What principles should the professional nurse use when delegating to unlicensed personnel?

When delegating tasks to the UAP, the RN must remember to only delegate those tasks which the UAP is qualified to perform. These tasks may require unit or care area specific training or education but do not involve assessment of the patient in any way. The nursing process itself and responsibility for nursing assessment must remain the sole responsibility of the RN (Huston, 2019). In our facility, UAP are required to demonstrate competency annually, just as licensed personnel, to complete the tasks which they may be assigned. This is not the case in all care areas national standards exist to define scope of practice for unlicensed assistive personnel with many simply completing on the job training specific to the unit assigned. This has resulted in poorly delineated rules by which licensed staff may assign tasks, a situation not comfortable for the RN or the UAP (Kleinman, 2006).

Because the licensed nurse is liable for care performed by an unlicensed person, how do you protect yourself and your patients?

Communication is key to providing appropriate patient care in any setting. Communication between licensed and unlicensed personnel, a working relationship in which each understands the boundaries and limitations of both licensure and experience. By building relationships with unlicensed personnel, the RN may identify the ability and knowledge base of each person and therefor designate tasks appropriately. By communicating openly regarding level of experience and ability and knowing there is respect and appreciation on both sides of the conversation, unlicensed personnel and licensed personnel can work together to provide the patient with the best care environment possible.

What does your state’s nursing law and rules say about delegation to unlicensed workers?

The Illinois Department of Public Health maintains a healthcare worker registry along with a registry for individuals completing a basic nurse aide course and passing a competency exam consisting of 21 manual skills and a written exam. Requirements can be met through on the job training as long as manual skills and written exam are completed successfully (IDPH, 2019). These 21 skills are the only required manual skills to obtain certification along with demonstrating basic patient care knowledge by written exam. The Illinois Nurse Practice Act mandates registered professional nurses to delegate tasks based on patient assessment, stability of condition, potential for adverse patient outcome, predictability of expected patient outcome and known competency of the individual to which care is being delegated. This with the understanding that the registered professional nurse may not delegate to an unlicensed individual as task which is outside of the known scope of practice by that individual (Illinois Nurse Practice Act). Additionally, the nurse practice act defines the ability of the registered professional nurse to choose NOT to delegate tasks in the event the nurse deems it is inappropriate to do so and defines protections for the nurse for that choice.

References:

Healthcare Worker Registry, Illinois Department of Public Health. Accessed August 4, 2019 from: https://hcwrpub.dph.illinois.gov/ (Links to an external site.)

Huston, C. J. (2019). Professional images in nursing: challenges and opportunities. (vitalsource). Philadelphia, PA: Wolters Kluwer.

Illinois Nurse Practice Act. Accessed August 4, 2019 from: http://www.ilga.gov/legislation/ilcs/ilcs5.asp?ActID=1312&ChapterID=24 (Links to an external site.)

Kleinman CS, & Saccomano SJ. (2006). Registered nurses and unlicensed assistive personnel: an uneasy alliance. Journal of Continuing Education in Nursing, 37(4), 162–170. Retrieved from https://search-ebscohost-com.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=106338366&site=eds-live&scope=site (Links to an external site.)

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