Nursing is an essential component of health care, and the consumer of health care needs to be assured of the availability, accessibility, and quality of nursing care. It is in the spirit of this responsibility that this statement related to the use of assistive personnel has been developed. Historically, unlicensed personnel have assisted registered nurses in the delivery of patient care. However, in recent years, with growing economic pressures increasingly driving the health care delivery system, the role of unlicensed and other ancillary personnel has grown considerably and, concomitantly, there have been increasing concerns about the role of assistive personnel.
It is extremely important to use assistants in a manner that assures appropriate delegation or assignment of nursing functions and adequate direction and supervision of individuals to whom nursing activities are delegated.
Nursing care is delivered primarily by registered nurses (RNs), Licensed Practical/Vocational Nurses (LPN/LVNs) and unlicensed assistive personnel. In addition, through the use of "cross-training" and "multi-skilling" programs, other assistive personnel, some of whom are licensed to perform a limited set of patient care tasks, are being utilized to perform some nursing care functions.
The nursing profession is accountable for the quality of service it provides to the consumer. This includes responsibility for developing nursing policies and procedures and setting the standards of practice for the nursing care of populations being served. The nursing profession must also define the appropriate educational preparation and role of any group that provides nursing services. The State Board of Nursing is responsible for the legal regulation of nursing practice for the RN and LPN and should be responsible for regulating the provision of nursing care delivered by any other personnel as well. When the RN delegates or assigns nursing care activities to LPNs and other ancillary personnel, including unlicensed personnel, appropriate relationships must be present, and the RN must retain responsibility for the services provided by the personnel to whom these activities have been delegated or assigned. Decisions regarding which tasks to delegate or assign, and under what circumstances, must be made by the registered nurse who is providing care to the patient, based on the patient's condition, the complexity of the task, the preparation of the assistive person, and other relevant factors. In all situations, RNs and LPNs, as individually licensed caregivers, are accountable for their respective individual nursing activities.
Managers and supervisors of nursing services are responsible, as registered nurses, for ensuring that these relationships are made explicit in workplace policies and that such policies serve to protect the role of nurses in delivery of and responsibility for patient care.
The Tri-Council for Nursing is comprised of the American Association of Colleges of Nursing, American Nurses Association, American Organization of Nurse Executives, and the National League for Nursing.