Maximizing Nursing Satisfaction With Skill Mix On A Pediatric Step Down ICU By Standardizing ACT Competencies.

Purpose:
RNs expressed a desire to increase UAP accountablity for delegated tasks. Analysis of NDNQI skill mix data confirmed UAP usage was above the mean and delegation of tasks was expected. The purpose of this initiative was to standardize UAP competencies and improve RN satisfaction with delegation.

Significance:
Skill mix is a National Quality Forum endorsed standard that impacts patient outcomes. Delegation of nursing care to a UAP is an acceptable strategy for maximizing staffing on nursing units. Variation in professional background, knowledge, & expertise of the UAP can impede RN delegation.

Strategy and Implementation:
A collaborative practice team was developed among the UAPs, RNs and Unit Educators. Using the nurse practice acts and the human resources job description for the UAP, a guideline was developed to serve as the framework for delegation of tasks. A skill fair for education and re-assessment of UAP competencies was held. The structure of accountablity for delegated care was re-designed. Each UAP now receives an assignment for particular group of patients and is responsible to coordinate care with the RN instead of from UAP to UAP at shift change. The collaborative structure promotes accountablity between the UAP and RN. RNs were educated to the guidelines for delegation and expectations for collaboration with UAP throughout the shift.

Evaluation:
RN satisfaction with the UAP role increased by 62%. RN improvement in ability to delegate increasd by 81% and UAP staisfaction in thier role was unchanged.

Implications for Practice:
Nursing care on can safely be delegated to UAPs. RNs must be knowledgable of the skill level and competency of those to whom they delegate. The development of a UAP skill guideline and core competencies can ensure that accoutabitly for delegated tasks is clear and patient safety is assurred.