What can unlicensed personnel do?

Home Health Columnist / Guide · Apr 15, 2007

I would like to get some input on this situation.. At a local clinic there are UAP's that are doing much more than what I feel comfortable knowing about. These are women that have no formal training or certifications (not even a CNA/PCT), but are doing the following.. Intramuscular antibiotic shots, performing EKG's, phlebotomy, running UA's, running CBC's, administering PO med's, x-rays, administering breathing treatments, removing sutures. When questioned about it, I am told that as long as the doctor who is the medical director of the facility signs his name on the chart, then they are allowed to perform the afore mentioned tasks. I feel a bit uneasy about what is going on, but I would like to get input from other health care proffessional's as to how they feel about the situation. Thanks

Same thing occurs in PA as practicing UNDER doctor's license as medical assistants with on the job training.

One dernatology doc DID get in hot water for allowing UAP to suture, office was licenesed as medical clinic and regs there forbid it.....

vamedic4, EMT-P · Apr 15, 2007

CNAs and techs: nothing intrusive. Can't even d/c a foley.

That's sad...talk about an increase in workload for nurses.

My facility allows techs (who demonstrate continued proficiency) to perform IVs, blood draws, foleys/I&O caths, CT / CL dressing changes, suctioning...the list goes on. Some of us even insert PICC lines after the appropriate training has been given.

BeccaznRN, RN · Apr 15, 2007

When I was a student nurse tech, I could start and d/c foleys, d/c IVs, do blood draws and accu checks, dressing changes, and the student nurse techs could also start IVs as long as it was a saline lock and we did not use more than 3 mls of NS (after taking the IV class the hospital offered during orientation). However, the techs were usually so busy that the RNs usually just started the IVs themselves!

RNsRWe, ASN, RN · Apr 15, 2007

Some of us even insert PICC lines after the appropriate training has been given.

Are you SERIOUS??

My facility doesn't even allow techs to disconnect IV fluid tubing from someone's HL to change a gown. A nurse must do this, and then reconnect.

Honestly, from some of what I've seen out there, this is just fine with me. If I'm responsible for my patient's well-being during my shift, *I* will be the one suctioning, doing dressing changes, etc. Sterile insertion of a Foley? Never. Student nurses under the supervision of their instructors (who are responsible for them), fine.

If a tech does suction, or does a dressing change, is she/he the one to document in the patient's chart?

Not comfortable with that much leeway.

Cattitude · Apr 15, 2007

Are you SERIOUS??
My facility doesn't even allow techs to disconnect IV fluid tubing from someone's HL to change a gown. A nurse must do this, and then reconnect.
Honestly, from some of what I've seen out there, this is just fine with me. If I'm responsible for my patient's well-being during my shift, *I* will be the one suctioning, doing dressing changes, etc. Sterile insertion of a Foley? Never. Student nurses under the supervision of their instructors (who are responsible for them), fine.
If a tech does suction, or does a dressing change, is she/he the one to document in the patient's chart?
Not comfortable with that much leeway.

I'm with you on this. Now I'm sure that there are some very capable UAP that "could" do a lot of things BUT it's too individual. I too would not feel comfortable with all CNA's across the board being allowed to do some of these intrusive tasks ie: foley insertion, IV starts, etc.

I'm just a little surprised that there is so much difference from one place to the next. I guess that is kind of scary too. There is no uniformity.

mom2michael, MSN, RN, NP · Apr 15, 2007

As a PCS during NS I was allowed to d/c and start foley's, in and out caths, do blood draws and accu-checks and d/c IV's but these were all extensive training sessions and involved 15+ times of being observed after attending classes before I was allowed to do them "alone" w/o the supervision of an RN.

As an ER tech also through NS, I was allowed to do everything except give meds and start IV's as long as I had been signed off in school by my instructors. But I also worked for a very small facility, so the RN's usually were always right there with me for anything considered "envasive".

Susan9608 · Apr 15, 2007

In my current unit (pediatric intensive care), we have no unlicensed personnel. The closest we come is an equipment tech; he is allowed to stock our bedside carts and linen closets in the rooms, but nothing else. He's not even allowed to count our emergency carts (air way cart, procedure cart, neuro cart, etc.) A nurse has to sign that all equipment in those carts is accounted for.

On our pedi floor, however, we have PCAs (patient care assistants) and they are allowed to take vital signs and do I&Os, do bed baths, bed changes, and escort people to and from procedures and off the unit to go home. I'm not sure what PCAs are allowed to do on the adult units, but in peds, that's the extent of their practice.

When I am floated to the floor, I am very uncomfortable with this. I personally feel like taking vital signs is part of my nursing assessment, as is monitoring a patient's I&O. Usually, when I am floated to the pedi floor, I ask the PCA to let me do those things for my patients.

At my old hospital, I worked on a general pedi floor rather than the ICU, and again we did not have any UAPs. The nurses did everything themselves, from baths to linen changes to escorting patients off the unit, and I have to say I much prefer it that way. It does increase the amount of busy work a nurse has to do, but I feel like you have a much better idea of what's going on with your patient physically, mentally, emotionally, and socially if you're the one responsible for all those tasks.

Of course, staffing in that situation is an issue ... in the ICU, we never have more than 2 patients, and at my other hospital (where I worked in general pediatrics with no UAPs) we never had more than 4 patients, and only had 3 if we had one on a vent.

vamedic4, EMT-P · Apr 18, 2007

Are you SERIOUS??
My facility doesn't even allow techs to disconnect IV fluid tubing from someone's HL to change a gown. A nurse must do this, and then reconnect.
Honestly, from some of what I've seen out there, this is just fine with me. If I'm responsible for my patient's well-being during my shift, *I* will be the one suctioning, doing dressing changes, etc. Sterile insertion of a Foley? Never. Student nurses under the supervision of their instructors (who are responsible for them), fine.
If a tech does suction, or does a dressing change, is she/he the one to document in the patient's chart?
Not comfortable with that much leeway.

To answer your question, yes, I am serious. If I perform a procedure on a kiddo then I chart it, plain and simple.

You all are correct that it is quite "individual", meaning that there are those who can't perform these skills/tasks. Only those of us with specific training/certifications/experience are allowed to perform these duties. And again, it frees up the nurse to do the more important things that I can't do...like a nursing assessment.

Oh, forgot...about the PICC line question...yes, years ago we all (those of us who did many IVs) were taught PICC line insertion by the surgeons to supplement them in times of need. I've never done one myself. Again, this was years ago, nowadays anyone who needs a PICC gets a surgical resident/senior resident/attending.

I completely understand your reservations about UAPs doing these type of procedures, but NONE of us are "just CNAs" (not that CNAs aren't a great thing...no flames por favor). We have a specific, defined set of responsibilities, and we perform within that set. It just happens that our skill set is broad ranging (and seems to change week to week)...

kanzi monkey · Apr 18, 2007

I think that person is a student based on the name "nurse2b"

kanzi monkey · Apr 18, 2007

I agree with you and it even states that in the terms of service here on All Nurses. User names with nurse in it for licensed people only.
Yea, yea I know I'm not a mod or the username police just a sensitive sort.

I think that person is a student based on the name "nurse2b"

Cattitude · Apr 18, 2007

I think that person is a student based on the name "nurse2b"

Yes we know :smackingf . Apparently some posts were pulled which explained this. The original username did not have 2B in it and was CHANGED. I have deleted my post which you quoted above. Now can we let it go to anyone else that may read this? Thank you!

Cattitude · Apr 18, 2007

I completely understand your reservations about UAPs doing these type of procedures, but NONE of us are "just CNAs" (not that CNAs aren't a great thing...no flames por favor). We have a specific, defined set of responsibilities, and we perform within that set. It just happens that our skill set is broad ranging (and seems to change week to week)...

I understand. I do think it is so highly individualized though and that is part of the problem. If a policy comes out across the board setting scope of practice for a CNA for instance, there are going to be some that are great and can do it. But there will be some that may be downright scary and you would not want doing intrusive things to patients. As you said the skill set is broad ranging as are people's capabilities.