Increasing UAP's (CNA, PCT, PCA) scope of practice

JBMmom, MSN, NP · Mar 13, 2021

I think that in most facilities, the workload of UAPs currently would not allow for expansion of roles to include most of the items you listed above.

First though, my answer has absolutely nothing to do with feeling threatened. Nada. I would be happy for some of the things I can do as a nurse to become tasks that I can delegate, IF it's in the best interest of the patient.

For that reason I would say med administration is a no for me. I understand there are medical assistants that are medication administration approved in some settings. If you're talking about patients in a hospital, I think that medications should be administered by nurses, especially new medications, due to the risk of adverse effects. For example if a patient has a dose of lasix ordered, a PCT isn't going to have access to the lab results to see their most recent potassium was low, and the medication might be administered without thought to the downstream effects.

IV insertion- I guess if they're trained that would be fine. I know that in my critical care unit, CCTs used to draw labs on patients without central lines, so inserted IVs would be about equivalent.

Foley insertion- probably, as long as infection control was followed appropriately. It's a huge hot button lately in our hospital because CAUTIs have been up, so they wouldn't likely allow it.

Our PCTs used to DC Foleys and IVs, but we were told recently they can't do that anymore. No reason was given.

Sour Lemon · Mar 13, 2021

7 hours ago, detxsccosta said:

Hello, I am a senior nursing student doing a project about UAPs performing nursing skills such as medication/vaccine administration, inserting and d/c IVs, inserting and d/c Foley catheters, etc.

I just have a few questions about your opinion regarding the matter and if you have experience with this subject.

- Do you agree with allowing UAP's to perform more invasive procedures if they were provided more education or certifications to do so?

- Would you or would you not feel like your role as a nurse would be threatened?

- What does your hospital (or state) allow UAP's to perform? Do you see a benefit?

I can agree with it, if it's delegated by the "supervising RN" who is ultimately responsible for the patient.

Once upon a time, someone at a hospital I worked for decided that CNAs would do all wound care. RNs were still responsible for assessment and charting, so it wasn't a popular decision and it didn't last long. Along with that, your CNA might be too busy with wound care to help Patient X to the bathroom ...the wound you have to chart on later, but never see because you were stuck in the bathroom with Patient X.

I tend to think that LVNs are often a better choice for these sorts of tasks in acute care, since they are actually nurses and can chart their own observations.

At my hospital, CNAs assist with ADLs and do vital signs. Not much else, at least not on the record.