UNLICENSED HEALTH WORKERS: Worrisome Nursing Trend?
The recent trend among health care providers of allowing unlicensed employees to provide nursing care is "the most critical issue that nursing has faced in years and years," according to nursing professor Carol Huston of Chico State University. The Chico Enterprise-Record reports that Huston, who cites her own doctoral research as well as "several large studies on the use of unlicensed workers" currently under way, said many hospital patients "experience more pain and acquire more infections" under the care of "unlicensed assistive personnel" (UAP). Shelly Schlenker, regional vice president of the Hospital Council, an association of northern and central California hospitals, said that while the 1980s brought a trend of hiring more registered nurses to perform patient care, "the pendulum is swinging back the other way" with the growth of managed care. Now, RNs "still care for patients," but they're also being asked to "supervise unlicensed staff who provide some care." Schlenker does not see the trend as problematic: "It's true more unlicensed people work in patient care these days, but their employment is appropriate and well regulated by the state."
Huston is concerned that the trend will contribute to "a huge nursing shortage within five years," since the fact that "many RNs are losing their jobs" is causing nursing schools to become smaller. Huston said the problem posed by growing numbers of UAPs may not be receiving the attention it deserves because the credibility of nurses who sound the alarm appears questionable in light of the trend's threat to their jobs. To substantiate her claims about the impact of UAPs on patient care, Huston has received permission to study two unnamed 250-bed urban hospitals in California that have "recently replaced significant numbers of RNs and licensed vocational nurses (LVNs) with unlicensed workers." Huston said, "I'm not saying that UAPs aren't good people, but there are no established safeguards. You don't know if they've had 300 hours of on-the-job training or none, if they have a college degree or lack a high school diploma." What the industry needs, she said, is "objective studies showing the effects of 'RNs' being replaced by a cheaper counterpart.'"
Not A Replacement Issue
Schlenker said she "disagree[s] that unlicensed personnel are replacing nurses." She said the UAPs are "used to augment the nursing staff within (the appropriate level) of competency and scope of practice" (Mitchell, 2/26).