An Examination of Delegation Policies for UAPs in California
The California State Board of Nursing says that Unlicensed Assistive Personnel cannot be allowed to replace registered nurses in performing functions assigned to them or perform tasks that require a lot of technical skills and scientific knowledge. A registered nurse practitioner is permitted to offer some primary care services both in routine and emergencies. Unlicensed assistive personnel may not be assigned roles in place of registered nurses or be delegated with tasks that are beyond the skills and knowledge they have. Tasks that are not suitable for unlicensed assistive personnel include caring for patients with unpredictable outcomes or who are unstable. The California State Board of Nursing provides guidelines for a nurse practitioner in delegating patient care tasks to ensure that nurses delegate tasks to workers who are competent for the roles assigned, exercise judgment to ensure the circumstances are right for delegation and that all the functions delegated are within the licensed scope of practice of the registered nurse.
Unlicensed assistive personnel (UAP) may not function in the place of a registered nurse or have tasks delegated to them that are beyond their ability to carry out competently. Competency here means that these assistants should have the necessary scientific knowledge, and technical skills. Unlicensed assistive personnel is not allowed to administer medication, provide intravenous therapies or carry out tasks that require them to perform venipuncture procedures on a patient (Cahill, Painter, & Branch, 2021). Task and functions that involve tube feeding or alternative means of feeding that necessitate surgery such as parenteral procedures require knowledge and skills that are beyond those possessed by unlicensed assistive personnel. Unregistered medical assistants should not be assigned roles that require the application of invasive techniques such as tracheal suctioning, inserting catheters, and inserting nasogastric tubes. Tasks that cannot be delegated to medical assistants include assessing the condition of the patient, educating the patient and the family concerning healthcare problems, and carrying out laboratory tests that have at least moderate complexity.
A registered nurse is responsible for checking to ensure that the unlicensed assistive personnel has the necessary qualifications to carry out the task before it is delegated. This means that before assigning any task the registered nurse should check the documented evidence of the existing ability in terms of the appropriate skills, experience, and education for it. The registered nurse should adhere to the “Five Rights of Delegation” when assigning any task (Lowe, Gerald, Clemens, Gaither, & Gerald, 2021). The right task should be delegated which means that it should match the ability of the worker to satisfactorily perform it. It is necessary to monitor the circumstances and only delegate when the situation allows for the smooth accomplishment delivery of patient care. The right person should be selected and provided with the appropriate communication and direction. The person selected should also be supervised adequately.
The registered nurse should constantly monitor the unlicensed assistive personnel to provide guidance and assess their ability to perform the assigned patient care tasks accurately. This means that unlicensed assistive personnel cannot carry out any tasks without supervision or consulting with the nurse practitioner to obtain feedback about how the task is being carried out. However, simple routine tasks that do not require extensive skills and scientific knowledge can be delegated and done without constant supervision (National, 2016). Such tasks include observing, recording, and reporting treatment and clinical information such as patient’s behavioral changes. UAPs can also assist in simple rehabilitative measures such as motion exercises and providing patients with answers for general questions such as providing directions (Wagner, 2018). Registered nurses can also delegate general tasks without much supervision as long as they fall under the nurse’s scope of practice such as the collection of specimens for medical tests, assisting in hygiene tasks for patients, ambulation/mobilization of patients, and grooming tasks.
In the State of California, a registered nurse cannot delegate tasks to unlicensed assistive personnel in an ICU environment as they would in a general medical-surgical unit as this would violate most of the required guidelines. The five rights of the delegation include delegating the right task, under the right circumstances, to the right person, by providing the right supervision and correct direction and communication. Most patients who are referred to the ICU have conditions that require a high degree of problem-solving and the patient care tasks associated with these conditions often carry high risks that may have fatal consequences (Williams & Cooksey, 2004). The registered nurse also may lack the necessary sufficient information about the UAP concerning their experience such as whether the UAP has successfully done such tasks before. Even when supervising directly, it is not wise for registered nurses to delegate tasks because the patient’s condition can be unpredictable in the ICU environment.
In conclusion, before delegating duties to unlicensed assistive personnel registered nurses should check to ensure that the worker has documentation to show that they are competent to handle the functions to be delegated. Responsibilities of the registered nurse when delegating patient care tasks include ensuring that the worker meets the minimum required competence to handle the assigned function and making sure the task delegated are within the legal scope of practice. A registered nurse cannot delegate patient care tasks in the ICU environment like they would do in a general medical-surgical unit because the rules that guide delegation allow it to happen only under the right circumstances. Policies outlined by the California Board of Nursing strongly discourage nurse practitioners to delegate tasks within the ICU environment because most tasks are beyond the ability of the UAP to perform successfully.
References
Cahill, M. L., Painter, D. R., & Branch, J. L. (2021). The Authority for Certain Clinical Tasks Performed by Unlicensed Patient Care Technicians and LPNs/LVNs in the Hemodialysis Setting: An Update and Invitation to Take Action. Nephrology Nursing Journal, 48(2), 119. doi:10.37526/1526-744x.2021.48.2.119
Lowe, A. A., Gerald, J. K., Clemens, C., Gaither, C., & Gerald, L. B. (2021). Medication Administration Practices in United States’ Schools: A Systematic Review and Meta-synthesis. The Journal of School Nursing, 105984052110263. doi:10.1177/10598405211026300
National Guidelines for Nursing Delegation. (2016). Journal of Nursing Regulation, 7(1), 5-14. doi:10.1016/s2155-8256(16)31035-3
Wagner, E. A. (2018). Improving Patient Care Outcomes Through Better Delegation-Communication Between Nurses and Assistive Personnel. Journal of Nursing Care Quality, 33(2), 187-193. doi:10.1097/ncq.0000000000000282
Williams, J. K., & Cooksey, M. M. (2004). Navigating the difficulties of delegation. Nursing, 34(9). doi:10.1097/00152193-200409000-00026
