The California State Board of Nursing has defined and differentiated the roles of the Unlicensed Assistive Personnel (UAP) and Registered Nurses (RNs). The level of skills and education differentiates the function allocated for RNs as differentiated to those assigned to UAP duty. Another difference between the RNs and UAP is that the latter staff lacks a license and mandatory professional requirements by the state. Professional RNs coordinate and deliver healthcare functions but prohibits UAP even when practicing under experts.
UAP define the health care staff as trained and certified persons but not licensed to engage in nursing tasks. While prohibited from working as practicing nurses in the state, the California Nursing Practice Act identifies the functions that they cannot perform (DCA, 2010). The law clarifies tasks assigned to unlicensed and licensed healthcare employees. As such, Unlicensed Assistive Personnel (UAP) are prohibited from performing certain functions in lieu of RNs.
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Section 1250 of the Health and Safety Code provides the primary function of the RNs. UAP are prohibited from performing these roles even when under the direction of a licensed nurse. RNs’ have the power to administer medication, perform venipuncture or intravenous therapy, and provide tube feedings (DCA, 2010). These roles require experience and expert skills, which makes it illegal for an institution to delegate them to a UAP. The law allows RNs to perform invasive procedures like inserting catheters.
RNs activities require the application of technical skills and scientific knowledge. Contrastingly, UAPs display technical skills but require more skills to use advanced scientific and practical skills to deliver care. For example, the law bans UAPs from assessing patient conditions because the function demands the skills of RNs (California Board of Registered Nursing, n.d.). Likewise, only a licensed nurse can conduct complex laboratory tests. This reduces errors associated with such complex procedures. UAPs lack knowledge about the practical measures of implementing patient privacy matters. As such, the state demands only RNs to educate patients and their kin about the patient’s health care problems. Licensed nurses have grasped the practical implications of sharing patient information without consent, which means that they understand the basic sharing principles from workplace experience. RNs have practical approaches to handling patient data and addressing the legal and ethical guidelines of delivering patient and family members' communication based on acceptable procedures.
California also provides guidelines for the integration of unlicensed nursing staff due to scarcity improve the healthcare of its citizens. UAP can perform routine nursing care roles without requiring the direct supervision of RNs. These encompass using the UAP staff as nursing assistants, home health aides, and patient care technicians (California Board of Registered Nursing, n.d.). The state has allowed unlicensed caregivers to participate in the management of care. The law requires RNs to assign UAPs assistive functions that enhance the delivery of healthcare. Section 2727 (a) of the Nursing Practice Act grants UAPs the power to act in their roles without the supervision of RNs or other personnel (DCA, 2010). UAP can perform most clinical practice functions in California except those executed by RNs exclusively.
Tasks assigned to UAP have to meet five conditions. Firstly, typical routine care activities towards the patient. Secondly, tasks with a limited occurrence of error and pose no harm to the patient (California Board of Registered Nursing, n.d.). Thirdly, tasks that require no modification of the client’s care plan. Fourthly, tasks with predictable outcomes. Lastly, UAPs cannot perform assessments, interpretation of results, and make decisions about intervention plans for the patient. UAPs can clean medical equipment based on their skills (California Board of Registered Nursing, n.d.). Unskilled personnel can perform simple wound dressing tasks. Technical skills associated with UAP determine their roles that include suctioning chronic tracheotomies. Likewise, UAPs can engage in gastrostomy feedings and perform wound-healing gastrostomies.
RNs can assign UAPs duties based on the fragility of a process and patient seeking treatment. Effective clinical practice demands patient safety as a core principle, which requires the RN to determine the complexity of a task and competence of the UAP before assigning duties. The basic guide is that the RN cannot assign a task that demands the application of scientific knowledge and technical skills to the UAP. Prohibited functions include triaging, monitoring, patient assessment, and education.
ICU
Patients in ICU are critically ill and fragile compared to patients in the general medical-surgical unit. This means that RNs can assign duties to UAPs in the general medical-surgical unit, but highly experienced and technically advanced UAPs can provide services in ICU and under the direct authority of the RN. ICU demands specialized skills and knowledge to continuous monitoring of vitals, provide life support, medication, and assessment of patients’ needs (Bakhru et al., 2016). These functions require experienced RNs, particularly in the ICU. Even in the general medical-surgical unit, RNs must provide direct patient-related diagnosis, assessment, and medication.
The ICU RN treats patients that demand the highest acuity of care in a controlled setting. This environment is highly structured to fit the needs of providing specialized care, which demands the extensive application of knowledge and disease pathology, which the UAP lacks. Likewise, the ICU caters to fragile patients who require specialized knowledge that includes intubation, ventilation, and life-sustaining medication drips. While UAPs can handle patients in the general unit with tasks like toileting and routine assigned duties, the ICU environment is dedicated to close monitoring of patients and is unfit for unlicensed personnel.
References
Bakhru, R. N., McWilliams, D. J., Wieve, D. J., Spuhler, V. J., & Schweickert, W. D. (2016). Intensive Care Unit Structure Variation and Implications For Early Mobilization Practices. Ann Am Thorac Soc, 13 (9), 1527-1537. DOI: 10.1513/AnnalsATS.201601-078OC
California Board of Registered Nursing. (N.D.). Understanding The Role Of The Registered Nurse And Interim Permittee. The State Of California . https://www.rn.ca.gov/pdfs/regulations/npr-b-53.pdf
DCA. (2010). Unlicensed Assistive Personnel. The State of California .
