The United States healthcare system is currently experiencing a shortage of nurses. It is projected that more than half a million nurses will be needed to 2022 (National Council of State Boards of Nursing (NCSBN), 2016). As a result, more healthcare facilities in the United States are massively hiring registered nurses. However, the number of registered nurses in the market cannot satisfy the demand (NCSBN, 2016). That is why hospitals have enacted a stopgap policy to employ more assistant personnel, commonly known as unregistered assistant personnel. The unregistered assistant personnel are helpful, although they do not provide the same level of services as registered nurses (Tompkins, 2016). Since they are prone to medical errors, unregistered assistant personnel need to be closely monitored. The American Nursing Association has formulated guidelines for nursing delegation to guide individual states on how and when a registered nurse can delegate their nursing duties. The state of Minnesota has ratified these guidelines in line with the federal policy.
The Role of Unlicensed Assistive Personnel in the State of Minnesota
The state of Minnesota recognizes that there is a shortage of registered nurses. Following this realization, the state has opted to comply with national guidelines of hiring unregistered assistant personnel to advance the provision of quality healthcare (Matthias-Anderson, Manthey & Halcón, 2019). Unlicensed healthcare providers are trained to help registered nurses in providing primary care. These Unlicensed Assistive Personnel (UAPs) can assume patients' supportive care duties that do not require specialized attention or any form of special skills. The state of Minnesota has divided the roles of UAPs into direct and indirect primary care activities. Direct care duties comprise of preparing/cleaning and feeding patients. These roles do not require any specialized skill; thus, the Minnesota Board of Nursing deems it fit to assign these duties to the unregistered personnel who operate under the close watch of the RN. Indirect nursing activities include housekeeping and transportation. These duties include taking patients to the radiology departments for MRI, CT scans, and x-rays (Tompkins, 2016). Other responsibilities are replacing beddings in ward beds. These unlicensed assistant personnel are critical in improving patient outcomes.
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There are other reasons why Minnesota hospitals are hiring UAPs. The principal cause of hiring UAPs is to reduce operating costs. Hospitals run on limited budgets; hence, they strive to minimize their recurrent expenditure. Compensating a registered nurse is expensive; thus, having many of them in the payroll could result in cost-implications. As a result, hospitals are advised to balance between benefits, and the provision of quality healthcare (Matthias-Anderson, Manthey&Halcón, 2019). Minnesota healthcare facilities are allowed to hire a proportional number of licensed nurses and unregistered assistant personnel.
The Role of Registered Nurses
According to the Minnesota Board of Nursing, registered nurses perform duties based on their training and expertise. Registered nurses provide a wide range of services that are essential in improving patient outcomes. A registered nurse is tasked with caring and educating the patient about early recovery and disease prevention measures (NCSBN, 2016). The Registered Nurse (RN) is also responsible for keeping in touch with the patient’s family and friends, where they update them on the patient’s medical progress. Therefore, registered nurses are mandated to manage the client’s health concerns and needs, design and implement nursing care framework, and maintain patient’s data.
Additionally, there are other duties and responsibilities of registered nurses as sanctioned by the Minnesota Board of Nursing. They include; Observing and recording the patient’s behavioral tendencies. Coordinating with all healthcare stakeholders such as doctors, physicians, pharmacists, lab technicians, and unlicensed assistant personnel in designing and executing customized care plans. Diagnosing the disease by collecting and analyzing patient’s symptoms. Managing the reports of patient’s medical history as well as monitoring changes in their progress. Lastly, they are tasked with maintaining hygiene and safe working atmosphere in line with compliance guidelines ( NCSBN , 2016) .
Responsibilities of a Registered Nurse When Delegating Duties
Nursing delegation is governed by five rights of delegation, namely the right person, the right task, the right circumstance, the right direction and communication, and the right supervision and evaluation (NCSBN, 2016). It is upon the registered nurse to observe all these rights when delegating duties. The registered nurse delegation involves three steps: assignment, delegation, and supervision. A registered nurse can only delegate tasks that require little or no expert knowledge or training since it helps them to concatenate on other specialized patient’s needs that requires urgent attention.
The Right Person
RNs are responsible for delegating a supportive care duty to the right person. In the healthcare setting, all the unlicensed assistant personnel are under the supervision of the registered nurse. The RN is mandated to know about the skills, experience, and capabilities of every UAP (Tompkins, 2016). These UAPs have different strengths; thus, not all of them are capable of handling any duty. For instance, some UAPs are good at grooming patients, while others are excellent in monitoring the progress of patients. Once the RN has mastered the strengths of each UAP, they can proceed to assign the task to the right person.
The Right Task
It is apparent that not every task can be delegated. Registered Nurses are trained to provide specialized care to patients. Nursing duties such as administering medication and monitoring patient’s progress require specialized knowledge; thus they are rarely delegated (Tompkins, 2016). Most duties that are delegated are known as supporting roles. The RN can opt to delegate either direct or indirect roles. Functions such as feeding and grooming patients do not require any specialized training; thus they fall under the category of the right tasks that can be delegated (Tompkins, 2016). Other duties, such as transporting the client to other medical departments, can also be delegated. There are other specialized tasks such as taking and maintaining the client’s records that can be delegated. However, it is essential to note that a registered nurse must closely monitor every form of delegation. This measure has been put into place to minimize the occurrence of any medical accident.
The Right Circumstance
Generally, registered nurses are the busiest healthcare practitioners. They always suffer from divided attention due to the workload (Tompkins, 2016). There are some specialized duties, such as managing the doctor’s prescription that must be observed by the RN. However, an RN can delegate this duty after putting into place all the necessary measures. They must ensure that the circumstances are right for the UAP. This measure helps in freeing up time for the RN to concentrate on other critical duties. Therefore, the RN must ensure that circumstances are right before delegating supportive tasks to the UAP based on client’s needs.
The Right Direction and Communication
The registered nurse is mandated to provide the right direction and communicate to the right person who is assigned to the right task, under the right circumstances. UAPs are under the strict supervision of the RNs; thus, it is vital to communicate to them directly (Tompkins, 2016). Providing direct instructions is critical in monitoring the progress of the delegated duty.
The Right Supervision and Evaluation
It is the responsibility of the RN to provide the right supervision and evaluation to the UAPs who have been assigned duties. Since these UAPs are not as skilled as the RNs, they need to be closely supervised (Tompkins, 2016). The right supervision and evaluation help in minimizing the rates of medical accidents that may occur.
How ICU Environment Differ from the a General-Medical Unit under the Responsibilities of the UAPs
The intensive care unit has low number of patients as compared to the general-medical surgical unit that host a large number of patients. Therefore, UAPs oversee fewer patients in the intensive care unit in comparison to the general-medical surgical unit. Since the number of patients in the ICU is relatively smaller, UAPs are likely to devote more time, and attention to the patient’s in this unit. This practice is only possible when assigned UAPs are closely monitored by the RNs (Bellury et al., 2016). The activities that take place in the general-medical unit are dependent on the specific needs of a client. Thus, the UAPs are responsible for evaluating every client’s needs and report to the RN for more specialized attention. Additionally, the UAPs are likely to work with fewer RNs in the intensive care unit as compared to the general-medical surgical unit. When under the supervision of fewer RNs, the UAPs can effectively learn more about critical care hence improving their skills for future practice.
Conclusion
The Minnesota Board of Nursing has ratified the National Guidelines for Nursing Delegation. The state of Minnesota appreciates the roles played by both registered nurses and unlicensed assistant personnel in providing primary care that is critical in improving the patient’s outcomes. The nursing delegation is governed by five rights of delegation, namely the right person, the right task, the right circumstance, the right direction and communication, and the proper supervision, and evaluation. The Nursing Board of Minnesota mandates registered nurses to observe these rights when delegating nursing duties. Finally, it is essential to note that the only responsibilities that can be delegated are the supportive roles that do not require high-level specialized training or skills.
References
Bellury, L., Hodges, H., Camp, A., &Aduddell, K. (2016). Teamwork in acute care: perceptions of essential but unheard assistive personnel and the counterpoint of perceptions of registered nurses. Research in nursing & health , 39 (5), 337-346.
Matthias-Anderson, D., Manthey, M., &Halcón, L. (2019). Minnesota nurses peer support network. Journal of addictions nursing , 30 (1), 67-70.
National Council of State Boards of Nursing. (2016). National guidelines for nursing delegation. Journal of Nursing Regulation , 7 (1), 5-14.
Tompkins, F. (2016). Delegation in correctional nursing practice. Journal of Correctional Health Care , 22 (3), 218-224.
