the void created by the current shortage of nurses and decreases the costs of providing patient care. Although much has been published about the need for nurses to delegate and supervise patient care-related activities, little has been written about the skills needed to do this effectively or how these skills may be learned. Academic and clinical educators must find ways to facilitate the development of delegation and supervision abilities as nurses increasingly work with nonprofessional staff. Continuing education is an effective way for nurses to learn the skills required by changing models of patient care delivery and evolving professional roles.

Registered nurse leadership style and confidence in delegation

“…When not adequately prepared for supervisory functions, RNs often do not have the necessary level of confidence to lead and delegate (Kleinman & Saccomano 2006). Each time patient care tasks are delegated to a UAP, the RN needs to assess the clinical situation, simultaneously evaluate patient care needs and appraise the competence of the UAP in performing the specific patient care task.…”

“…While few staff nurses may be born with the ability to intuitively delegate and lead, most must learn these skills through educational experiences (Jung 1991, Davis & Farrell 1995). As it is the staff nurse who holds the ultimate responsibility for delegating tasks to UAPs (Kleinman & Saccomano 2006), the RNs leadership style may impact delegation. Thus, a key determinate of the RN and UAP relationship success may rest on the leadership style of the RN.…”

“…In the development of the leadership role, RNs, who have been uncomfortable with this new task of delegation, are being challenged to take on a role which has inherent difficulties. Some of the concerns are related to fear of litigation, undeveloped sense of autonomy, inadequate knowledge of training issues related to the UAP role and supervision (Anthony 2001, Kopishke 2002, Kleinman & Saccomano 2006).…”

Transitional Care

“…9 Evidence supports the fact that licensed caregivers are not taught delegation skills in formal education and do not feel comfortable. Continuing education programs using simulation can be an effective way for nurses to learn supervision and delegation skills.…”

Confidence in delegation and leadership of registered nurses in long-term-care hospitals

“…, Kim & Jeong ). Unlicensed nursing personnel mostly assist in direct nursing care, such as vital signs, range of mobility, feeding and bathing (Kleinman & Saccomano ). However, inadequate supervision can engender health‐care errors, which has an impact on patients’ outcomes (Anthony et al .…”