The Commonwealth of Massachusetts

Executive Office of Health and Human Services
Department of Public Health
Division of Health Care Quality
10 West Street, 5th Floor, Boston, MA 02111
(617) 753-8000

ARGEO PAUL CELLUCCI
GOVERNOR
WILLIAM D. O’LEARY
SECRETARY
HOWARD K. KOH,M.D.,MPH
COMMISSIONER	

CIRCULAR LETTER: DHCQ-5-98-381

TO:		Acute Care Hospital Administrators and Directors of Nursing Services
FROM:		Paul I. Dreyer, Ph.D., Director; Division of Health Care Quality
DATE:		May 14, 1998
RE:		Unlicensed Assistive Personnel

The Department of Public Health is issuing this circular letter to advise acute care hospitals licensed by DPH on the utilization of Unlicensed Assistive Personnel (UAP).

Nursing care services have been and continue to be essential for the provision of care to patients in the acute care setting.  Many hospitals are examining and reorganizing the utilization of personnel to provide nursing care to patients.  These reorganization efforts are concurrent with the rapidly increasing level of patient acuity.  The personnel category of UAP is a component in many of these reorganization efforts.

In April 1997, the Department of Public Health conducted a survey of the roles of UAP in a small sample of Massachusetts hospitals.  As a follow up to the study, the Department established a Work Group to more fully identify and analyze the utilization of UAP in the provision of nursing care in the acute care setting.  Since the provision of nursing care services in the acute care setting is subject to the regulatory authority of both the Department of Public Health (105 CMR 130.311 et seq.) and the Board of Registration of Nursing (244 CMR 3.00) the Work Group was Co-Chaired by the Director of the Division of Health Care Quality and the Executive Director of the Board of Registration in Nursing.

Members of the Work Group developed the attached Principles for the Appropriate Utilization of UAP in Acute Care Hospitals.

Concurrent with its participation in the Work Group, the Board of Registration in Nursing approved and published the attached advisory to clarify its regulations which define the legal criteria for delegation and supervision by licensed nurses.  This document presents a framework for decision-making and accountability when nurses delegate activities to UAP.

The Department recommends that hospitals adopt each of these attached documents.

If you have any questions regarding this letter, you may contact:

DPH: 	Maureen Foley-Rousseau			BoRN:	Bette Lindberg
	Policy Analyst						Nursing Practice Coordinator
	Division of Health Care Quality				Board of Registration in Nursing
	(617) 753-8178						(617) 727-9960