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Working with Unregulated Care Providers
Unregulated care providers (UCPs) are members of the health care team in many practice settings. As the health care system changes, nurses are increasingly working with UCPs in new ways. Nurses may be expected to teach, supervise or assign activities or procedures to UCPs. Learning to work collaboratively as a team and understanding each other’s roles is essential to providing safe client care and the overall functioning of the health care team.
Who are UCPs?
UCPs are care providers who are not regulated under the Regulated Health Professions Act, 1991 nor licensed by a regulatory health college. They have no legally defined scope of practice.
UCPs include, but are not limited to:
- Personal Support Worker (PSW)
- Healthcare, Home Support, or Personal Aide
- Physician Assistant
- Clinical Extern
*The titles of UCPs may vary depending on employer.
Who are UCPs accountable to?
UCPs are accountable to their employers, not CNO. It is up to employers to determine the scope of the UCP role, their responsibilities and any role requirements (including training or education). Employer policies, as well as sector-specific legislation (for example, the Public Hospitals Act), may outline whether UCPs can perform particular activities and procedures. If you have questions about the accountabilities of the UCP, you are encouraged to discuss them with your employer.
How can I work effectively with a UCP?
CNO’s Code of Conduct outlines that nurses are expected to work with colleagues to best meet client needs. This includes both regulated and unregulated health care providers.
When working with UCPs, nurses must ensure they assess clients’ needs carefully to contribute to and implement safe and effective care plans.
Good communication is also a key aspect to safe client care. It is important that both nurses and UCPs are aware of their accountabilities and communicate with each other to ensure patient care is provided safely and in a timely fashion. This may involve collaborating with your employer to understand the roles and responsibilities they have developed for the UCP.
Do UCPs work under my certificate of registration?
UCPs do not work under another health care professional’s registration. Nurses are responsible for their own actions and the consequences of their actions, but they are not accountable for the decisions or actions of other care providers, including UCP’s.
If a nurse is concerned about a UCP’s knowledge, skill, or judgement to perform a certain task, they will need to work with the UCP and notify the manager and employer that the UCP reports to.
I am working with UCPs in my practice setting. The UCPs have their own set of responsibilities, am I responsible for supervising their daily tasks?
UCPs have a set of responsibilities and/or daily tasks set out by your employer. As a nurse, you are not accountable for supervising the UCP in their daily tasks unless your employer requires you to do so, or you ask a UCP to help you with your assigned nursing tasks.
If you assign a task to a UCP, you are accountable for:
- assessing the client’s condition, the environment and any associated risks involved with the activity or procedure
- ensuring the UCP has the competence to perform the task
- supervising or teaching the UCP, if it is their first time performing the task,
- and following up with the UCP once the task is performed.
While nurses are not required to supervise UCPs’ daily tasks, communication between nurses and UCPs is extremely important to maintaining a comprehensive view of the client’s health status and care plan. If there are client specific tasks assigned to a UCP, the client’s nurse and the UCP must work together to ensure each are up to date with the client’s needs and care.
What is the difference between assigning, supervising and delegating to UCPs?
Assigning is the act of determining and allocating responsibility for particular aspects of care (typically a range of care needs, rather than specific procedures) to another individual. This may or may not include controlled acts.
Any nurse with the knowledge, skill and judgement may assign care to UCPs, however this may be dependent on employer policies.
Supervising involves the monitoring and directing of specific activities and procedures UCPs perform. It does not include ongoing managerial responsibilities.
Often, the nurse who assigns a task also supervises the performance of the task. Supervision can be direct (where the nurse is physically present) or indirect (when a UCP reports back to the nurse through regular check ins).
Delegating occurs when a regulated health professional who is legally authorized and competent to perform a controlled act grants their authority to perform that act to another individual. A number of requirements need to be met to ensure the delegated activity is performed safely, one of which is confirming the delegatee has the knowledge, skill and judgment.
Nurses can only delegate controlled acts that they are competent to perform.
Can UCPs call themselves nurses?
No. In Ontario, only individuals registered with CNO can use the titles “Nurse,” “Nurse Practitioner,” “Registered Nurse” and “Registered Practical Nurse.” This includes any variation or abbreviation of these titles or equivalent titles in other languages. Anyone calling themselves a nurse without being registered with CNO is considered an illegal practitioner and can be prosecuted under the Nursing Act, 1991 and the Regulated Health Professions Act, 1991.
