AORN spells out position on unlicensed personnel

[Editor’s note: To help our readers, Same-Day Surgery is printing advice in the top 10 areas that receive the most questions at the Center for Nursing Practice, Research, and Health Policy at the Association of Operating Room Nurses (AORN) in Denver. The tenth topic, in this month’s issue, focuses on unlicensed assistive personnel.]

The AORN position statement on unlicensed assistive personnel (UAP), as ratified by the House of Delegates at the 42nd annual Congress (1995), states:

"Perioperative registered nurses are accountable for patient outcomes resulting from the nursing care provided during the perioperative experience. A perioperative registered nurse must plan and direct the care of every patient undergoing operative and other invasive procedures. A 1:1 perioperative RN to patient ratio is required for each patient during operative and other invasive procedures. To ensure that patients receive the highest quality and standard of care, the circulating nurse must always be a registered professional nurse."

The statement identifies the core activities of perioperative nursing as assessment, diagnosis, outcome identification, planning, implementation, and evaluation. The perioperative nurse may not delegate assessment, diagnosis, outcome identification, planning, or evaluation; however, depending on the patient’s potential for adverse outcomes and need for complex interventions and teaching, the perioperative nurse may delegate appropriate patient care activities. The perioperative nurse uses judgment to decide to whom and under what circumstances to delegate these activities.

Factors that must occur before UAP assume responsibilities for patient care activities are:

1. ursing practice factors.

• Patient’s risk for adverse outcome must be determined.

• Patient’s need for complex technology and complex intervention must be determined.

• Patient’s need for teaching must be determined.

2. Training and education factors.

• RNs must receive education and demonstrate knowledge and skills of delegation.

• Level of preparation/education of UAP required to perform task must be determined.

• UAP must receive appropriate didactic and psychomotor training.

• UAP must demonstrate competency for each patient care activity that will be delegated.

3. Management factors.

• UAP position descriptions and job duties must delineate which patient care activities can be performed.

• Perioperative nurses must participate in defining UAP position descriptions.

• Perioperative nurses must assist in validating UAP competencies.

• An appropriate number of perioperative nurses must be provided to perform core patient care activities that may not be delegated.

• An appropriate number of perioperative nurses must be provided to supervise and coordinate the performance of patient care activities that may be delegated to UAP.

[Reprinted with permission from AORN Online (http://www.aorn.org/), 1997. AORN, Inc., 2170 S. Parker Road, Suite 300, Denver, CO 80231.]