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Unlicensed Does Not Mean Untrained or Unskilled

Tuesday October 9, 2001
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Exposé TV programs, magazines, and journals have portrayed a healthcare industry that sacrifices patient care at all levels to bow to the bottom line. The public has heard that nursing positions have been abolished to accomplish downsizing and redesign. In reality, employment sites have shifted, but overall employment opportunities exceed the supply of nurses to fill positions in acute, primary, and home care, as well as other less traditional employment venues. Even if cost was not an issue, there aren't enough RNs to meet the current market demand.
As a consequence of both cost-containment factors and the reduced supply of RNs, the mix of the healthcare team, especially in acute and primary care settings, has changed. Healthcare facilities are hiring more support staff, care extenders, or paraprofessionals, known as unlicensed assistive personnel (UAPs). Two common models for integrating UAPs into the system have perhaps exacerbated complaints from nurses regarding support personnel. Most healthcare facilities provide support staff by either recruiting certified nursing assistants (CNAs) or providing on-the-job-training (OJT) to job applicants. Several factors work against the effectiveness of hiring CNAs and providing OJT.
CNAs are prepared to work with geriatric clients in long-term care facilities. Their training is the direct result of the 1987 Omnibus Budget Reconciliation Act. The purpose of the CNA rider to this bill was to improve the level of care being provided to elderly Medicare patients. The 80 to 120 hours of instruction, lab, and clinical practice CNAs receive is targeted to the long-term care of the elderly and does not provide in-depth study of the human life span or the acuity of care found in the acute hospital setting. The OJT model presents its own challenges for providing patient-care support staff. Issues include -
· Which institutional budget provides the training both in terms of cost and time?
· How is competency of workers ensured?
· What does the institution do after investing several weeks in wages for a person who leaves because he or she does not like the work or for someone who must be terminated for poor performance?
In many healthcare facilities across the nation these issues are far too familiar. In northern Virginia, Inova Health System and Northern Virginia Community College have developed a program to address the need for better-prepared, more-skilled patient care support staff. The goal of the program is to prepare individuals for entry-level employment, with direct patient care, in the acute care setting. The program, which has been operational for two years, is 10 weeks long; it consists of 92 hours of classroom and laboratory practice and an additional 80 hours of clinical internship with a preceptor, for a total of 172 hours. The program has been designed with an integrated curriculum that addresses the cognitive, psychomotor, and affective domains of learning. It emphasizes the team approach to healthcare delivery with clear role expectations for both professionals and paraprofessionals on the team.
Reports from patient care managers who have hired UAP graduates indicate the new employees are exceeding expectations for support personnel. As many as two-thirds of the program graduates are enrolled in education and/or training programs to advance themselves in healthcare.
Benefits of a program like this to the healthcare industry include -
· increased supply of people prepared for institutional orientation rather than basic skills training
· preemployment deselection of applicants who are not personally suited for the work of a UAP or are unprepared academically or skill-wise for the nature of the work
· partnership with education to meet changing workforce needs
· opportunities to create career pathways for upward mobility among paraprofessionals, which improves both employee retention and morale
· cost-shifting for preemployment training for persons entering the workforce, or cost reduction for employee benefits for existing employees via a tuition assistance program.
For the graduates of the UAP program, unlicensed does not mean untrained or unskilled. UAP graduates are prepared to be competent and confident members of the healthcare team in the acute care setting.