Models of care using unlicensed assistive personnel. Part I: Job scope, preparation and utilization patterns.

This article describes the results of a NAON-funded descriptive design research project developed to gather data on how clinical nursing assistants are being used in the practice setting by examining the role responsibilities, extent of delegation, training effectiveness, and evaluation measures designed by agencies to evaluate the effectiveness of this model of care. Fifty-three hospitals from 31 states participated in the investigation, with 53 nurses managers, 620 staff nurses, and 305 nursing assistants responding to questionnaires. The most common role description of clinical nursing assistants was in providing supportive care; however, there was a clear trend toward using clinical assistants to provide care requiring higher levels of observation and technical skill. Deficiencies in the infrastructure to support this model were identified as limited education and training of both assistants and staff nurses, inadequate mechanisms to deal with role confusion and delegation deficits, lack of evaluation systems, and lack of ongoing procedures to assure competency.