UAPs are no substitute for registered nurses
By Gail Loadman, RN, CEN
Director of Emergency Services
Grant/Riverside Methodist Hospital Columbus, OH
Recently, the role of a multiskilled assistive worker has been supported by emergency department managers developing strategies to re-engineer and decrease operating costs.
In the ED’s task-oriented environment, it seems logical that workers who can perform a variety of tasks, including phlebotomy, EKGs, low- to moderate-complexity lab testing, application of sterile dressings and orthopedic appliances, and perhaps, the insertion of urinary catheters, could be valuable and might maximize the opportunity for the professional nursing staff to assess, plan, implement, and evaluate patient care. However, it must be mentioned that the multiskilled workers usually replace some of the RN full-time equivalents.
In many instances, existing emergency department technicians (EDTs) are trained to assume the new multiskilled role. Their EDT job duties include taking vital signs, transportation of patients, collection of urine and stool specimens, undressing patients to prepare for exams, and cleaning and restocking patient treatment rooms.
Clearly, all of these tasks, in addition to performing the new skills, could not be accomplished by one worker. So it often becomes necessary to add yet another assistive role. Therefore, the registered nurse has two categories of workers to train, supervise, and, ultimately, ensure competency for an ongoing basis.
In the ED, assessment is often simultaneous with developing and implementing a short-term plan of care. Evaluation is ongoing during the episode of care. The overall time spent with the patient is limited, by nature of an emergency visit.
When a new patient arrival demands immediate and sometimes extended attention, the nurse must be able to transfer care in a seamless manner. Every opportunity for the knowledge-based caregiver to interact with the patient and family supports these inevitable transitions of care.
An astute nurse at the patient’s bedside performing phlebotomy, inserting a urinary catheter, or starting an intravenous line can be simultaneously making a psychosocial assessment, observing family interactions that may impact the plan of care, and performing reassessments and responses to therapy. I would suggest that the ultimate multiskilled worker is the registered nurse.
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