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As a result of major changes in health care delivery and financing over the past decade, unlicensed assistive personnel (UAP) are being increasingly used in the health care arena to perform tasks beyond their education and training, placing patients at risk. ANA has defined UAP as "individuals who are trained to function in an assistive role to the registered professional nurse in the provision of patient/client care activities as delegated by and under the supervision of the registered professional nurse." In 1997, ANA monitored 24 bills addressing UAP. By 1998, the number of bills had increased to 30, in 18 states. AZ passed legislation to define a medical assistant as someone who assists in a medical practice under the supervision of a nurse practitioner or physician assistant. Inappropriate supervision was added to the nurse practice act under unprofessional conduct for enforcement purposes. VA amended the nurse practice act to require the BON to determine what nursing tasks could be executed by a UAP under the direct supervision of an RN. AK required the BON to adopt regulations on the education and training of certified nurse aides. MD also required the BON to certify nursing assistants, and medical aides and assistants. OK amended its Home Care Act to provide for registration and certification of home health aides and to provide for an exception if the aide is under continuous training of an RN. CO extended its sunset provision to continue the authority of the Dept. of Public Health to regulate UAP in the administration and monitoring of medications. SD repealed its medication aide provision, while WA state established a definition of medical assistants in community-based settings. In 1999 29 legislative and regulatory changes were proposed in 19 states; 16 were enacted. In AZ, the BON was given the authority to issue nurse assistant certification and to impose disciplinary measures. CA prohibited hospitals from assigning UAP to perform nursing functions (including medication administration) in lieu of an RN. CA also will convene a work group to develop training programs for nurse assistants. CT will adopt regulations for certification of UAP in nursing homes, and IL will allow nursing home UAP to provide hygiene and feeding. Also in IL: required new training programs for those who supervise direct care staff in programs for the developmentally disabled when administering oral/topical medications. MN rules allow RNs to delegate to UAP insulin injections. MT added unlicensed practioners to the list of persons subject to criminal prosecution. NJ rules require UAP education and competency evaluations by nursing staff. ND allows licensed nurses a 2-year waiver to delegate medication administration in centers for the developmentally disabled. OK broadened physician supervision by adding the services of unlicensed physician's assistants. VA passed laws relative to administration of insulin in schools. Not enacted: a NJ bill would mandate additional training for RNs in the supervision and delegation of nursing tasks to UAP to be included in the nursing school curricula. OH would allow the BON or Attorney General to apply for an order to enjoin unauthorized practice. OR would require the BON to promulgate rules on the training and education of nursing assistants for medication administration. WA would allow RNs to delegate tasks in community-based settings to registered or certified nurse assistants.

ANA Position Statements on Unlicensed Assistive Personnel

1999 State Legislative Trends main page