Working with Unregulated Care Providers - College of Nurses of ...

Working with Unregulated Care Providers
Anthony Derro, Practice Consultant
Ackeisha Hamilton, Practice Liaison
August 28, 2012
Copyright © College of Nurses of Ontario, 2012.

Purpose
Assist nurses to understand their roles and
responsibilities when working with unregulated care
providers (UCPs)
Note: The slides are an assistive tool for the teleconference. They are not
meant to be used as a stand-alone reference.
2

Learner Objectives
Understand the role of the nurse when:
• teaching,
• delegating to,
• assigning duties to, or
• supervising UCPs
Note: we will respond to dial-in questions from participants at the end of the
teleconference or you may email us at prp@cnomail.org.
3

New UCP Practice Guideline
• Replaces the previous guidelines Working With
Unregulated Care Providers and Utilization of
Unregulated Care Providers (UCPs)
• Content from the two previous guidelines merged into
one guideline
• Some new content added that did not appear in either
of the two previous guidelines
4

Introduction
• The term UCP refers to a paid care provider, family
member or member of the household
• UCPs are not accountable to a regulatory body
• UCPs perform a variety of tasks based on role or
employment
5

Role of the Nurse
A nurse who teaches, delegates to, assigns duties to or
supervises UCPs must:
• know the UCP is competent,
• ensure that the UCP understands their
responsibilities, how to ask for assistance and how to
report outcomes,
• ensure there is an ongoing assessment of client
needs
6

Nurses’ Accountability
• Taking responsibility for decisions and actions
• Taking action when needed
• Ensuring practice is consistent with entry-to-practice
competencies, standards of practice, guidelines and
legislation
7

Controlled Acts Procedures
• Administering Ventolin inhalation to clients
• Administering narcotic injection via subcutaneous or
intramuscular route
Non-Controlled Acts Procedures
• Administering medication via a G-tube
• Administering oral narcotics
8

Controlled Acts Exceptions
• Family member (member of household), e.g., parents,
spouse, brother/sister, etc.
• Paid care provider, e.g., home care agency workers
9

Routine Activity of Living
Is this a routine activity of living
• Administering insulin to a client who was recently
diagnosed with diabetes
• Administering insulin to a client with diabetes whose
blood glucose levels remain relatively unchanged
• A client receiving routine suppository
• A client requiring routine in and out catheterization
10

Is this task appropriate for a UCP
Assess:
• each client’s situation and condition,
• the activity and associated risk, and
• the environmental supports
11

Teaching
Teaching involves providing instruction and determining
that the UCP is competent to perform a procedure.
12

Delegation
Delegation is the transfer of authority from a person who
is authorized to perform a controlled act procedure to a
person who is not otherwise authorized to perform the
procedure.
13

Teaching
14

Delegation
15

Conditions for Teaching/Delegating
1. Nurse has the competence to perform
2. Nurse has additional competence to teach/delegate
3. Nurse accepts accountability for decision to
teach/delegate
4. Nurse has determined that the UCP has competence
5. Nurse may teach for more than one client, but
delegation is client-specific
6. Nurse evaluates continuing competence of UCP or
reasonably believes that mechanism is in in place to
monitor competence
16

Assigning
• Allocating responsibility for providing care
• Includes procedure that may or may not be a
controlled act
17

Supervising
• Monitoring and directing performance of specific
activities for a defined time period
• May be direct or indirect
18

Examples
• Nurses who work with UCPs but are not responsible
for teaching, delegating, assigning or supervising
• Working with physician assistants (PAs)
• Ensuring that a mechanism is in place to determine
continuing competence of the UCP (when delegating)
19

More Examples
• A nurse who is expected to delegate but does not
believe that delegation is appropriate
• A delegating nurse leaves the place of employment
• Documentation of care provided by UCPs
20

Resources: Standards and Guidelines
• Working With Unregulated Care Providers
• Authorizing Mechanisms
• Decisions About Procedures and Authority, Revised
2006
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Other Resources
• The Standard (Quiz, “You Asked Us” and feature
articles)
• CNO website: www.cno.org (“Ask Practice” section at:
www.cno.org/askpractice
• Outreach Consultants: www.cno.org/outreach
• Practice line, email: prp@cnomail.org phone: 1-800-
387-5526, ext. 6397
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Teleconference Feedback Form
Thank you for participating in the “Working with Unregulated Care Providers” teleconference on August 28, 2012. Please take a
few minutes to complete this survey. Your feedback is appreciated and will help us improve our process!
You can also complete this form online at http://www.cno.org/en/learn-about-standards-guidelines/educationaltools/teleconferences/working-with-unregulated-care-providers/
1. Usefulness of teleconference to
your nursing practice:
Please explain your answer:
Very
Useful
Useful Not very Useful Not at all Useful
2. Overall satisfaction with
speakers:
Please explain your answer:
Very
Satisfied
Satisfied Dissatisfied Very Dissatisfied
3. Satisfaction with
speakers’:
a) clarity
b) understanding
of the topic
c) responses to
questions
Very
Satisfied Satisfied Dissatisfied
Very
Dissatisfied
Please explain your answer
4. As a result of this teleconference, do you have a better understanding of:
a) The changes to the Working With
Unregulated Care Providers practice
guideline
b) The accountabilities of nurses
who teach, delegate to, assign duties
to or supervise UCPs
c) The difference between teaching
and delegating and when each is
required
d) The application of the Working
With Unregulated Care Providers
practice guideline to your practice
5. Other comments:
Yes No Unsure Please explain your answer
6. Your nursing category:
RN
RPN
NP
Non-nursing
(specify):
7. Your health care sector:
Academia
Acute Care
Community & Public Health
LTC & Rehabilitation
Mental Health & Corrections
Paediatrics
Palliative
Other:
8. Your role in your organization:
Staff Nurse
Nurse Practitioner
Manager
Administration
Clinical Educator
Clinical Nurse Specialist
Other:
Thank you for your feedback.
Please fax the completed form to 416 928-9643 (attn: Denise Hastings) by September 10, 2012