January 10th, 2018
using Unregulated Health Care Providers – continued framework.
With such a diverse designation and range of duties it becomes difficult to establish a regulatory framework that is applicable throughout the UHWs spectrum. However; various organizations have come up with guidelines for health professionals to decide when to or not to delegate their duties to UHWs. CRNM (2002) for instance provides the guidelines for delegation of duties by health professionals. According to the guidelines minimal requirements must be met before tasks and procedures are delegated to an UHW and these are: the health status of the client should be stable and his response to the task being delegated predictable; the UHW has the ability to safely perform the delegated task; and the UHW has the support and supervision of the health professional – licensed practical nurse, registered nurse or registered psychiatric nurse (CRNM, 2002, p. 3). The degree of such supervision must be established by the professional involved and the amount determined by “the complexity of the task or procedure being delegated, and the ability of the worker performing it” (CRNM, 2002, p. 3).
Similarly CNO (2009) has provided guidelines for delegation of duties to unregulated care providers. According to these guidelines, where a regulated health professional is working with an UCP the former is accountable for: ones actions and decisions such as when teaching, delegating, supervising or assigning duties to UCPs; knowing and comprehending the roles and obligations of UCPs; and taking the responsibility for action to guarantee client safety (CNO, 2009). The nurse is however “not accountable for decisions or actions of other care providers when there is no way of knowing about those actions” (CNO, 2009, p. 6). Accordingly before delegation a nurse should assess whether client’s state, risks associated with the state and available support in addition to the competency of the UCP allows the performance of delegated tasks satisfactorily (CNO, 2009). Only when all these evaluations are into the affirmative should the procedures be delegated (CNO, 2009). Such aspects have also been addressed in a joint guidelines issue by Newfoundland and Labrador’s Association of Registered Nurses and College of Licensed Practical Nurses (2009).
Once the tasks are delegated the UHWs is charged with performance of assigned tasks and procedures; learning the limit of procedures they can perform with the delegated approval; and rejecting performance of delegated tasks and procedures until appropriate authorization and training for safe performance of the tasks is received from the employers (CNRM, 2002). As such UHWs are accountable to the regulated care providers, their employers and the clients for various duties (CNRM, 2002). While to the registered care providers they bear the responsibility of performing assigned tasks and procedures; to employers and clients they are responsible for competent performance of such tasks and procedures (CNRM, 2002). While such guidelines have been delineated the lack of information such as statistics on UHWs operating in most countries challenges the planning and formulation of effective healthcare policies such as the development of a uniform training and classification system (CNA, 2008).