Impact of Unlicensed Personnel Leadership in Nursing Term Paper

Excerpt from Term Paper :

Unlicensed Personnel

The use of unlicensed assistive personnel (UAPs) has sent a poor message to nursing professionals. In general, the medical establishment has used UAPs in ways that have disregarded the principles of the nursing practice and that have demeaned the value that nurses provide. Rather than showing a willingness to compensate nurses for years of training and performing a demanding job, health care institutions attempted to replace nurses with UAPs without regard to the welfare of the patient.

The misuse of UAPs rather than the use of UAPs is a having a tremendous negative impact on the nursing profession. Of major concern is the increasing use of UAPs to perform services that should be restricted to licensed professionals. By placing untrained, non-credentialed individuals in a position that affects the patient's health, public protection is being sacrificed for increased profits. UAPs should play a role in providing support services to nurses so that nurses have more time to provide nursing case, but UAPs should not be used to replace licensed professionals.

The current nursing shortage was in part caused by higher paid licensed nurses being downsized in favor of UAPs. As the replacements took place, the stresses and strains of the nursing profession increased. Workloads measured by the number of patients the licensed nurses' care for and the acuity of the care became unmanageable and nurses became subject to mandatory overtime. Nurses also became concerned about their own legal responsibilities for directing an increasing number of UAPs under their supervision. Because of the reasons, licensed nurses began to leave the nursing profession or cut back their hours. Layoffs of licensed nurses led nursing schools to cut back on curricula and expenditures and enrollments in nursing programs dropped.

Now, hospitals are faced with a severe shortage of nurses that is projected to get worse.


There's overwhelming evidence to support that the increased use of UAPs has come at the expense of quality health care. An investigation conducted by the Chicago Tribune found that since 1995 at least 1,720 hospital patients have died and 9,548 others have been injured due to nursing medical errors. Most issues occurred when patients were given an incorrect drug, a drug overdose, or life sustaining treatment was delayed. The investigation found that much of the blame was because of the increased reliance on unlicensed nurses' aids, most of who are not trained and earn only $9 per hour. The investigation discovered one hospital that assigned the housekeeping staff to dispense patients' medications. In addition to this investigation there are many other examples of how licensed providers are being improperly replaced with UAPs. For example, the American Society of PeriAnesthesia Nurses is concerned that perianesthisia registered nurses are being replaced with UAPs in recovery rooms. In 1998, Kaiser-Sacramento facility was sited for allowing unlicensed technicians to function as First Assistants during orthopedic surgery. An American Journal of Nursing survey stated that two out of five registered nurses said that UAPs were replacing registered nurses where they work.

A study of every patient in every Pennsylvania hospital during a seven-year time frame in the 1990s revealed that the workload of nurses had increased fourteen percent. During this time, the number of licensed nurses compared with unlicensed nurses dropped two percent. The study also discovered that in hospitals where licensed staffing was lower, even after controlling for patient severity and other factors, patients were more likely to experience problems such as lung collapse, pressure sores, falls, pneumonia, post-surgical and treatment infections and urinary tract infections. The study estimated that increasing licensed nursing staff by ten percent could reduce the frequency of lung collapse by one and a half percent, pressure sores by two percent, falls by three percent, and urinary tract infections by one percent.

Experts disagree on the reason for the current nursing shortage. Some blame factors that are beyond their control such as a gain in opportunities for women in other professions, declining nursing school enrollments, and changes in medical technology and patient care that require fewer nurses. Others feel that the health care industry itself rather than market forces is directly responsible for the nursing shortage. Motivated by cost-cutting and profit-making rather than quality care, health care firms implemented restructuring…

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