Role of huc/unit secretary

SoldierNurse22, BSN, RN · Feb 18, 2014

Part of the problem you're having is that you're looking for legislation on UAP--unlicensed assistive personnel. There isn't going to be a great deal of information on the roles of a UAP as they are, by definition, unlicensed. They have no governing body.

As a result, you need to look on the nursing side of the house--laws, guidelines and BON regulations--to determine the scope of a UAP's practice in your state by determining what cannot be delegated versus what can.

http://www.wisconsinnurses.com/work_advoc/pdf_files/uaps.pdf

While this may not directly apply to you (I'm not sure what state you're in), take a look at this resource from the WI BON. Page 8 has a delegation flowchart that's designed to help nurses determine if they can delegate tasks to UAP.

I got down to #3: "Can the task be performed without observations or critical decision-making that requires nursing knowledge, skills, and judgment?" In answer to that question when it comes to making patient assignments, I'd say "no".

Hope that helps!

D.R.A. · Feb 18, 2014

I'm all over the nursing side. I've got stacks of information on that. It is a cut and dry issue from that side, and in my perspective. I am just grasping at straws to find mention of UAP's in the capacity of handling written orders, etc., and the role that is essentially theirs, which is not necessarily one that is 'delegated,' in a well intentioned effort to validate the individual. Entering orders is not a task that we delegate, it is a task that falls under the job description. Answering the phone is not a task that we delegate. Basically, I have to go in and say, "While I appreciate your 15 years of experience, and I realize that you do possess a lot of knowledge regarding doctors, nurses, and patients, and while you have been allowed, wrongfully so, for many years, in the past to do so, the BON prohibits me from allowing you to make patient assignments." Period.The.End.

SoldierNurse22, BSN, RN · Feb 18, 2014

That's what I mean. You're not going to be able to find a breakdown of what a UAP can do in most states that I know of. Unlicensed personnel don't have rules and regs like nursing does as a profession. You're going to have to narrow down by nursing regulations within your state what can and cannot be delegated.

MunoRN, RN · Feb 18, 2014

... Basically, I have to go in and say, "While I appreciate your 15 years of experience, and I realize that you do possess a lot of knowledge regarding doctors, nurses, and patients, and while you have been allowed, wrongfully so, for many years, in the past to do so, the BON prohibits me from allowing you to make patient assignments." Period.The.End.

Have you actually found something from the BON that says this? I've worked in two different places where the patient assignments were done by staffing clerks, so it wouldn't appear that as a general rule only RN's can make patient assignments as an actual regulation.

LadyFree28, BSN, LPN, RN · Feb 19, 2014

I have never been in a place of employment where a unit secretary makes the assignment; it has always been a nurse.

Now, I remember 10 years ago being in my PN program where the unit secretaries at the hospital I was rotating at was still taking off orders and one was notorious for using "not approved" abbreviations :facepalm:

I am sure that unit secretaries at this local hospital do not take off orders anymore. :no:

jadelpn, LPN, EMT-B · Feb 19, 2014

Regardless of what you choose to do, any task that a UAP or Unit Clerk does falls under someone's license. By nature of the task being in a job description is a delegation.

In other words, you need to have this discussion with the nurses in your unit. To just put it out there. What are they most comfotable with? YES, there are many, many unit clerks who are awesome and know their stuff. However, in putting in orders and say something gets missed, there is a delay--then that becomes the licensed nurse's issue. In my own experience, there is a great deal of assuming that the unit clerk put stuff in, and the communication was such that they did not, and there's delays in treatment. Which is never a good thing. Or orders are put in twice....IF the job of the unit clerk is to put in all orders, perhaps it should be after the nurse reviews them for accuracy. However, if your going to review them, you might as well put them in.

The patient assignment part is something that I would think would need a nursing judgement. This is usually in the realm of the charge nurse.

Bottom line--If a unit clerk (or any UAP) is going to be tasked to complete any patient related orders, assigning nurses to patients, someone who is licensed needs to take responsibility for this. Usually, in most BON websites they have a delegation chart that can answer this question. And a unit clerk who participates in patient care in any way, shape or form IS a UAP.

D.R.A. · Feb 21, 2014

Have you actually found something from the BON that says this? I've worked in two different places where the patient assignments were done by staffing clerks, so it wouldn't appear that as a general rule only RN's can make patient assignments as an actual regulation.

What I have found from my BON: 1.) Generalized opinion regarding delegation which includes questions to answer before you delegate. 2.)Decision making tree for delegation to the UAP. Utilizing those two things, the first criteria that must be met prior to ANY delegation is an RN assessment of the client's nursing care needs must be completed.

I think we can all agree that an RN must first be aware of a patient to even make an assessment of nursing care needs. So, while the BON does not directly "prohibit" the UAP from making patient assignment, utilizing the delegation tree I cannot in good conscience delegate that task.

In my state, even the LPN works under the supervision of an RN. I don't make the rules. I just follow them. The responsibility falls back on the RN. How I feel about it is, when the responsibility falls back on my license, I need to be the one who made the decision that I am to taking responsibility for.

The UAP's assessment of nursing care needs for a patient cannot replace the RN's assessment. While the UAP may be very experienced and knowledgeable, and good at guessing how the patient needs to be assigned, he or she does not posses the critical thinking and assessment skills of a professional nurse, and, therefore, the assignment is made based on a guess. Delegating patient assignment to a UAP is not permissible in my state based on my assessment of the law. It would be much easier, however, if that was spelled out.

And I think that is why I choose this forum to post my question in. If the professional nurse continues to give away her responsibilities to the UAP, I feel patient care will suffer firstly, and secondly, she will soon find her role not needed. Patient care begins and ends with the professional nurse.

ADeks · Feb 21, 2014

Basically, I have to go in and say, "While I appreciate your 15 years of experience, and I realize that you do possess a lot of knowledge regarding doctors, nurses, and patients, and while you have been allowed, wrongfully so, for many years, in the past to do so, the BON prohibits me from allowing you to make patient assignments." Period.The.End.

So you're trying to find something to show your workplace that a HUC can't make a patient assignment. Have you looked into your hospital's policy about HUCs?

Also, it's really your charge nurses who have "delegated" this task whether incorrectly. So are they aware you're having problems?

D.R.A. · Feb 21, 2014

So you're trying to find something to show your workplace that a HUC can't make a patient assignment. Have you looked into your hospital's policy about HUCs?
Also, it's really your charge nurses who have "delegated" this task whether incorrectly. So are they aware you're having problems?

We really don't have a policy that spells this out. But, if the BON can't spell it out, then I wouldn't expect the hospital to.

I am a charge. I do not delegate the task. The HUC has been assigning patients for 15 years. Yes, the other charges are aware that I have a problem. They agree that patient assignment is to be based on acuity. We all agree that a UAP cannot make that determination, however, this falls under a gray area for most of them. They don't want to upset the basket.

ADeks · Feb 21, 2014

If all the charge nurses agree that this should be standard. Why don't you all just implement it. If you all stand together that this is now the charge nurses responsibility.

MunoRN, RN · Feb 21, 2014

I get the impression that you're looking for some sort of regulatory requirement justification for having only Nurses make the assignments but I don't think that exists. Other than California's mandated ratios, staffing by acuity isn't a requirement of any BON. So while the UC may not be able to staff by acuity as accurately as an RN might, it really doesn't matter because there's no requirement they staff by acuity at all much less do it accurately. Whether the UC does the assignments by room number or by some quasi acuity based system makes no difference.

I get your argument about delegation, but staffing assignments aren't actually patient care. They certainly affect patient care, although I don't know of any BON that has argued that everything that affects patient care falls under Nursing delegation. In other words, when a UC does the staffing assignment it isn't a patient care delegation, it's a clerical delegation just like answering the phones and many other things a UC does.

I agree with others that you'd have more success if you can get the NTLs as a group to take over this task, but personally I hate doing staffing and don't know of many NTLs who would fight to keep doing the assignments.