|Type of paper:
|Knowledge Medicine Healthcare policy Nursing care
Unlicensed health providers who are healthcare providers whose training is to assist in a supportive role in the provision of healthcare are commonly known as Unlicensed assistive personnel (UAP). They are mostly but not limited to nurse aides, orderlies, assistants, technicians, and also attendants. The duties that they perform are usually delegated by the nurses in advanced roles to enable them to tend to the magnitude of patients. According to Vizcarra (2016), they are used to assist clients in situations where the health care of the patients seems to be improving. Assignment of unsilenced personnel to a patient whose health is declining is against the health care policies, and in case an event such as death occurs, the nurse that assigned the unlicensed assistive personnel is held responsible.
Mr. Smith is a 75-year-old male who was transferred to a unit upon the diagnosis of a urinary tract infection. The patient seems alert but displays constant signs of confusion. The vital signs of the above patient have required assessment after every 4 hours. He was also experiencing urinary frequency and reminded him to ring his bell or use the urinal allocated to him rather than getting out of bed by himself to use the bathroom. Another case is where Ms. MacDonald, a 60-year-old female patient, is admitted to the unit of an advanced nurse following a hysterectomy case, which occurred some days before her admittance. The post-op course of the latter patient was deemed uncomplicated with the surgeon ordering that Ms. MacDonald ambulate a day thrice. The vital signs of Ms. MacDonald are stable, with the patient being alert, oriented, and also cooperative with the treatment offered to her. In both cases, the patient's health seems stable at the time, and it allows their care delegated to UAPs. In the case of Mr. Smith, the task which could be charged include, assisting him with elimination, and completing of the assessment for the vital signs after-hours indicated. These were 4 hours, and as long as the supervising nurse gives the most precise directions to report the vital signs of the patient in the least time possible, they're attaining the technique of being supervised by the nurse and them confirming their satisfaction. In the case of Ms. MacDonald, since her health status is stable, the tasks which they could delegate include the assistance of Ms. MacDonald's ambulation.
It would be wrongful delegation when a UAP is allowed to feed a patient who suffered from a stroke in the absence of a nurse or without the nurse helping in activities involving feeding the patient, such as assessing the ability of the patient exhibited in his swallowing. The patient is prone to cases such as choking with the UAP not having any knowledge of such a matter could, therefore, lead to fatalities. UAP may, however, assist in cases such as the determination of the output of a patient's urine as per the time frame. Still, the latter is not allowed to report that the production is low, with such an interpretation only assessed by a documented nurse.
All types of delegation should be based on the primary Five Rights of Delegation. They include; commission to the right individual, the delegation of the right task, delegation in the right circumstances, the delegation of the right directions and also constant communication of the delegated, and finally, the right to correct supervision and evaluation of those appointed to (Barrow & Sharma, 2019).
It is important that the delegation of duties is done following the different practices conducted by each of the staff members to which functions are delegated. Responsibilities are, however, supposed to be transferred based on education preparation differences among members belonging to the nursing team. Care is by the latter grounds assigned to members according to their level of education. A patient care technician certified assistance of the nurse, a licensed practical nurse, and also a bachelor's degree nurse that is registered delegated different duties to their counterparts of nurse care only.
It should be considered that validated and also documented competencies should be considered before the assignment of individuals to patient care. Since there's a variation on the competencies, a newly graduated nurse is not expected to perform patient care tasks at the same level of skill as that of an experienced nursing assistant or even a registered nurse. The latter is because it takes a lot of time for the graduate nurse to acquire the same level of experience and knowledge that matches one of the experienced individuals in the hospital setup.
Upon delegation, it is advised that no aspect of care should be delegated to individuals unless the staff provides valid documented evidence that proves they are proven competent by a registered nurse to perform such a task. According to standards say, a newly hired nurse aid that is certified should not be allowed to perform bed baths. It should be done only when a registered nurse that is in a supervisory position has observed the certified nurse aid perform bed baths and decide that they are then competent without the direct supervision of a certified nurse.
It is a requirement that healthcare facilities should assess and even validate the competency of the unlicensed personnel before issuing total care or any aspect of care to a patient. That is done regardless of the years of experience of the unauthorized personnel. Documents put into play in such a situation include competency checklists, which are mostly referred to when assignments are made. Care is then delegated when only and only when the individual in question is deemed competent in the performance of the required roles and tasks and the competency of the individual is documented for future reference.
In the United States, all states are required to have scopes of practice for advanced nurse practitioners, licensed nurses in practice, advanced nurse practitioners, nursing assistants who are not permitted, and also patient care technicians. Scopes of practice have, over time, been considered before the assignment of general care. Infusion therapy and vascular access placement are the treatment orders that are commonly prescribed for patients that are in the setup of healthcare after treatment. With infusion therapy involves the administration of solutions to the patients, provision of medication, and also nutritional products that would help on the improvement of the patient's health. The latter also involves t administration of blood and component of blood through the parietal route of the patient.
Vascular access devices, on the other hand, are catheters incorporated with other devices that are inserted into the vascular system, which is inclusive of arteries, bone marrow, and even veins. Scope of Practice indicates that any role, responsibility, or accountability of each of the involved tasks are delegated by nurses at advanced functions to UAP. It is acceptable and follows the rules of the Boards of Nursing. It is within the policies of the organization. Delegating the two activities to the UAP was not accepted by many states, affirming that the initiation, infusion, and even the monitoring of the infusion therapy was not to be conducted by the UAP. The rest were convinced it was right to let the UAP handle the issues, which were the insertion of peripheral catheters that were short following the meeting of the delegation criteria.
In the case of assignment and also supervision of the care provided by UAP, the nurses in advanced roles must follow up on the staff members and have them supervised as they deliver the consideration to which they are assigned. Their job is far from done when client care has been delegated to members of the nursing team. The nurse advanced in roles account for the quality of service delivered by UAP. They are in charge of, appropriateness of service, completeness of task issued, and timeliness in concern to care provided to the patient.
The involvement of the nurses in advanced roles includes supervision. The aspects of monitoring of healthcare include monitoring the care provided by the UAP, coaching the individual on how the care is provided, and also giving their support to the members who are providing the care. Other aspects of supervision include the assistance of say, the nurse aides getting aid with the priority setting, and also skills involved in time management as per the indication of their work by a knowledge or skills deficit. It is also of important that the staff is positively reinforced whenever they get a job well done. The advanced nurse involved in delegation is also accountable for the client's care, which is delegated to others.
Infusion Nurses Society in the United States addressed the issue involving Nursing Assistive Personnel involvement in the provision of infusion therapy. They believed that the delegation of such related procedures and activities of the latter could lead to potential adverse outcomes to the patient in care and also to the general public. The latter was proven that they led to a significant increase in the risks involved with increased liability to the advanced registered nurse. Since the issue presented was addressed, substantial changes in the health care systems and nursing practice environment occurred. In a bid to respond to the case, Infusion Nurses Society therapy experts reviewed and also updated that the unlicensed assistive personnel is included in providing infusion therapy.
In the United States, there are around 4 million UAP who are employed. The situation is mainly driven by the scarce resources involved in the provision of health care, such as reduced healthcare personnel and also demand on the time that health services are needed to be provided (Grove & Gray, 2019). 29% of the UAP work in a hospital setting with their job growth expected to increase by at least 20% following the next year. How they are called, their training, roles performed, and also what they're responsible for vary a great deal within the institutions in which they are located. Most institutions might refer to them as nurse aides with others referring to them as phlebotomists, patient care technicians, dialysis technicians, and even medical assistants.
Vascular access was added to the tasks which nurses in advanced roles could delegate. The change was when statements made from American Nephrology Nurses Association offered their advisories to the American Nurses Association and the National Council of State Boards of Nursing (NCSBNs) on the delegation of nursing care and also duties performed by nurses to the unauthorized personnel. A survey was conducted in a bid to the identification of issues, concerns, and even trends that are in regard to the use of unlicensed health care personnel and providing infusion therapy in all practice settings. The survey was conducted on the Internet within four weeks and inclusive of 504 respondents. Many healthcare settings have sited the increasing aging population, which requires health care as a need to increase the UAP. Other cited reasons include the drastic change in the reimbursement structure and also the constant increase in the efforts that are made in containing healthcare costs. With only situations that require nursing judgment and even the necessary components of the process involved with nursing being delegated. Improper delegation can easily lead to negatively diverse impacts on the care of the patient. It exposes the patients to risks such as death as well as presenting the delegator to getting legal action taken on them.
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