ED nurses: Don’t be afraid of UAPs
By Judy Selfridge-Thomas, RN, MSN, CEN, FNP
General Partner
Selfridge, Sparger, Shea, and Associates
Ventura, CA
"It is giving away what belongs to nursing" is the quote heard sometimes when nurses are questioned about using unlicensed assist- ant personnel (UAP) to provide patient care. Administrative and clinical nurses are on either side of the debate over whether using UAPs is appropriate. In the published literature, financial and personnel turf issues appear to lie at the root of the debate.
According to the Washington, DC-based American Nurses Association (ANA) Social Policy Statement, the practice of nursing is defined as "the diagnosis and treatment of human responses to actual or potential health problems." This definition addresses the very core of nursing. It places into perspective the interpretation and assimilation of information the nurse gathers from the multitude of sources that are involved in providing patient care. It implies the nurse has a knowledge base to detect normal and abnormal physiological, social or psychological conditions that a patient may be experiencing, and to determine the multitude of interventions necessary to return the patient to a functioning person.
It is so much more than performing nursing tasks. It is not only managing an identified episodic illness period in a person’s life but also helping that person cope with the period of illness and any long-term effects.
Unfortunately, nursing is often equated with the tasks of nursing such as starting an intravenous line, inserting an indwelling urinary catheter, obtaining laboratory specimens and EKG tracings, or obtaining a blood pressure. It is not the task that defines nursing but the evaluation of the results of those tasks, e.g., trending and understanding changes in blood pressures and pulse rates, recognizing decreased urinary output early, and understanding the importance of adequate fluid replacements. It is enabling patients to express their fears, questions, or concerns over the care they are receiving. These are the areas that belong to nursing.
Nursing has long been adamant about taking on the tasks of other members of the health care team but is reluctant to admit that there is room for nursing tasks to be delegated to lesser skilled personnel. For example, the administration of medications to a patient is ideally performed by a pharmacist because that person has the greatest knowledge of medication interactions and reactions.
Yet, I daresay it is not standard policy in acute care hospitals to have a pharmacist administer all intravenous, intramuscular, and oral medications to patients. This would be cost-prohibitive and less than optimal use of a specialty skilled health team member. Therefore, an alternative health care member with lesser specific knowledge performs that service. Granted, that person is a licensed health care provider, but the analogy applies.
Nurses are forever complaining about the work involved in nursing. One can walk into any area of the hospital, and the ED is no exception, and hear nurses vocally reacting to their current situations. This is true today and was just as true when primary nursing was the model du jour. And yet, any talk about utilizing UAPs to aid the nurse is frequently met with vehement resistance.
So what is the answer? Can UAPs be incorporated into the health care team with the nurse as the leader of the team, the delegator of tasks, and the evaluator not only of care provided but also of monitoring patient responses? Certainly, they can and have been in various institutions through out the United States.
At the core of implementing UAPs in a health care setting the ED included is for the nursing leadership to have a clear understanding of the overall goals of nursing and what is involved in obtaining those goals. Delineating the patient care tasks involved in reaching those goals must be done.
Nursing must take a critical look at what it provides to the patient. We cannot be everything to the patient, but we must identify those components of nursing care that make us a vital and indispensable member of the team. The tasks that do not fall into that category are most likely those small pieces of patient care that can safely be provided by a lesser skilled member of the team, and we need not be fearful of allowing that to occur.
(Editor’s note: For another view, read story below.)
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content