Unlicensed assistive personnel

Unlicensed assistive personnel (UAP) is a class of paraprofessionals who assist individuals with physical disabilities, mental impairments, and other health care needs with their activities of daily living (ADLs) and provide bedside care—including basic nursing procedures—all under the supervision of a registered nurse, licensed practical nurse or other health care professional. UAPs must demonstrate their abilities and competencies before gaining any expanded responsibilities within the clinical setting.

They provide care for patients in hospitals, residents of nursing facilities, clients in private homes, and others in need of their services due to effects of old age or disability. UAPs, by definition, do not hold a license or other mandatory professional requirements for practice, though many hold various certifications. They are collectively categorized under the group "Personal care workers in health services" in the International Standard Classification of Occupations, 2008 revision.


The nursing assistant, nursing auxiliary, auxiliary nurse, patient care technician, home health aide/assistant, geriatric aide/assistant, psychiatric aide, nurse aide, or nurse tech are all common titles that are considered to be UAPs in many countries.

In the United States, the certified nursing assistant (CNA) typically works in a nursing home or hospital, and performs everyday living tasks for the elderly, chronically sick, or rehabilitation patients who cannot care for themselves. There are some differences in scope of care across UAPs based on title and description. CNAs must become certified based on respective states' requirements. Not all states' requirements are the same. Below is a list of general requirements.[1]

Once the above requirements are completed, the person will then be certified for that respective state. Moving to a different state, however, would require recertification in the new state, unless both states use the NNAAP standard.[2] In this case, the new state would accept previous NNAAP test scores and allow registration. These certification exams are distributed by the state. Classes to study for these exams are provided by the American Red Cross as well as other providers. The courses offered by the American Red Cross encompass all facets that are addressed in the state exams from communication to health terms to sensitivity.[3]

Similar titles in the United Kingdom and elsewhere include healthcare assistant, healthcare support worker, or clinical support worker. These providers usually work in hospitals or community settings under the guidance of a qualified healthcare professional.[4]

A home health aide (HHA) provides in-home care for patients who need assistance with daily living beyond what family or friends are capable of providing. Patients include those who have a physical or mental disability, are recovering from an injury or surgery, have a chronic illness, or are advanced in age. Training requirements to become an HHA are generally minimal and vary depending on the state. HHA training is available from various outlets such as:[5]

Personal support worker is the title for a similar type of health worker in the Province of Ontario in Canada. Some of the responsibilities and duties of a personal support worker include, but are not limited to:[6]

Personal support work is unique among health care professions in that the scope of the PSW's duties does not extend beyond what the client could do him/herself, if the client were physically and cognitively able. No other profession's scope is similarly described.[8]

Surgical technologists are considered UAPs in the US, where they are also sometimes called "Scrub tech". However the title can mean different things in different countries. For example, in Mozambique, surgical technologists are medical professionals trained and registered to perform advanced clinical procedures including emergency surgery.[9]

Birth assistants, such as doulas, childbirth educators and other persons providing emotional support and general care and advice to women and families during pregnancy and childbirth, are also typically considered UAPs. They are distinguished from midwives, physicians, nurses, and other professionals who are trained and licensed to provide basic and emergency pregnancy and childbirth-related health care services and manage complications.

Training and practice

Unlicensed assistive personnel are important members of the health care team who often hold a high level of experience and ability. While they do not require extensive health care training to practice their profession, a high level of manual dexterity and good interpersonal communication skills are usually necessary. They often undergo some formal education, apprenticeship or on-the-job training in areas such as body mechanics, nutrition, anatomy and physiology, cognitive impairments and mental health issues, infection control, personal care skills, and records-keeping.[4][10][11][12] Most community colleges offer CNA training in one semester. However, there are other sources that offer accelerated programs. Many nursing homes will actually pay for their employees to take CNA training on the premise that once completed the student will then work for them.

In the context of aging populations and health care reform, UAPs are in growing demand in many countries.

However, without formal health professional qualifications, UAPs are often unable to perform some tasks due to issues of liability and legality. Attempts to regulate, control, and verify education have been made in some places. This allows an employer to verify experience and knowledge as well as to assist in preventing individuals who have been "struck off" (had registration/certification invalidated) from continuing to work in healthcare roles. For example, in the UK, the credibility of the Healthcare Assistant and other social care workers is intended to be strengthened by their compulsory registration from 2009 with the General Social Care Council in England or its Scottish or Welsh equivalents.

In the United States, families and employers can verify a UAPs certification in accordance with state and local laws by checking with a Family Care Safety Registry (FCSR). A Family Care Safety Registry was established by law to promote family and community safety. The registry helps to protect children, seniors, and the disabled by providing background information on that individual. Families and employers can call the registry's toll-free line by phone, fax or E-mail to request background information on registered child care, elder care, and personal care workers or to request licensure status information on licensed child care and elder care providers at no-cost to the requestor.

In Ontario, Canada in May 2011, the Ministry of Health and Long-Term Care (MOHLTC) announced the creation of a Registry of Personal Support Workers to acknowledge the care they provide daily to some of Ontario's most vulnerable populations, including seniors and people with chronic illnesses and disabilities.[13] On June 1, 2012, the Ontario PSW Registry was officially launched and now has over 23,000 registered PSWs and counting.[14]

In the United Kingdom, The Care Certificate was introduced in April 2015, following the Cavendish Review of April 2013 into standards of care among Healthcare Assistants and Support Workers in the NHS and social care settings.[15] It was produced to address inconsistences in training and competencies in the workforce so that all staff have the same introductory skills, knowledge and behaviours to provide safe, high quality and compassionate care of the highest standards.[15] The Care Certificate was jointly developed by Skills for Health,[16] Health Education England[17] and Skills for Care.[18][19]

Turnover and job stability

Typically, the turnover rate among unlicensed assistive personnel within an organization is very high, which can be detrimental to quality of care of patients and also create negative stress and dissatisfaction among the personnel.[20] Studies exploring the reasons for turnover show that turnover is not simply a matter of higher pay, but can have many factors such as the degree of respect experienced by the unlicensed personnel, scheduling flexibility, commitment and calling to the profession and so forth.[21]

See also


  1. Certified Nursing Exam Board "Requirements to Become a CNA". Accessed 16 March 2014.
  2. National Council of State Boards of Nursing. "NNAAP Testing Standard". Accessed 16 March 2014.
  3. National Certified Nurse Assistant Resource "CNA Resource". Accessed 11 March 2014.
  4. 1 2 National Health Service. NHS Careers in Detail: Healthcare assistants/auxiliary nurses. Accessed 12 April 2011.
  5. Home Health Aide training "How to Get Home Health Aide Training". Accessed 16 March 2014.
  6. Personal Support Worker Canada. PSW Personal Support Worker Information. Accessed 12 April 2011.
  7. "HHA Job Description".
  8. "About PSWs". Personal Support Network of Ontario.
  9. Cumbi A et al. "Major surgery delegation to mid-level health practitioners in Mozambique: health professionals' perceptions." Human Resources for Health; 2007, 5:27 doi:10.1186/1478-4491-5-27
  10. World Health Organization. Classifying health workers: mapping occupations to the international standard classification. Geneva, WHO, 2010.
  11. U.S. Department of Labor, Bureau of Labor Statistics. Occupational Outlook Handbook, 2010-11 Edition – Nursing and Psychiatric Aides. Accessed 12 April 2011.
  12. National Association of Career Colleges. Personal Support Worker. Accessed 12 April 2011.
  13. http://pswregistry.org/Web%20Documents/junk/MOHLTCv20110519.pdf
  14. "About the Ontario PSW Registry". pswregistry.org.
  15. 1 2 "CQC welcomes launch of the Care Certificate from April". cqc.org.uk.
  16. "Skills for Health - Home".
  17. http://hee.nhs.uk/
  18. "Care Certificate".
  19. "The Care Certificate". skillsforhealth.org.uk.
  20. Cohen-Mansfield, Jiska. "Turnover among nursing home staff: A review." Nursing management 28.5 (1997): 59-64.
  21. Kupperschmidt. B.R. (2002). Unlicensed assistive personnel retention and realistic job previews. Nursing Economics, 20, 279-283.

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