Caught in the cross fire of change: nursesʹ experience with unlicensed assistive personnel

Under tremendous pressure to contain costs, most U.S. hospitals are radically altering the composition and skill mix of their staff, thinning their skilled registered nurse (RN) ranks, and often substituting them with minimally trained, lower paid, unlicensed assistive personnel (UAP). Twelve staff nurses were interviewed to illuminate the experience of working with UAP, who function largely in untested, expanded roles. Only two nurses viewed this experience positively; the rest were either opposed to or had strong reservations about UAP use. Confusion and emotional turmoil predominated as these nurses struggled to maintain safe, comprehensive care with the assistance of UAP who were often ambivalent and sometimes dangerously inept.