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What the legal implications for RNs supervising unlicensed assistive personnel?

Friday May 11, 2012
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Dear Nancy,

I am an RN working in the ED. Recently, the nurses were informed that the nursing assistants would now be performing blood pressure checks. I would like to know what the legal implications are for the RNs supervising these PCAs, and what is the hospital’s responsibility?


Nancy Brent replies:

Dear Jeff,

Unlicensed healthcare workers, such as nursing assistants, have been performing various nursing care tasks for some time. If they are properly trained to do the tasks they are assigned, very few liability problems arise.

However, in addition to being properly trained, unlicensed assistive personnel (UAPs) also must be properly supervised. When working with a UAP or PCA, the RN must be certain to obtain feedback from the PCA regarding the results of the task undertaken (e.g., "What was Mr. X’s blood pressure?") or be certain that the task is done ("Did you take Mr. X's BP? What was it?"). The documentation of the results — in your case the BP — should be done pursuant to your facility's protocol.

If you observe that your PCA is not performing his or her responsibilities properly, or is overstepping his or her responsibilities, it is your duty to inform the PCA's immediate supervisor, again pursuant to facility policy. That person may be the CNO of the ED or the PCA’s supervisor.

You might want to review the concept of delegation and other issues when working with UAPs, generally and in the ED. “The Emergency Nurses Association Position Statement — The Use of Non-Registered (Non-RN) Caregivers In Emergency Care” (2003), is located at www.ena.org?SiteCollectionDocuments/Position%20Statements/Non-RN_Caregivers. “The Five Rights of Delegation” (1997) of the National Council of State Boards of Nursing (www.ncsbn.org/fiverights.pdf) and “Delegation As a Management Function” (2011) found at currentnursing.com/nursing_management/delegation.html, might be helpful. They were all accessed on May 10, 2012.


Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.