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Utilization of Non-Licensed Personnel (Medication Aides, Lifting Teams, Transport Teams)

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Strategies to prevent or minimize work-related musculoskeletal injuries associated with patient handling are often based on tradition and personal experience rather than scientific evidence. The most common patient handling approaches in the United States include manual patient lifting, classes in body mechanics, training in safe lifting techniques, and back belts

Surprisingly there is strong evidence that each of these commonly used approaches is not effective in reducing caregiver injuries. A major paradigm shift is needed away from these ineffective approaches towards the following evidennuce-based practices.

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The nursing literature often uses the terms "delegation" and "delegated authority" to define the professional interaction between a registered nurse and a UAP. By definition, delegation is the act of transferring the authority to perform a selected nursing task to a competent individual, while a registered nurse takes responsibility and accountability for this care. Delegation is now an entry-level nursing practice skill requirement. Still, novice nurses report a lack of knowledge, skills, and attitudes for the delegation decision-making process. Learning delegation skills “on the go” is a common pattern. The literature reports that there is a gap between the expected skill levels and the actual abilities of new graduate nurses relative to delegation. Delegation is a complex managerial skill that strongly affects all parties involved, i.e., the nurses, UAPs and patients. To provide quality and safe nursing care for their patients, nurses have to delegate the right task to the right person under the right circumstances with the right direction/communication and appropriate supervision. The concept of delegation between nurses and UAPs, and the relationship between nurses and UAPs in clinical practice was not broadly studied since the new joint statements issued by the ANA and the NCSBN. Few studies were found in the literature regarding nursing delegation and the relationship between nurses and UAPs. Only few qualitative studies were found on this topic, of which, only one was qualitative in nature. Studies have found that nurses report a lack of knowledge on how to properly delegate activities to UAPs and an insufficient knowledge regarding the UAPs training. Although still responsible for the comprehensive patient care, many nurses expressed frustration with multiple additional responsibilities unrelated to direct bedside care, even if they were assisted during the work by an UAP.

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Given the robust literature on the importance of nurse staffing to patient safety (Aiken, Clarke, and Sloane 2002; Aiken et al. 2010; Needleman et al. 2011), a significant yet largely unexplored question is how CNLP staffing levels and nurse staffing levels affect each other. Is it a relationship of complementarity, in which staffing of both groups rises and falls together in response to factors such as patient volume? Is it a relationship of substitution, in which the hiring of more CNLP allows hospitals to hire fewer nurses? Or is it some combination of the two, depending on management strategies and a hospital and region's context? These questions are relevant to hospitals’ efforts to maximize labor efficiency, minimize nurse burnout and turnover, and, of course, protect and improve patient outcomes. They are also pertinent to the question of state laws regarding minimum nurse‐to‐patient ratios. With two states mandating ratios (California and Massachusetts1) and 14 other states requiring either staffing committees or public reporting of nurse staffing levels, the policy focus has been primarily on RNs, with little or no consideration of how CNLP staffing affects nurses’ workloads (Emergency Nurses Association 2014; ANA 2015).On the other hand, Potter et al. (2003) found a negative association between RN and patient care technicians, suggesting a possible substitution effect

More recent studies on the effects of California's nurse staffing law also found decreased use of nurse aides and orderlies associated with increased use of nurses in hospitals attempting to meet the minimum patient‐to‐nurse ratios.

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In either case, performance of health-related tasks by unlicensed persons is predicated upon an assessment and determination by the registered nurse that the health-related activity under consideration is appropriate for performance by each unlicensed person with each individual patient. Non-nursing functions not involving direct patient care require professional nursing knowledge and oversight, but do not need case by case assessment and decision making by the registered nurse

It is the nurse's obligation to judiciously determine tasks that can reasonably be assigned to unlicensed persons.

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McHugh, M. D. , Kelly L. A., Sloane D. M., and Aiken L. H.. 2011. “Contradicting Fears, California's Nurse‐to‐Patient Mandate Did Not Reduce the Skill Level of the Nursing Workforce in Hospitals.” Health Affairs 30 (7): 1299–306.

Donaldson, N. , Bolton L. B., Aydin C., Brown D., Elashoff J. D., and Sandhu M.. 2005. “Impact of California's Licensed Nurse‐Patient Ratios on Unit‐Level Nurse Staffing and Patient Outcomes.” Policy, Politics, & Nursing Practice 6 (3): 198–210.

Emergency Nurses Association . 2014. “50 State Nurse Safe Staffing Laws”

Potter, P. , Barr N., McSweeney M., and Sledge J.. 2003. “Identifying Nurse Staffing and Patient Outcome Relationships: A Guide for Change in Care Delivery.” Nursing Economics 21 (4): 158.

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