The impact of RN-UAP relationships on quality and safety

Abstract

Nursing Management R i s k M a n a g e m e n t N ursing assistive personnel support RNs in carrying out their responsibilities and completing their work. These individuals typically have a short training program of several weeks to 3 months, although some have no formal preparation, not even a high school diploma. 1,2 The assumed model is that the RN retains responsibility and accountability for the entire care of the patient but delegates specific tasks to the unlicensed assistive personnel (UAP). The American Nurses Association points out that RNs retain ultimate responsibility, accountability, and legal liability not only for delegated work, but also for any associated errors. 3 As is true of teamwork among all members of the healthcare team, the relationship among UAP, RNs, and LPNs has implications for quality of care and patient safety.For purposes of parsimony, all of the various job titles for assistive personnel (such as unlicensed assistive personnel, certified nursing assistants, nurse techs, nurse aides, healthcare assistants, and others) will be referred to in this article by the abbreviation UAP. Nurse refers to RNs. Because there were few LPNs practicing in the hospitals involved in the study, they weren't included. The responsibilities of the UAP are a combination of clinical (such as vital signs, baths, mouth care, ambulation, turning, and toileting) and nonclinical (such as keeping the environment orderly) work. 2,[4][5][6][7][8][9][10][11][12] The aim of this study was to determine the barriers that inhibit effective RN-UAP teamwork and then to ascertain if and how dysfunctional teamwork leads to problems in quality of care and patient safety. The specific study questions addressed were:• What are the specific teamwork problems in the working relationships of RNs and UAP in acute care hospital settings? • How do these problems lead to diminished quality of care and patient errors? Method SampleThe study took place in three acute care hospitals (one academic medical center and two community hospitals) in two states. Data were collected on 15 medical-surgical patient-care units. In the first wave of data collection, a series of nine focus groups were completed with 81 RNs and 12 focus groups with 118 UAP. International Review Board approval for the study was obtained in all three facilities. Participants signed an informed consent before initiating the focus groups, which included staff from all shifts. The RNs and UAP were in separate focus groups to maximize open discussion. The second wave of data collection involved 19 individual interviews with 10 staff nurses, six UAP, and three nurse managers. These individuals worked on the study units in phase 1 of the study. Data collectionA semistructured design was employed in the focus group interviews in phase 1 of data collection, which were 60 to 90 minutes in length. Focus group participants were asked to commit to confidentiality (to not quote the others in the group outside the focus group). They were assured of the confidentiality of their com...

Correlates and predictors of missed nursing care in hospitals

“…, ). Lack of effective nursing teamwork is a serious matter as it threatens patient safety and quality care (Kalisch ).…”

Nursing teamwork and time to respond to call lights: an exploratory study

“…Nursing staff members often do not answer call lights for patients not assigned to them (23) . This is referred to as "it's not my job syndrome," and we have found that it is common in acute care hospital patient care unit teams.…”

The forgotten rung

“…11 The implications of this study demonstrated that the RN-UAP relationship does impact patient care and that these issues need to be addressed on a unit level by engaging staff, focusing on teamwork, and changing the UAP model of care. 11 The implications of this study demonstrated that the RN-UAP relationship does impact patient care and that these issues need to be addressed on a unit level by engaging staff, focusing on teamwork, and changing the UAP model of care.…”

“…[7][8][9][10][11][12] The literature focuses on the change of culture with the addition of UAP, the financial impact, legal issues, controversy over the UAP role, and nurse delegation and supervision of UAP. When using the search term "unlicensed assistive personnel," 281 peer-reviewed articles were found, with 195 since 1992.…”