Over the years, I have worked with countless unlicensed assistive personnel (UAP) in a variety of settings in many different states. Without a doubt, the majority of the time working with them as part of the healthcare team has overall helped me to deliver more efficient professional nursing care. However, if I had a dollar for every time I heard over the last nearly twenty years, “They [UAP] work under YOUR nursing license,” I’d probably have a hefty sum of money by now…and not chump change either! I’m sure I’m not alone in having this exact statement said to me. I have found that this is actually a very common misconception in nursing across the country.
Who exactly falls under the UAP umbrella? Nursing assistants, nurse techs or nurse’s aides (NAs), home health aides (HHAs), patient care technicians (PCTs), and behavior health aides/techs. Note that this is not an all-inclusive list. In fact, according to Ohio University, there are over two million unlicensed assistive personnel working across the United States and that’s just in the hospital setting!
With so many unlicensed assistive personnel out there, how does one navigate the conversation of “working under” a licensee? Well, “working under” someone else’s license is a fallacy. It makes sense when you start to really pick this statement apart. The only person that can work under your hard-earned registered nursing license is you. You as the registered nurse obtained the education and passed the board exam to practice. So, if “working under” a license isn’t possible, then what exactly is taking place? I’m glad you asked… it’s in fact delegation. According to the Merriam-Webster online dictionary, delegate as a verb means “to entrust to another”, or “to appoint as one’s representative.” It’s understandable why so many nurses feel that delegating carries so much weight. That’s because it does!
There is a colossal amount of literature pertaining to delegation by a registered nurse. A complete survey of this topic is beyond the scope of this article. However, a good first step in the process is researching what your state board of nursing says about delegation. Each state has its own rules pertaining to this. What’s allowed in one state may not be okay in another. Next, investigate the policies at your place of employment. You’ll also want to ensure that you have your own personal malpractice policy to protect your license and assets. While your employer may carry malpractice insurance, remember that their policy is designed to protect them, not you as an individual. This would make you liable for anything that your employer is unwilling or unable to cover with their policy. Finally, there are a number of tools out there that can help you decide if delegation is appropriate. Many state boards of nursing offer their own decision trees as a guide. In addition, several professional nursing organizations such as the American Nurses Association and National Council of State Boards of Nursing have put together some helpful resources easily found online to aid registered nurses, including decision trees, flow charts, in-depth research articles, and checklists.
Ultimately, the decision whether or not to delegate is up to the individual registered nurse. In today’s complex healthcare environment, we registered nurses are encountering an increasing amount of UAPs and I predict that their numbers will continue to grow. It’s important to stay up to date with our nursing practice, and this includes the ins and outs of delegation. Delegation is not something to take lightly and it involves careful consideration by the registered nurse. After all, the definition of delegation carries a ton of weight; you are entrusting another person to perform a task in your place.
Even in the best delegation scenario, patient care could take an unexpected turn. Following your state board of nursing, your employer’s policies, and the resources offered by national professional nursing organizations can help you defend your practice, but you also don’t have to defend your nursing practice alone. Make sure to protect yourself with a solid personal malpractice insurance policy in your corner. A malpractice policy is one of the most essential tools in your nursing toolbox to protect your hard-earned license.
Written By: Michelle Batlle, BSN, RN
Michelle Batlle is a registered nurse with almost 20 years of experience and currently works as a nurse consultant for a major international company. She’s passionate about sharing unique nursing experiences with others. She enjoys learning new things, while sipping green tea lattes. You can find her on https://www.linkedin.com/in/michelle-batlle/