Unlicensed assistive personnel (UAP)

1. Unlicensed assistive personnel (UAP) Katie, Nicole, Pete, Will

2. Background UAP is no longer accurate. Now it is nursing assistive personnel (NAP) “Individuals trained to function in an assistive role to RN’s to provide patient care as delegated by the nurse.” (Huston, 2010) p.117

3. History Early 1990's- Restructuring of healthcare organizations • Use of UAP became widespread as many hospitals attempted to cut costs by cutting RN positions and supplementing with UAP. Late 1990's- Re-recruitment of RN’s • many hospitals tried to hire back more RN's but many were slow to return to the workplace after losing their jobs. • Hospitals again increased use of UAP to help with the nursing shortage in the late 1990's & early 2000's. Today- UAPs remain an important asset in many healthcare settings

4. Washington State Requirements Nursing Technicians: students enrolled in a Registered Nurse Bachelor of Science Degree program or a Registered Nurse Associate Degree program... Licensed practical nurse students are not eligible for registration. Nursing Assistant-Certified: A minimum of 85 hours of training through a state approved program. Students who are in an LPN or RN program and have met the minimum requirement also qualify. In addition, military medic or corpsman training may meet our requirements. Nursing Assistant- Registered: No formal training required. Registered nursing assistants employed in a nursing home have four months to complete an approved training program and testing for certification. (http://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/HealthcareProfessionalCredentialingRequirement.aspx)

5. Common job titles: a lesson in ambiguity Nursing support personnel UAP Nurse extender CNA (1987) Nurse tech URA Do any of you know of titles that are associated with different skill levels or tasks?

6. It’s about money! Certain Uncertainties: Several investigators have examined the association between the ratio of RN staff and costs. While some have reported that a staff with a higher proportion of RNs is more costly staffing and cost is not clearly delineated (Kraphol & Larson, 1996). Argument from the past: Patient case mix. Both length of stay and patient acuity in hospitals are changing. For example, in 1990 average length of stay for a patient undergoing coronary artery bypass surgery was 8-10 days; today it is 3-5 days. While patients are in the hospital for shorter periods of time, the intensity of their care is increasing (Bertram, 1994). Additionally, people are living longer and consume more hospital resources in the last months or years of life. These factors contribute to a growing demand for both the amount and sophistication of nursing care (Huston, 2010).

7. Is there good research on this? “Studies were frequently anecdotal in nature, conducted at a single institution, lacked comparison groups, used instruments of untested reliability and validity, and were of small sample size.Hence, no empirically strong evidence was found to confirm that nursing support personnel improved quality or increased nurse and patient satisfaction.Nor were these studies sufficiently rigorous in nature to measure costs, since a number of multiple variables such as increased supervisory personnel, readmission rates, length of stay, and training costs were not addressed (Kraphol & Larson 1996).”

8. What's best for the patient? "The outcomes associated with the increased use of UAP are not fully known; however, considerable evidence exists that demonstrates a direct link between decreased RN staffing and declines in patient outcomes (Huston, 2010)." Do you think UAP enhance a patient's experience by providing more contact time?

9. Role of the RN: Delegation and Liability Shifted from RN being direct care provider to delegator of care. The RN is now responsible for supervising those who have been delegated to. “Although nurses are not automatically held liable for all acts of negligence on the part of those they supervise, they may be held liable if they were negligent in the supervision of those employees at the time that those employees committed the negligent acts”. (Huston, 2010) p.123 When assigning the UAP patient care tasks the RN must know what the UAPs job description is, what their knowledge base is, and how competent they are. UAPs are accountable for knowing how to do the tasks within their scope of practice in a safe manner, as well as being able to voice if as task they were delegated is beyond their scope of practice.

10. Restructuring the work environment 41% of the time in a typical RN work week is spent on direct patient care (Huston, 2007) Remainder of time spent on documentation (23%) locating supplies & equipment (8%), transporting patients (5%), making pt-related phone calls (8%), in meetings (7%) (Huston, 2007) Shifting appropriate patient-care duties (transporting patients, gathering supplies, bathing, ambulating, feeding...) to a UAP can give RNs more time to provide quality bedside care • Why are professional RN’s still completing so many non-nursing tasks? Are they reluctant to delegate them to UAP? Or are there not enough UAP to take on these tasks?

11. Safeguards for the work environment • Adequate staffing of RN’s & UAP • Clearly defined job roles for UAP with standardized task lists • Standardized education & orientation for UAP Education for RN’s on UAP- delegation, keep up to date on guidelines • Appropriate Terminology & Identification • Appropriate patient assignments • Appropriate communication and delegation Has anyone working as a CNA or NT ever had a patient confuse you with the nurse? How did you handle this situation?

12. Factors in the shortage of UAP • High turnover • Low motivation to enter field • Low Pay/long hours • Responsibility/stress • Image/lack of respect • Physical strain • Emotional demands • Lack of benefits • Little direct input into organizational decision-making • What do you think can be done to help correct the shortage of UAP?

13. Socialization into nursing

14. Socialization: the process by which a person acquires the technical skills of his or her society, the knowledge of the kinds of behavior that are understood and acceptable in that society, and the attitudes and values that make conformity with social rules personally meaningful, even gratifying (Huston, 2010).

15. History Before 1970s: Minimal thought given to the socialization process 1974: Marlene Kramer's book published Simultaneously happening in the 80s: feminism

16. Kramer’s Research There are two major points to Kramer's research. 1. New place, new people 2. Role transition What contributing factors exist other than those that Kramer has mentioned?

17. Strategies for Socialization and Resocialization New Graduate • Preceptorships • Nursing Residencies • Formal and informal mentors • Cohort "support" group of new grads in similar practice settings Returning Nurse • Mentor • Refresher courses What do you think will be most helpful for you when transitioning from the student role into a novice nurse role?

18. Positive and Negative Socialization Positive • Mentoring • Precepting • Role Modeling • Coaching • Guiding Negative • Bullying • Harassment • Verbal Abuse • Intimidation What are the advantages and disadvantages to a nursing professional of having positive or negative socialization strategies?

19. Professional Oppression Oppression, what is it? What kind of behavior do oppressed groups or persons exhibit? How does it start? How do we fight this?

20. Characteristics of a positive mentoring relationship • Open • Flexible • Perceptive • Belief • Vision • Positive • Motivates • Willing • Unobtrustive • Protects In what ways does a mentoring relationship provide an advantage to the mentor?

21. Stages of Mentoring Relationships 1. Finding & Connecting 2. Learning & Listening 3. Changing & Shifting 4. Mentoring others What strategies can be used when a mentee remains grateful & connected to the mentor but also begins to feel restricted by the mentoring relationship?

22. Guide Roles Mentor: A relationship between an experienced professional and a less experienced novice. Has been described as a parent-child relationship. Role Model: A person whose behavior can be emulated by others, especially younger people. Preceptor: Encourages a positive relationship between peers as they help each other succeed. A specified nurse/colleague that answers questions, provides support, and assists the individual nurse. Sponsor/Guide: Individuals available in explaining the system.

23. Conclusion “Understanding the socialization of novice nurses and the resocialization of nurses in transition or at the peak of their performance is critical to the nursing profession and the health of society (Huston, 2010).”

24. Resources Huston, C. J. (2010). Professional issues in nursing: Challenges and opportunities. Philadelphia, PA: Wolters Kluwer/Lippincott Williams and Wilkins Washington State Department of Health: http://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/HealthcareProfessionalCredentialingRequirement.aspx