Unlicensed assistive personnel have been working in patient care roles for many years, but recently, they’ve become an even more prominent and integral part of the wider healthcare team. Why? With the nursing shortage reaching near-crisis level, UAPs are readily available and can, in some circumstances, be more cost-effective than hiring certified nursing assistants (CNAs), license practical nurses (LPNs) and licensed vocational nurses (LVNs), or registered nurses (RNs).
Unlicensed personnel can provide valuable services as nursing assistants and nurse aides, but any nursing practice must understand what they can and can’t do without licensure, and what that may mean for the practice’s patient outcomes and risk mitigation. Here, we’ll take a deep dive into UAPs in the nursing field, how they support registered nurses and other licensed nursing professionals, and answer your questions about responsibility, liability, and risk.
What Is a UAP in Nursing?
A UAP in nursing is a member of the support staff who works under the direct supervision of a registered nurse or licensed practical nurse (known as a licensed vocational nurse in Texas and California). RNs and LPNs/LVNs are typically in charge of the UAPs assigned to them, delegating tasks that can be completed without licensure. These tasks often involve direct patient care and personal care services, like assisting with activities of daily living (ADLs). Although the UAP's scope of practice is more limited than that of a licensed nurse, they are still extremely valuable in many healthcare settings.
Common Types and Titles of UAPs
There are several types of UAPs found in different care facilities, including:
- Certified Nursing Assistant: CNAs go through a certification process but are not licensed. They can perform basic nursing tasks like checking vital signs and helping with ADLs.
- Nurse Aide: A nurse aide often performs the same functions as a CNA, but isn’t necessarily certified.
- Nursing Assistant: Nursing assistants are often the same as a CNA, and can provide basic patient care under supervision from an RN or LPN.
- Patient Care Technician: PCTs offer direct patient care under the guidance of qualified licensed nurses. They can do everything a CNA or nursing assistant does, but also can assist with other areas like phlebotomy, EKG monitoring, or collecting urine samples.
- Medication Assistant: A medication assistant may be uncertified, or may be a Certified Medication Aide (CMA). CMAs are responsible for administering medications to patients accurately and on time, and ensuring the medication is properly taken.
- Home Health Aides: Home health aides provide personal care to patients in their homes. They are largely responsible for assisting with activities of daily living, but may also help with medication administration, check vital signs, or perform light housekeeping duties.
- Psychiatric Aides: Psychiatric aides are nursing assistants who work with patients undergoing mental healthcare. They perform the same tasks as a CNA, but also keep an eye on patient behavior and mood, and may also need to be available to de-escalate tense situations.
- Geriatric Aides: A geriatric nursing assistant (GNA) works with elderly patients in assisted living facilities or in their own homes.
What UAPs Are Authorized to Do
UAPs can perform a wide variety of basic patient care and nursing tasks. While they are required to perform these duties under the supervision of a registered nurse or a licensed practical/vocational nurse, the support they provide ensures that licensed nurses have more time and bandwidth to focus on higher-level care.
In a hospital or healthcare setting, UAPs are typically authorized to:
- Take vital signs
- Assist in ambulatory care and transportation
- Assist with activities of daily living like toileting and bathing
- Provide emotional support to patients and families
- Observe patients and note changes in their charts
- Collect urine specimens and occasionally collect blood samples or perform blood glucose tests
- Administer medications and (when qualified) give shots, remove IVs and catheters
UAPs can do a lot, and their contributions are valuable to both patients and licensed nurses. However, there are some job responsibilities that UAPs are NOT authorized to do, including:
- Starting IVs or performing venipuncture
- Inserting or removing feeding tubes
- Administering medications if they are not qualified
- Making diagnoses
- Suggesting care plans
- Performing invasive procedures like tracheal suctioning or catheterization
What Training & Qualifications Do UAPs Have?
UAPs often have varying levels of training that impact their overall competency and qualifications. CNAs go through a brief certification program and complete an exam before receiving their credential. Qualifications for working in a hospital or healthcare setting are different for every state, but most have requirements that include a high school diploma (or GED), an approved training program (like a CNA program), and certification in first aid and CPR.
Some UAP roles, like a medication aide, may require more specific training. Many of the skills required for UAPs are learned on the job. Most UAPs will need to complete training more than once to continue practicing. CNAs are required to recertify every two years in most states, and CPR and first aid training also need to be renewed every two years.
The Importance of Delegation (and Who's Responsible)
When it comes to nursing care, professional responsibility is critical to patient outcomes. When unlicensed assistive personnel are delivering patient care, they must be well supervised and overseen by licensed nurses, usually RNs, but also LPNs. These nurses are the ones responsible for the care the patients ultimately receive. Any nurse supervising a UAP is expected to follow the “Five Rights of Delegation.” This framework provides a guide for delegating tasks to UAPs and ensuring they are performed accurately and responsibly. The Five Rights of Delegation include:
- Right Task: The task being delegated should always be appropriate for the person who will perform it.
- Right Circumstance: The setting, environment, and patient condition all factor into whether or not a task should be delegated to a UAP.
- Right Person: The UAP in question should have the necessary skillset and background to perform the task.
- Right Direction: The delegating nurse is responsible for clearly communicating the task and providing guidance to the UAP.
- Right Supervision: The delegating nurse is responsible for monitoring and evaluating the UAP’s performance in order to confidently delegate more responsibilities.
Legal Considerations and Implications
Registered nurses and licensed practical/vocational nurses who are charged with supervising and delegating tasks to UAPs need to understand what type of risk they may be assuming and what it could mean for their career. The two major considerations are accountability and liability.
Accountability
No matter what type of task a nurse delegates to a UAP, the nurse is the one who is to be held accountable for the outcome. If there are questions as to whether the nurse should have delegated a particular task to the UAP or how the UAP's care impacted the patient, the supervising nurse is always the responsible party. In every state, there is a Nurse Practice Act that outlines supervisory responsibilities within the scope of practice for RNs and LPNs/LVNs. This should always be reviewed by the supervising nurse to fully understand his/her responsibility and accountability when overseeing a UAP.
Liability
A supervising nurse may ultimately be held responsible if a UAP makes an error while under his/her supervision. The licensed nurse may be liable for negligence in delegation or a failure to properly supervise the UAP. This means the supervising nurse is vulnerable to legal actions and malpractice claims if a UAP’s actions lead to patient injury or other issues.
Role of Insurance in Protecting Nurses
Malpractice insurance or professional liability insurance plays a critical role for nurses in supervisory roles over UAPs. While supervising nurses will still be held accountable for the actions of UAPs practicing underneath them, the right insurance policy can help protect them from some of the consequences. A good policy will cover defense costs, settlements, and investigations, and can help protect the nurse from financial hardship or potentially having their professional license revoked. Most employers offer some form of malpractice insurance, but additional
individual policies can extend the coverage and fill in any gaps. With NSO, you get a partner who can keep you covered while providing unmatched peace of mind.
FAQs About Unlicensed Assistive Personnel
Still have more questions about UAPs and nurse supervisors? We’ve got the answers.
Can UAPs give medications?
Some UAPs can give medications if they have the right training and qualifications. Certified Medication Aides (CMAs) are unlicensed, but they are trained in accurately and safely administering many types of medications. UAPs who do not have these qualifications typically are not authorized to administer any medications.
Who is responsible if a UAP makes a mistake?
If a UAP makes a mistake while performing a nursing task, the supervising nurse — an RN or LPN — is the responsible party. The nurse supervisor is accountable for patient outcomes and the performance of the UAP and can be held liable if a mistake is made that results in patient injury and/or subsequent legal action.
Are LPNs or LVNs allowed to supervise UAPs?
Yes. Licensed practical nurses (LPNs) and licensed vocational nurses (LVNs) are allowed to supervise UAPs in most situations. LPNs/LVNs can provide direct or indirect supervision and can delegate most basic tasks to UAPs. However, if a situation requires complex decision making or care that is outside the licensed nurse’s scope of practice, it cannot be delegated by them. Scenarios like that should be handled or overseen by a registered nurse (RN).
What happens if a nurse refuses to delegate a task to a UAP they believe is unqualified?
If a nurse refuses to delegate a task to a UAP they believe is unqualified, they must first ensure that the required care is still provided to the patient, whether by themselves or by delegating to a qualified individual. As the supervising nurse is the responsible party for the outcome of the UAP’s treatment, it is within their right to refuse to delegate. However, it is also the nurse supervisor to document their justification and explain their reasoning. Refusal to delegate may lessen the liability of the supervising nurse while ensuring the patient is not put in a potentially harmful situation.
How NSO Can Help Protect Your Nursing Staff
When it comes to performing nursing activities, RNs, LPNs, and LVNs assume a large amount of risk. That risk is compounded if they’re also supervising and delegating to a UAP. While UAPs provide valuable support, especially in the midst of industry-wide staffing shortages, they can also add to the liability and level of risk to both your nurses and your organization. It is critical that each nurse is covered, especially when supervising UAPs. But standard employer-provided malpractice insurance may not be enough.
Additional
business policies can fill in the gaps and help provide more protection in the case of legal actions. Make sure you or your professional nursing staff have optimum coverage with individual malpractice policies from NSO.
Get a quote for an individual policy, business, or nursing institution today.