unlicensed assistive personnel (UAP)

[CABG Patch RN]

Does anyone have experience with using unlicensed assistive personnel(UAP) in the ICU? My unit a CTICU, is piloting this work redesign in our hospital to address the RN staffing shortage. A UAP is essentially a UT that has had additional hospital based training that enables them to perform tasks such as dressing changes, suctioning, ROM, and recording vitals/I&O. They are paired with one or two RNs to care for 4-5 patients. Many are RN students. Anyone that is familiar with this approach to patient care, please offer some much needed pointers on how to make this a successful solution to the desperate staffing situation. Thanks:confused:

[hoolahan, ASN, RN]

In the CT ICU where I used to work, the UAP's didn't do personal care. They were a wonderful support by restocking each bedside with needed supplies, "running" labs, blood, for supplies, and they assisted with weights, bedbaths, turning, etc...Call me old school, but i PREFER TO DO MY OWN BATHS IN CRITICAL CARE, IT ALLOWS ME TO MAKE A THOROUGH SKIN ASSESSMENT(sorry about the caps.) And definitely my own dressing changes.

Frankly, I think a dressing change is inappropriate for a UAP to do in this setting. If they are changing a groin drsg, this must be assessed not only by sight, but by palpation. Wounds must also be carefully assessed, and in our unit, some surgeons will keep CT's for 48 hours, period, no matter how little drainage, so re-dressing around CT's takes further nursing clinical assessment.

I think if you want to involve UAP's in direct pt care, several things must be done.

First and foremost, find out what can and cannot be delegated in your state. In NJ, there is an on-line chart that is decent. Can give you a link to the site, but I don't have the exact page bookmarked. Not sure how helpful it will be, since I am not sure you are in NJ...NJ BON

Second, make a job description, with the qualifications you are looking for. If you think they will hire all nursing students, great, in my experience, it would be naive to assume this will always be the case. So, get it in writing. Include a statement such as "second-year or greater enrollment in a school for registered nursing" under minimum qualifications for the job. Accept nothing less than what you have determined as safe. I am only giving a hypothetical example.

Third, you must not allow TPTB to substitue a UAP for a RN. I can see this easily happening. You have to get ratios in writing, or in a policy somewhere to prevent this "loophole" in staffing crunches.

I hope that is a start. Sorry I couldn't be more help.

PS Totally jealous of your name...CABG Patch RN. Wish I had been so clever. Cute!!

(Edited to correct web address)

[CABG Patch RN]

Hoolihan,

Thanks for the suggestions. I'm in Rochester, NY, the land of the regulated. We are finding that there is much UAPs will not be permitted to do. I believe we have to protect and preserve our profession whenever possible. However we're losing the staffing battle; we are working with ratios of 2-3:1 without UAPs. The staff is cautiously optomistic about the idea. Thanks again for the input. CABG Patch RN