UAPs present risks to ED nurses
Nurses should exercise control over what is delegated to unlicensed assistive personnel (UAPs), says Linda Lawson, RN, BSN, director of emergency and critical care services at Antelope Valley Hospital Medical Center in Lancaster, CA.
"There needs to be a proper understanding about what the role change will be for the urse before it is implemented," she says. "Otherwise there will be a negative outcome and big problems."
Nurses need to be aware of liability risks involving delegation, emphasizes Polly Zimmermann, RN, MS, MBA, CEN, senior course manager at the National Center for Advanced Medical Education in Chicago.
"A nurse as a professional is accountable for what she delegated," she says. "If something went wrong, I could also be sued, because if I hadn’t delegated the nursing task, the bad outcome wouldn’t have happened. That clearly draws the nurse into the scenario."
ED nurses shouldn’t assume assistive personnel will exercise proper judgment, she says. "Nurses tend to assume the techs know the priority of tasks, but they often don’t," Zimmermann observes.
During one training session on priority setting, techs were given a hypothetical scenario of two call lights coming on one for a patient complaining of chest pain and another for one who wants a glass of water.
"Some of the techs in the room actually said they’d get the glass of water first because it was easier, and they knew how to do it," says Zimmermann.
"Another time, a tech who was a first-year medical student was putting in a catheter, and I told him he was contaminating the sterile field. He didn’t understand what constitutes a sterile field or why it would be a problem."
Watch out for super heroes
Nurses should watch for a "Rambo" mentality among UAPs, warns Zimmermann.
"Some of them are really very aggressive," she says. "One tech tried to start an IV, saying, I’ve watched you enough; I know what I’m doing.’ Another had CPR training and tried to defibrillate somebody. We’ve caught techs giving phone advice and taking out IVs on their own initiative. To make this work, you need clear job descriptions with an understanding of the consequences if you overstep your boundaries and having that enforced."
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