- •Define UAPs/NAPs as unlicensed personnel who are not professional registered nurses but who are accountable to and work under the direct supervision of a professional registered nurse to implement specifically delegated patient care activities.
- •Evaluate the individual state's current nurse practice act to ensure that UAP/NAP job descriptions and delegated activities are consistent with established rules, regulations and statutes.
- •Provide written job descriptions that clearly delineate duties, responsibilities, qualifications, skills, and supervision of UAPs/NAPs.
- •Ensure that UAPs/NAPs are readily identifiable by the patient as non-licensed.
- •Establish competence-based performance expectations and systems for ongoing performance appraisals.
- •Provide orientation and education for UAPs/NAPs, including didactic content as needed and appropriate for the clinical setting, evaluation of knowledge, and verification of clinical skills consistent with performance expectations and role responsibilities.
- •Clearly define parameters in writing to ensure that all UAPs/NAPs are supervised directly by and responsible to professional registered nurses.
- •Monitor and evaluate adherence of UAPs/NAPs to patient care guidelines and their effect on patient outcomes.
The Role of the Nurse
- •Accountability: Being responsible and answerable for actions and inactions of self or others in the context of delegation.
- •Delegation: Transferring to a competent individual the authority to perform a selected nursing task in a selected situation. Responsibilities related to making nursing judgments may not be delegated to UAP/NAP.
- •Supervision: The provision of guidance or direction, evaluation and follow-up by the professional registered nurse for accomplishment of a nursing task delegated to UAPs/NAPs (American Nurses Association and National Council of State Boards of Nursing, 2006).
- •Potential for harm,
- •Complexity of task,
- •Problem solving and critical thinking required,
- •Unpredictability of outcome,
- •Level of care giver-patient interaction, and
- •The practice setting (American Association of Critical-Care Nurses, 2004).
- American Nurses Association
- American Nurses Association
- National Council of State Boards of Nursing
- •Telephone triage,
- •Triage of women and their fetus(es) who present for care,
- •Initial and ongoing assessments of women and newborns,
- •Application of electronic fetal heart monitoring components,
- •Initial and ongoing assessment of maternal-fetal status, including auscultation and interpretation of electronic fetal heart rate pattern,
- •Ongoing assessment of
- ○Women receiving oxytocin infusion,
- ○Pain management needs of women and newborns,
- ○Women receiving regional analgesia/anesthesia,
- ○Women who have complications of pregnancy,
- ○Progress of labor,
- •Management of the second stage of labor,
- •Circulator responsibilities for vaginal or cesarean birth,
- •Initial assessment during the postpartum period after vaginal or cesarean birth,
- •Assessments required for discharge from post-anesthesia care units,
- •Initial assessment of women and newborns during post-surgical care,
- •Assigning Apgar scores,
- •Newborn identification (e.g., assigning security device, placing identification bracelet),
- •Newborn assessment during the transition to extrauterine life,
- •Determining the plan of care based on nurse assessment,
- •Nursing interventions that require specialized knowledge, judgment, competence and skill,
- •Discharge planning,
- •Patient education,
- •Parent education, and
- •Evaluation of the outcome of nursing interventions.
- •Clerical duties,
- •Selected care tasks such as assistance with ambulation, feeding, mouth care, and bathing (activities of daily living), and
- •Gathering of data such as intake and output and vital signs.
- AACN delegation handbook.2nd ed. Author, Aliso Viejo, CA2004 (Retrieved from http://www.aacn.org/wd/practice/docs/aacndelegationhandbook.pdf)
- ANA's principles of delegation by registered nurses to unlicensed assistive personnel.Author, Silver Spring, MD2012 (Retrieved from)
- Joint statement on delegation.(Retrieved from https://www.ncsbn.org/Delegation_joint_statement_NCSBN-ANA.pdf)Date: 2006
- Guidelines for professional registered nurse staffing for perinatal units.Author, Washington, DC2010
- Decision tree for delegation to nursing assistive personnel.Author, Chicago, IL2005 (Retrieved from)
An official position statement of the Association of Women's Health, Obstetric and Neonatal Nurses
Approved by the Executive Board, February 1997 and September 2000. Revised and reaffirmed by the AWHONN Board of Directors June 2009 and November 2015.
AWHONN, 2000 L Street, NW, Suite 740, Washington, DC 20036, (800) 673-8499