Professional Resources

Position Statements

The Role Of Unlicensed Assistive Personnel In The Rehabilitation Setting

Unlicensed Assistive Personnel

It is recognized that unlicensed assistive personnel (UAP) make a significant contribution to the care and welfare of patients in a variety of clinical settings, including rehabilitation. The American Nurses Association (ANA) "recognizes that unlicensed assistive personnel provide support services to the registered nurse which are required for the registered nurse to provide nursing care in the health care settings of today" (ANA, 1992, p.1). The Association of Rehabilitation Nurses (ARN) supports the position of the ANA finding that utilization of unlicensed assistive personnel are 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).

Qualifications

• High school diploma or equivalent.
• Nurse's aide training certificate or a minimum of 4 weeks of documented on-the-job training.
• Completion of a basic cardiopulmonary resuscitation course.
• Additional training prior to performing tasks in secondary scope of care
• Demonstrated initial and ongoing competence in both categories.

Scope of Care

In settings where the scope of care for unlicensed assistive personnel is subject to state regulation, the tasks delegated by the registered nurse (RN) shall not exceed any restrictions in the scope of care as set forth by the state. The scope of care application should also be based on the patient's condition and the qualifications of the provider.

All care provided by unlicensed assistive personnel should be delegated and supervised by a registered nurse and based on the patient's written plan of care and the UAP's demonstration of a level of competency. The scope of care for unlicensed assistive personnel is divided into two categories, a basic and a secondary scope of care. The basic scope of care consists of those tasks that support the patient's activities of daily living, hygiene, and nutrition as well as those tasks that support professional nursing assessments. The second scope of care consists of those tasks that require additional training and demonstration of competence prior to being performed by the UAP.

Basic Scope of Care

• Obtaining and documenting vital signs, including temperature, pulse, respirations, and blood pressure (This skill is inclusive of adequate judgment to notify the RN of any changes or findings beyond normal limits.)
• Bathing and assisting the patient with hygiene and grooming needs
• Feeding and assisting with nutritional intake (This skill includes ability to follow dietary restrictions including thickened liquids.)
• Transferring and assisting with ambulation and mobility needs
• Monitoring and documenting input and output
• Applying external catheters and maintaining and cleaning urinary drainage bags
• Displaying behavioral management skills, including positive reinforcement and adherence to behavior management program structure
• Assisting with donning and doffing orthotics and prosthetics
• Adhering to and showing knowledge of infection control and safety measures
• Displaying adequate judgment to notify the RN of any changes in clinical or functional status
• Observing patient behaviors and reporting observations to the registered nurse
• Assisting in socialization activities and reporting the level of patient participation to the registered nurse
• Assisting patients with active and passive range of motion
• Performing other assigned duties consistent with the above basic scope of care tasks

Secondary Scope of Care

• Inserting indwelling and intermittent catheters
• Performing nasogastric tube feedings
• Performing digital stimulation and bowel programs
• Performing single dressing changes
• Obtaining blood sample for glucose monitoring
• Obtaining ECGs and bladder scans

Settings

Care can be provided by UAPs under the supervision of a registered nurse 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.

References

American Nurses Association. (1992, November). Position statement on registed nurse utilization of unlicensed assistive personnel. Washington, DC: Author.

Association of Rehabilitation Nurses. (1994, May). Registered nurse utilization of unlicensed assistive personnel. Skokie, IL: Author

Approved July 1995;Revised October 2003

Association of Rehabilitation Nurses
4700 W Lake Ave
Glenview, IL 60025
800/229-7530
info@rehabnurse.org