licensed professional nurses with unlicensed assistive personnel (UAP). In doing so, many patient-care functions and tasks normally performed by licensed providers have been transferred to the unlicensed personnel (Huston, 1996).
The introduction of unlicensed personnel is apparent in the dialysis centers. In this environment the balance of licensed and unlicensed employees shifts to favor the unlicensed. The replacement of nurses trained to care for patients with technicians trained to perform the dialysis procedures lowers the level of clinical training and skill of the personnel who deal directly with patients. The two most frequently reported consequences of excessive reliance on Unlicensed Assistive Personnel (UAP) are negative patient outcomes and reduced treatment duration, and both are occurring because of cost pressures on dialysis clinics (Held et al, 1990; Levinsky & Rettig, 1991; Josefson, 1999).
Dunetz & Paret (1996) report that, under pressure, licensed personnel are frequently used to improve the training of unlicensed personnel. Nephrology nurses can play an important role in providing a high quality care for hemodialysis patients. The role of the Patient Care Technician is defined as a person who, under supervision, performs safe, effective, and adequate hemodialysis treatments (NKF: Renal Career Fact Sheet, 1999). A Delphi Study on the research priorities for nephrology nurses for the year 2000 reported that levels of nursing competence and the effect on patient outcome and validation of nursing interventions to achieve patient outcomes were high priorities (Bonner, Cooper, Frauman, Lewis & Parker, 1996).
Be this as it may, there is such a shortage of nephrology nurses that it may ultimately mean rethinking the way non-licensed personnel are used, and may in fact require expanded roles for them (Robbins, 1999). Vogel (1999) reports there is an increased use of permanent catheters (tunneled cuffe...