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From Silence to Voice

The book From Silence to Voice encourages nurses to end their “silence” and establish a new consciousness about the nursing profession. It inculcates a new-found pride, appreciation and confidence to the nursing profession and suggests a revolutionary way for nurses to present themselves to the world. It promotes a new level of understanding of the nurses’ dedication and contribution to the healthcare industry. The book is an eye-opener for everyone, but most of all to the nurses who had silently dedicated their lives to the profession.

Nurses comprise a big portion of practitioners in the healthcare industry but they do not have the voice beyond the realms of their agency. They do their job in quiet dedication that is often overlooked and taken for granted. The relevance of From Silence to Voice is not just to alter the way people look at nurses but more importantly, to change the way nurses look at themselves. Use of Unlicensed Assistive Personnel The use of Unlicensed Assistive Personnel (UAP) has been practiced for years. In nursing settings, use of UAPs is regulated with guidelines imposed by the State.

However, introduction and proliferation of new models of care delivery systems using unlicensed practitioners raised new controversies about the issue. The increasing use of UAPs in both nursing practice and other purposes presents a threat not only to the patient’s protection but also to the integrity of the nursing profession. Use of Unlicensed Assistive Personnel (UAP) According to the Board of Registered Nursing (n. d. ), the term “unlicensed assistive personnel” refers to those health care workers who are not licensed to perform nursing tasks.

The increasing demand for nurses and the low supply of professionals prompted the use of UAPs. Tasks and activities that are not exclusively nursing functions are assigned to assistive personnel. This arrangement “enables the professional nurse to fulfill responsibilities and duties exclusive and inclusive to the practice of nursing” (New York State Nurses Association, 1989). To ensure the protection of the patients, use of UAPs follows strict guidelines imposed by the State. The Board of Registered Nursing (n.

d. ) has as its primary focus consumer protection and believes that the registered professional nurse bears responsibility for all the activities involving professional expertise. In their position statement, they defined the different functions which can be delegated to UAPs, qualifications, training and competencies of UAPs and the kind of clients or patients for whom tasks may or may not be assigned. The Veterans Health Administration (2006) also issued a directive on the discretionary use of UAPs.

The directive outlines qualifications of a UAP who can be allowed in medical administration and suggests strict guidelines to be followed prior to the delegation. The directive pointed out the role of the Medical Director and the Nurse Executive in delegating and supervising tasks to UAPs. In the National Council for Nursing (1998), the widespread use of UAPs in Indian Health Service was highlighted. The paper offered recommendations for proper practice that includes relevant training and education, strict management and avenue for monitoring and evaluation.

Controversies The New York State Nurses Association (1989) observed that in recent years, unlicensed personnel have been used as substitutes for professional nurses rather than in their appropriate assistive roles under professional supervision. In the past three years, the institution of health care delivery systems that employ unlicensed practitioners and the desire of institutions to downsize and reduce expenditures posed a threat to the safety of healthcare practice.

According to the New York State Nurses Association (1989), “inappropriate utilization of unlicensed assistive personnel to perform professional nursing responsibilities is illegal, impedes quality of care and places patients and practitioners in positions of potential jeopardy. ” Since 1975, the New York State Nurses Association has sponsored legislation known as the Exempt Clause Repeal Bill. This aims to stop unlicensed personnel to practice professional nursing tasks. The State and Board of Professionals have strict guidelines on the delegation of task and utilization of UAPs.

These directives ensure that patients’ safety and right for professional service remains the main goal of healthcare industry. Action Plan The inappropriate use of UAP has adverse effects on the safety of the patients. Moreover, the blurring line between professional and non-professional practice presents a threat to the integrity of the nursing profession. To address this concern, nurses should evaluate the current practices about UAP delegation and observe strict implementation of the guidelines provided by the State.

Likewise, the State and the Board should look at other institutions in the healthcare industry and evaluate the qualifications and tasks performed by the practitioners and make sure that they follow the guidelines of the state. The present directives should be evaluated for their appropriateness and applicability in relation to these new trends. Nurses have the duty to raise awareness and to make sure these concerns are addressed by the proper authorities. Conclusion The limited number of nurses and the increasing demand for their services makes the use of UAP necessary.

However, proper adherence to the guidelines imposed by the state regarding task delegation to UAPs and supervision by professionals should be observed to ensure the safety of the patients and maintain the integrity of the nursing profession. References Board of Registered Nursing, California (n. d. ). Unlicensed Assistive Personnel. Department of Consumer Affairs. Retrieved 31 July 2009, from http://www. rn. ca. gov/pdfs/regulations/npr-b-16. pdf Buresh, B. & Gordon, S. (2009). From Silence to Voice: What Nurses Know and Must Communicate to the Public, 2nd ed. LOCATION: PUBLISHER. Indian Health Service (1998).

Use of Unlicensed Assistive Personnel. National Council of Nursing. New York State Nurses Association (1989). Registered Professional Nursing’s Utilization of Unlicensed Assistive Personnel. Retrieved 31 July 2009, from http://www. nysna. org/practice/positions/position1_04. htm. “Unlicensed Personnel Issues” (2001, August 1). Nurse Practitioners, Vol. 9, Iss. 8, p. 29. Veterans Health Administration (2006, September 12). Limitations on the Use of Unlicensed Assistive Personnel in Administering Medication. Retrieved 31 July 2009, from http://www. rn. ca. gov/pdfs/regulations/npr-b-16. pdf. \

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