Unlicensed Assistive Personnel (UAP), such as Certified Nursing Assistants (CNAs) and Patient Care Technicians, are healthcare workers who provide foundational support to patients under the direction of licensed professionals, like Registered Nurses (RNs). These individuals assist with activities of daily living (ADLs) and routine tasks but do not hold a formal professional license. Whether UAPs can perform blood glucose monitoring (BGM) depends entirely on the legal act of delegation and the specific policies of the care setting.
Defining Unlicensed Assistive Personnel and Blood Glucose Monitoring
Unlicensed Assistive Personnel are trained to function in an assistive role, performing tasks that support patient care and do not require the specialized knowledge or clinical judgment of a licensed nurse. Their titles are varied and include nurse aide, patient care technician, and home health aide, but their core function remains assisting patients with basic care like bathing, feeding, and taking vital signs. They are crucial members of the healthcare team, allowing licensed staff to focus on more complex assessments and interventions.
Blood glucose monitoring (BGM) involves obtaining a small blood sample, typically through a finger stick, and using a glucose meter to determine the patient’s current blood sugar level. This process is essentially a technical, repetitive task that falls under the category of a Clinical Laboratory Improvement Amendments (CLIA)-waived test, meaning it is simple and carries a low risk of incorrect results. When performed by a UAP, BGM is limited to the mechanical action of acquiring the sample and accurately recording the numerical result in the patient’s chart.
The Governing Principle of Delegation
The only mechanism that permits a UAP to perform a clinical task like BGM is the legal process of delegation, which is carried out by a licensed nurse. Delegation involves the transfer of responsibility for the performance of a task from the licensed nurse to another individual while the nurse retains accountability for the outcome. This process is governed by a framework known as the “Five Rights of Delegation,” which ensures patient safety and appropriate use of personnel.
The licensed nurse must ensure the Right Task is delegated to the Right Person, meaning the UAP has the documented training and competence to perform the action safely. The nurse must also consider the Right Circumstance, assessing the patient’s stability and the availability of resources before delegating. Clear communication must provide the Right Direction, and the nurse must provide the Right Supervision and evaluation of the task’s completion. The nurse is required to assess the patient’s status and needs before delegation.
State and Setting Variability
Whether a UAP can perform BGM is highly dependent on the legal scope of practice defined by the State Board of Nursing (BON) and the specific policy of the care setting. The BON in each state outlines the allowed duties that can be delegated to UAPs within that jurisdiction. Some states explicitly permit the delegation of finger sticks for BGM, especially in non-acute or community-based settings like schools or home health.
Even when state regulations permit delegation, the specific facility, such as a hospital or long-term care facility, must have an internal policy that authorizes and details the process for UAPs to perform BGM. This facility policy will often specify required training programs that the UAP must complete, ensuring demonstrated competency in the technique, proper use of the glucometer, and infection control procedures. The UAP must show proficiency in the skill and an understanding of when to report results to the supervising nurse.
School and Community Settings
In settings like schools, a UAP may be designated as trained diabetes care personnel and authorized to perform BGM on students. The delegation is often conditional, requiring the UAP to have successfully completed training modules on blood glucose monitoring. They must also follow a specific, written medical management plan for the student. This layered approach ensures the delegation is appropriate for the individual, the environment, and the complexity of the patient’s condition.
Prohibited Actions Beyond the Finger Stick
While the mechanical task of performing a finger stick and recording the result may be delegated, all subsequent actions requiring clinical judgment remain strictly non-delegable to UAPs. The UAP’s role ends with the accurate documentation of the numerical blood glucose reading. They cannot interpret the result, such as determining if a reading is “too low” or “too high” in the context of the patient’s overall condition.
The UAP is prohibited from making any clinical decisions based on the glucose reading. This includes deciding to retest the patient or notifying the physician directly without first reporting to the licensed nurse. Furthermore, adjusting or administering insulin or any other diabetes medication based on the reading is an act of medication administration that requires a professional license and is not within the UAP scope of practice. The overarching responsibility for assessing the patient’s needs, creating a care plan, and evaluating the outcomes remains solely with the licensed nurse.