The Role of Nursing Assistive Personnel in the Rehabilitation Setting
Nursing Assistive Personnel
It is recognized that nursing assistive personnel (NAP) make a significant contribution to the care and welfare of patients in a variety of clinical settings, including rehabilitation. It is the American Nurses Association’s (ANA) belief that "the utilization of NAPs in the provision of specific aspects of direct and indirect patient care, as the result of delegation and direction by a registered nurse (RN) in accordance with state nurse practice acts, is an appropriate, safe, and resource-efficient method of providing nursing care.” (ANA, 2007). The Center for American Nurses (2006) position statement, Registered Nurse Utilization of Nursing Assistive Personnel, recognizes that NAPs provide “support services which are required for the provision of quality patient care, as heath care changes and the registered nurse shortages demand adaptations in the manner care is provided…”.
The Association of Rehabilitation Nurses (ARN) further supports the ANA position, finding that utilization of NAPs (formerly known as unlicensed assistive personnel) is necessary for the registered rehabilitation nurse "to achieve the goal of assisting individuals in the restoration and maintenance of maximal physical, psychosocial, and spiritual health" (ARN, 1994, p.1).
Scope of Care
According to the International Council of Nurses’ (ICN) position statement, Assistive or Support Nursing Personnel, “the delegation of nursing care and the supervision of assistive nursing personnel is the responsibility of nurses” and “the role, preparation, standards, and practice of assistive nursing personnel must be defined, monitored, and directed by registered nurses” (ICN, 2000, p. 1). This responsibility is based on the nursing scope and standard of practice prescribed by the individual state nurse practice acts and regulations.
In settings or states where the job responsibilities for NAPs are subject to state regulation, the tasks delegated by the RN shall not exceed any restrictions set forth by the state. The delegation of tasks should be assigned based on The Five Rights of Delegation – right task, right circumstances, right person, right directions and communication, and the right supervision and evaluation (National Council of State Boards of Nursing, 1997).
All care provided by NAPs should be delegated and supervised by an RN and based on a patient's written plan of care and the NAPs demonstrated level of competency. The tasks that may be delegated to the NAP can be divided into two categories―a basic and a secondary skill set. The basic skills consist of those tasks that support a patient's activities of daily living, hygiene, and nutrition as well as those tasks that support professional nursing assessments. The secondary skills consist of those tasks that require additional training and demonstration of competence prior to being performed by the NAP and are dependent upon each individual state’s practice acts.
Basic Skill Set
Refer to your state’s individual practice act for current information.
Care can be provided by NAPs under the supervision of an RN in institutional, residential, outpatient, and community settings. These settings include, but are not limited to, acute care facilities, rehabilitation facilities, skilled nursing facilities, or nursing homes, residential facilities, day care agencies, or private residences.
American Nurses Association. (1992, November). Position Statement on Registered Nurse Utilization of Unlicensed Assistive Personnel. Washington, DC: Author.
American Nurses Association. (2007). Position Statement on Utilization of Nursing Assistive Personnel in All Settings. Washington, DC: Author.
Association of Rehabilitation Nurses. (1994, May). Registered Nurse Utilization of Unlicensed Assistive Personnel. Skokie, IL: Author.
Center for American Nurses. (2006). Registered Nurse Utilization of Nursing Assistive Personnel: Statement for Adoption. Retrieved from http://www.centerforamericannurses.org/positions/.
International Council of Nurses. (2000). Assistive or Support Nursing Personnel. Retrieved from http://www.icn.ch/psassistive.htm.
National Council of State Boards of Nursing, Inc. (1997). The Five Rights of Delegation. Retrieved from http://ncsbn.org/fiverights.pdf.
Approved by the ARN Board of Directors July 1995; Revised October 2003; Revised October 2007; Revised March 2014
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