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Nursing is an essential component
of health care, and the consumer of health care needs to be
assured of the availability, accessibility, and quality of
nursing care. It is in the spirit of this responsibility that
this statement related to the use of assistive personnel has
been developed. Historically, unlicensed personnel have assisted
registered nurses in the delivery of patient care. However,
in recent years, with growing economic pressures increasingly
driving the health care delivery system, the role of unlicensed
and other ancillary personnel has grown considerably and,
concomitantly, there have been increasing concerns about the
role of assistive personnel.
It is extremely important to use assistants
in a manner that assures appropriate delegation or assignment
of nursing functions and adequate direction and supervision
of individuals to whom nursing activities are delegated.
Nursing care is delivered primarily by registered
nurses (RNs), Licensed Practical/Vocational Nurses (LPN/LVNs)
and unlicensed assistive personnel. In addition, through the
use of "cross-training" and "multi-skilling"
programs, other assistive personnel, some of whom are licensed
to perform a limited set of patient care tasks, are being
utilized to perform some nursing care functions.
The nursing profession is accountable for the
quality of service it provides to the consumer. This includes
responsibility for developing nursing policies and procedures
and setting the standards of practice for the nursing care
of populations being served. The nursing profession must also
define the appropriate educational preparation and role of
any group that provides nursing services. The State Board
of Nursing is responsible for the legal regulation of nursing
practice for the RN and LPN and should be responsible for
regulating the provision of nursing care delivered by any
other personnel as well. When the RN delegates or assigns
nursing care activities to LPNs and other ancillary personnel,
including unlicensed personnel, appropriate relationships
must be present, and the RN must retain responsibility for
the services provided by the personnel to whom these activities
have been delegated or assigned. Decisions regarding which
tasks to delegate or assign, and under what circumstances,
must be made by the registered nurse who is providing care
to the patient, based on the patient's condition, the complexity
of the task, the preparation of the assistive person, and
other relevant factors. In all situations, RNs and LPNs, as
individually licensed caregivers, are accountable for their
respective individual nursing activities.
Managers and supervisors of nursing services
are responsible, as registered nurses, for ensuring that these
relationships are made explicit in workplace policies and
that such policies serve to protect the role of nurses in
delivery of and responsibility for patient care.
The Tri-Council for Nursing is comprised
of the American Association of Colleges of Nursing, American
Nurses Association, American Organization of Nurse Executives,
and the National League for Nursing.
revised 12/8/95
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