UAP charting assesments in the ICU

[alansmith52]

I will be slightly vauge but the facts are true and I have first hand knowledge of them.

UAP's (unlicensed assistive personal) are being used in the ICU. they are taking a patient assingment and charting assessments. mangments take is that the UAP doing this are nursing students and will eventually be nurses anyway.

the nurses of course have liability concerns with it. mangment swears that nurses will not be responsible for mistakes made.

the state board of Nursing has knowledge of the goings on and are doing nothing. I think this is a slippery sloap if nursing students could do this couldn't any lay person:devil: :devil:

[Cascadians]

Oh boy. The foistering of life-and-death responsibility on the inexperienced keeps increasing. It's one thing to shadow an RN and be taught and return-demonstrate tasks, but quite another to be handling care on a complex patient in an ICU, with different patients often.

If the student nurse does not fear this, it is simply because s/he has not yet experienced the horror of making a mistake, or having a crisis with no help around, or having a family taking "lawsuit notes" while watching every move, or suddenly finding oneself short-staffed and having to take 2 or 3 or more patients on, way over one's head, left swimming against a raging current circled by sharks.

[Dr. Kate, BSN, RN]

That's not an ICU I would want to be working in or be a patient in.

I don't know a thing about the laws in Utah, but assessment is the function of an RN and only an RN here in California. No matter how you sugar coat it a UAP can only collect data, even if in another life thta person is a nursing student. What does that mean in the real world, the UAP is a less knowledgable than a new grad. Put that person in an ICU without the cushion of even a mediocre new grad program and then say the RN is responsible/liable/accountable. I don't think so. The scope of practice for an RN includes the supervision of the work of UAPs, that encompasses those nasty words accountable and responsible. Anyone who tried to tell you differently is handing out a pile of what my office mate's horse leaves behind him.

Object, document, document, call BRN, DHS, the union if you have one, document, document, document your objections. This will come to bite someone in the patoot.

[disher]

What is the title used on the nurses name badges, Unregulated worker? If so, that is the level of responsibility they are accountable to. They are employees, not students and should not be doing procedures outside their scope of practice. Your employer has to find a safer way to endear potential new nurses to ICU.

[rncountry]

AmiK, while you may feel you are able to offer a competant job, what you are not understanding is if you make an error, big or small is that you automatically put the nurse who is your supervisor at risk for a license suspension, not to mention the lawsuit possiblities to yourself, the supervising nurse and the facility. An error on your part could potentially stop your nursing career before it started.

I went into an ICU with one years experience and I can't imagine going into that enviroment as an unlicensed person. In the unit I work in an LPN must have their assessment signed off by the RN. If the BON knows about this and are not acting then I would not hesitate to call the local paper and TV News. I can't imagine that patients and family members would feel too happy about UAP's taking care of their loved one in an ICU.

[NurseGirlKaren]

NO! NO! NO! A thousand times NO!!

Any nurse who is "paired" with the UAP IS responsible. I wouldn't jeopardize my license like that for anything. Nursing students in clinicals are supervised by and fall under the license of their instructor. Nurse externs are supervised by a licensed nurse who agree to it.

NO!

Do these students' instructors know about this situation? If they did I'll bet they would flip.

When I worked in a doctors office we had a nursing student who did telephone triage. I asked her if she was working under the license of our RN office manager. I made darned sure that the student and our manager knew for sure that she sure wasn't working under mine! (And I told her to call her nursing school just so that they knew what she was doing for work).

NO!

My 2 cents.

[New CCU RN]

From the original post it is not clear as to whether the student nurse is in clinical or employed in the hospital. As a recent grad, I am aware of the technicalities of both of these situations. If the student is in clinical, she is functioning as the RN. However, this is under the supervision of the clinical instructor so the clinical instructor's responsibility of something goes wrong. The instructor MUST be on the premises for the student to give meds or make any sort of assessment because she MUST be cosigning it. With that being said, there is an RN responsible that is collaborating with the student. There must also be some communication process b/n the clinical instructor/student and the staff RN. It should be clear w/ everyone what is going on,etc. I see no problem with this situation. The school sets contracts with the hospital/unit clearly stating what is expected, who is responsible, etc, etc.

If this student is part of the student extern type situation, the student may also participate in collaboration with the RN. It is a learning process however, what is done by the student is left up to the discretion of the RN caring for the patient. What harm is done by having a student RN come in the room with you and do the assessment together? As far as meds are concerned, I would give my own meds. But be sure to talk over med decisions w/ the student and try and help aid them in learning the rationale for this and that med. No harm done and hey maybe if you were a little more open to educating future RN's your ICU would not be so understaffed!!!!

However, I was schooled at a university that felt that ICU experience should happen as an RN after you get the basics down. Despite it being a four year program with much more clinical than the average BSN program, I spent a total of four clinical days in an ICU or ER and it was as observation. I firmly believe in this as well, spend your time in school learning the basics. Our last sem where some students spend in their 'specialty' field, we were on a med surg floor brushing up on skills so that we'd be proficient when we came out. From local opinion, nurses from my university did far better once out. I don't think that it is necessary to have an ICU class when you are in a nursing program.....however, the extern programs where a student can at least see what they may be getting themselves into can be a good thing. The key is that it MUST be in a controlled environment with clear objectives a good job description!!!