UAPs: Threat or help to ED nurses?
The increasing use of unlicensed assistive personnel (UAPs) in the ED is a hotbed of controversy, with some nurses extolling the benefits of this practice and others viewing it as an affront to the profession. (For point-counterpoint essays on this topic, see pp. 28, 29.)
Tasks frequently delegated to UAPs include:
• the application of splints or other orthopedic devices;
• obtaining vital signs;
• obtaining bedside glucose readings;
• inserting indwelling urinary catheters;
• attaching cardiac monitor leads;
• obtaining EKG tracings;
• obtaining pulse oximetry readings;
• application of dressings.
In regions heavily infiltrated with managed care, UAPs are a foregone conclusion. "In California, it is an old topic; we’ve been there, done that, and it’s pretty well accepted in hospitals as the norm," reports Linda Lawson, RN, BSN, director of emergency and critical care services at Antelope Valley Hospital Medical Center in Lancaster, CA. "The use of UAPs has leveled off, which will probably happen in other regions."
Still, it’s a mistake to assume that UAPs are more cost-effective than nurses, according to Polly Zimmermann, RN, MS, MBA, CEN, senior course manager at the National Center for Advanced Medical Education in Chicago. "UAPs have the same hiring costs and benefits, and their turnover is much higher, and they require more supervision than the nursing staff."
Keep productivity, skill levels in mind
Productivity is an important consideration, stresses Zimmermann. The nurse can always go down in skill level and do stocking, but a tech can’t go up in skill level and give a medication when I’m really busy," she says.
Qualifications for UAPs should be standardized as with home health care, she argues. "It’s always amazed me that you need six weeks of training to care for stable old people but absolutely no training to take care of unstable critical people, including pediatric patients," she observes.
UAP training requirements vary widely at different facilities, notes Zimmermann. (For more information about risks of delegating to UAPs, see story, below.) Some techs are certified as paramedics or have some amount of medical school education, while others don’t even have a high school diploma, she explains.
UAPs with additional training tend to be more motivated, she says. "If you have an EMT or a nursing student, it usually works out better because they have higher motivation," Zimmermann says. "Otherwise, it’s just a job for them, not a career, and they see tasks as unimportant so they don’t have a sense of ownership."
UAPs enable nurses to focus on things only nurses can do, argues Alison Wiebe, RN, BSN, director of emergency services for Northside Hospital in Atlanta. At Northside, UAPs are used to draw blood, administer EKGs, put Foley catheters in, discontinue IVs, stock rooms, transport patients, and measure vital signs, but they don’t do assessments.
"They are not making any judgments about what care needs to be provided, they are just providing technical support," says Wiebe. "Nurses make all the decisions about nursing diagnosis, intervention, and plan of care."
Nurses can delegate tasks while still being responsible for the overall care of the patient, says Lawson. "Nurses don’t necessarily have to put a Foley in or take vital signs," she says. "Nursing is not a task. It’s a knowledge-based profession."
While some nurses view tasks such as obtaining vital signs as menial, others view those same tasks as the core of emergency nursing.
"When a patient’s condition is unstable, you need ongoing assessment and constant evaluation," says Zimmermann. "When you talk to patients, you’re noticing how they’re breathing, their color, if they’re avoiding eye contact or hiding something from you. If the nurse is practicing at a high quality of her profession, she is doing more than getting vital signs that is the essence of nursing."
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