May 2006, Volume
33, Number 3
Oncology Nursing Society Position
The Use of Unlicensed Assistive Personnel
in Cancer Care
Oncology Nursing Society (ONS) supports the collaborative role of RNs with
members of multidisciplinary healthcare teams in the provision of quality
cancer care in diverse care sites. ONS recognizes that assistive personnel can
make significant contributions to cancer care delivery systems. The term assistive
personnel applies to an unlicensed individual who
is trained to function in an assistive role to the licensed nurse. Assistive
personnel may provide indirect and/or direct services as delegated by RNs. ONS
supports the American Nurses Association ([ANA], 2001) Code of Ethics of
Nurses With Interpretative Statements, which stated that RNs take
responsibility and accountability for individual nursing practice and determine
that appropriate delegation of tasks is consistent with nursesí obligation to
provide optimum patient care. In addition, the control and monitoring of
assistive personnel in clinical settings should be performed through the use of
existing mechanisms that regulate nursing practice (ANA, 2005).
ONS supports a multidisciplinary approach to achieve quality cancer care (ONS,
2006), professional licensure, regulation of nursing practice, oncology
practice standards, and patient care outcomes should be the criteria for making
staffing assignments. These issues, in addition to provider mix, care delivery
systems that ensure optimal clinical outcomes for patients with cancer, and
cost-effective interventions, require additional research.
It Is the Position of ONS That
- RNs must practice with a clear
definition of what constitutes their scope of practice across the care
- RNs must use professional
judgment to determine assignments and delegate based on the needs and
condition of patients, potential for harm, stability of patientsí
conditions, complexity of the task or tasks, predictability of outcomes,
and abilities of the staff.
- Any nursing intervention that
requires independent and specialized nursing knowledge, skill, or judgment
cannot be delegated to unlicensed assistive personnel.
- The repetitive performance of a
common task or procedure that does not require the professional judgment
of an RN may be delegated to unlicensed assistive personnel.
- Characteristics of tasks that
may be delegated include those that
- Recur frequently in the daily
care of a patient or group of patients
- Are performed according to an
established sequence of steps
- Involve little or no
modification from one patient care situation to another
- Are performed with a
- Lack inherent involvement of
ongoing assessment, interpretation, or decision making that cannot be
logically separated from the procedure itself
- Are determined by state
- RNs should retain
accountability for nursing practice, including
- Verifying competency of
unlicensed assistive personnel before delegating tasks
- Ongoing patient assessment
- Ongoing supervision of unlicensed
- Evaluation of patient response
- Interpretation and decision
making regarding patient care.
and Legislative Issues
- Professional guidelines must be
established to support RNs in working effectively and collaboratively with
other members of the healthcare team, including, but not limited to, state
boards of nursing, institutional policies, and external agency standards.
- Nursing needs to collaborate
with state agencies and professional associations to identify and
standardize core competencies for unlicensed assistive personnel.
American Nurses Association. (2001). Code of ethics of
nurses with interpretive statements. Washington,
American Nurses Association. (2005). Position statement:
Registered nurse utilization of unlicensed assistive personnel. Washington, DC:
Oncology Nursing Society. (2005). Quality cancer care [Position
by the ONS Board of Directors 2/97; revised 10/00, 9/02, 10/05.
obtain copies of this or any ONS position, contact the Customer Service
Center at the ONS
National Office at 125 Enterprise
Drive, Pittsburgh, PA 15275-1214
(866-257-4ONS; firstname.lastname@example.org). Positions also may be downloaded from
the ONS Web site (www.ons.org).