Comparison of basic and specialized care between nursing assistants and professional nurses
DOI:
https://doi.org/10.15649/cuidarte.5555Keywords:
Delegation, Professional, Nursing Care, Nurse’s Role, Nursing Assistants, Nurses, Professional TrainingAbstract
Highlights
- Basic and specialized nursing care fall within the competence of professional nurses; delegating them affects the role and identity of the nursing discipline within the healthcare system and society.
- Care recipients require a comprehensive approach that fosters autonomy and promotes well-being.
- Inadequate staffing of professional nurses leads to task delegation, with various repercussions.
- Although professional nurses may delegate tasks, they remain accountable for their execution and are not exempt from responsibility.
Introduction: Professional nurses are trained to provide direct care; however, in hospital settings, they delegate tasks to nursing assistants, which can lead to adverse events and patient dissatisfaction. Objective: To analyze basic and specialized nursing care activities, classifying them according to the scope of competence and level of criticality. Materials and Methods: This cross-sectional observational study was conducted between June 2021 and January 2022 and included 141 professional nurses and 259 nursing assistants from a university hospital in Bogotá. A structured questionnaire was used to record the activities performed by both roles, along with their frequency and execution time. Expert consensus was established regarding the set of nursing care activities, their alignment with each role’s scope of practice, and the classification of critical activities representing a risk when delegated. Descriptive analysis identified who performed each activity, along with its frequency and execution time. Bivariate analysis assessed differences between the activities performed. Results: A total of 40 basic nursing activities and 17 specialized nursing activities were identified, of which 18 were classified as critical. Significant differences were observed between nursing assistants and professional nurses in the performance and frequency of activities, including neurological assessment, pain management, and medication monitoring. Discussion: The delegation of critical activities to nursing assistants, driven by the multiplicity of administrative and care-related tasks and by inadequate staffing of professional nurses, highlights the need to examine the negative consequences for patients. Conclusion: At the hospital evaluated, nursing assistants perform activities that, given the required level of competence and the risks involved, should be carried out by professional nurses.
How to cite this article: Espinosa Aranzales Ángela Fernanda, Tibaquirá Torres Sandra Milena, Martínez Del Valle Anacaona, Casallas Murillo Ana Lucía, Patiño Quintero Adriana del Pilar. Comparison of basic and specialized care between nursing assistants and professional nurses. Revista Cuidarte. 2026;17(2):e5555. https://doi.org/10.15649/cuidarte.5555
References
Li Y, Liu S, Cai Y, Cun W, Zhang X, Jiang Y. Effectiveness of nursing interventions on patient experiences with health care: A systematic review and meta-analysis. Int Nurs Rev. 2025;72(3):e13075. http://dx.doi.org/10.1111/inr.13075
Burton E. Defensa e influencia de la enfermería en la política de salud global. Consejo Internacional de Enfermeras; 2023 sep. (76a Asamblea Mundial de la Salud Informe del CIE). Report No.: AMS76. Consulta: Marzo 18, 2025 Disponible en: https://www.icn.ch/es/recursos/publicaciones-e-informes/informe-ams76-defensa-e-influencia-de-la-enfermeria-en-la
Crevacore C, Coventry L, Duffield C, Jacob E. Factors impacting nursing assistants to accept a delegation in the acute care settings: A mixed method study. J Clin Nurs 33(6):2153-2164. http://dx.doi.org/10.1111/jocn.17127
American Nurses Association. Code of Ethics for Nurses. [Internet] 2025 [cited 2025 Mar 18]. Available from: https://codeofethics.ana.org/home
Moradi T, Rezaei M, Alavi NM. Delegating care as a double-edged sword for quality of nursing care: a qualitative study. BMC Health Serv Res. 2024;24:592 https://doi.org/10.1186/s12913-024-11054-4
Anthony M, Vidal K. Mindful communication: A novel approach to improving delegation and increasing patient safety. Online J Issues Nurs. 2010;15(2). https://doi.org/10.3912/OJIN.Vol15No2Man02
Wit RF, de Veer AJE, de Groot K, Batenburg RS, Francke AL. Task shifting in Dutch nursing practice: A repeated cross-sectional analysis of nurses’ experiences. J Adv Nurs. 2024;80(11):4593-4602. https://doi.org/10.1111/jan.16173
Yankam BM, Adeagbo O, Amu H, Dowou RK, Nyamen BGM, Ubechu SC, et al. Task shifting and task sharing in the health sector in sub-Saharan Africa: evidence, success indicators, challenges, and opportunities. Pan Afr Med J. 2023;46(11). https://doi.org/10.11604/pamj.2023.46.11.40984
National Council of State Boards of Nursing [NCSBN], American Nurses Association [ANA]. National Guidelines for Nursing Delegation [Internet]. 2019 [cited 2025 Mar 18]. Available from: https://www.ncsbn.org/public-files/NGND-PosPaper_06.pdf
British Columbia College of Nurses and Midwives (BCCNM). Delegation to Unregulated Care Providers: Practice Guidance [Internet]. Vancouver (BC): BCCNM.
Accreditation Commission for Education in Nursing (ACEN). 2023 Accreditation Manual for Nursing Education Programs [Internet] 2023 [cited 2025 Nov 5]. Available from: https://www.acenursing.org/accreditation/accred-manual/accreditation-manual
Canadian Council for Practical Nurse Regulators (CCPNR). Become a LPN/RPN – Minimum requirements for licensure [Internet]. Ottawa: CCPNR.
Conselho Federal de Enfermagem (COFEN). Resolução COFEN nº 564/2017: Aprova o novo Código de Ética dos Profissionais de Enfermagem. 2017. Consulta: Novembro 5, 2025. Disponível em: https://www.cofen.gov.br/resolucao-cofen-no-5642017/
Congreso de la República de Colombia. Ley 911 de 2004 (octubre 5): Por la cual se dictan disposiciones en materia de responsabilidad deontológica para el ejercicio de la profesión de enfermería en Colombia; se establece el régimen disciplinario correspondiente y se dictan otras disposiciones. Diario Oficial No. 45.693. Consulta: Marzo 24, 2025. Disponible en: https://www.mineducacion.gov.co/1759/articles-105034_archivo_pdf.pdf
Congreso de la República de Colombia. Ley 266 de 1996 Por la cual se reglamenta la profesión de enfermería en Colombia y se dictan otras disposiciones. Diario Oficial No. 42.710. Consulta: Marzo 24, 2026. Disponible en:https://www.mineducacion.gov.co/1759/articles-105002_archivo_pdf.pdf
Ministerio de Salud y Protección Social. Resolución 755 de 2022 (12 de mayo). Por la cual se adoptan la “Política Nacional de Talento Humano de Enfermería y el Plan Estratégico 2022–2031” para el fortalecimiento del talento humano en salud. Bogotá D.C. Colombia. Consulta: Marzo 24, 2025. Disponible en: https://www.suin-juriscol.gov.co/viewDocument.asp?id=30044300
Ministerio de Salud y Protección Social, Academia Nacional de Medicina. Perfiles y competencias profesionales en salud: perspectiva de las profesiones, un aporte al cuidado de la salud, las personas, familias y comunidades. Minsalud; 2016. Consulta: Marzo 18, 2025. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/TH/Perfiles-profesionales-salud.pdf
Ministerio de Protección Social. Perfiles ocupacionales y competencias laborales para auxiliares en salud. Bogotá D.C. Ministerio de Educación Nacional; 2004. Consulta: Noviembre 5, 2025. Disponible en: https://www.mineducacion.gov.co/1780/articles-237704_recurso_5.pdf
Ministerio de la Protección Social. Perfiles ocupacionales y normas de competencia laboral para auxiliares en las áreas de la salud. Programa de Apoyo a la Reforma de Salud PARS. PARS; 2005. Consulta: Marzo 18, 2025.
Ministerio de la Protección Social Colombia. Decreto 3616 de 2005 (octubre 10): Por el cual se establecen las denominaciones de auxiliares en las diferentes áreas del área de la salud, sus perfiles ocupacionales y competencias. Diario Oficial No. 46.059. Consulta: Marzo 24, 2025. Disponible en: https://www.minsalud.gov.co/Normatividad_Nuevo/DECRETO%203616%20DE%202005.PDF
Alfonso M. Proyecto de Ley 024 de 2024: “Por medio de la cual se expide el Código Deontológico de la profesión de Enfermería, se deroga la Ley 911 de 2004 y se dictan otras disposiciones”. Bogotá: Senado de la República; 2024. Consulta: Marzo 24, 2025. Disponible en: https://scare.org.co/wp-content/uploads/PL-024-24-CODIGO-DEONTOLOGICA-DEENFERMERIA.pdf
Ortega M, Jiménez A. Situación actual de enfermería en Colombia una reflexión. Revista cuidado y ocupación humana. 2020;9(1) https://ojs.unipamplona.edu.co/index.php/coh/article/view/894/862
El Espectador. Falta de enfermeros profesionales en Colombia pone en riesgo a los pacientes. Bogotá: El Espectador; 2014 abr 27. Consulta: Nov 4, 2025. Disponible en: https://www.elespectador.com/salud/falta-de-enfermeros-profesionales-en-colombia-pone-en-riesgo-a-los-pacientes-article-482029/
Adamuz J, González-Samartino M, Jiménez-Martínez E, Tapia-Pérez M, López-Jiménez M-M, Valero-Valdelvira P, et al. Impact of nurse staffing coverage and care complexity factors on health outcomes in hospitalized COVID-19 patients: a cross-sectional study. BMC Nurs. 2025;24:520 https://doi.org/10.1186/s12912-025-03142-5
Papathanasiou I, Tzenetidis V, Tsaras K, Zyga S, Malliarou M. Missed Nursing Care; Prioritizing the Patient’s Needs: a review of reviews. Healthcare. 2024;12(2):224. https://pubmed.ncbi.nlm.nih.gov/38255111/
Arias Barrera KP, Niño Cardozo CL, Sanjuanelo Corredor DW. Carga mental en enfermeros(as) que laboran en diferentes unidades de un hospital de Bogotá, Colombia. Rev Cubana Enfermer. 2018;34(1) https://www.medigraphic.com/pdfs/revcubenf/cnf-2018/cnf181a.pdf
Bridges J, Griffiths P, Oliver E, Pickering RM. Hospital nurse staffing and staff–patient interactions: an observational study. BMJ Qual Saf. 2019;28(9):706-713. https://doi.org/10.1136/bmjqs-2018-008948
Departamento Administrativo Nacional de Estadística. Clasificación Única de Ocupaciones para Colombia CUOC 2025. Bogotá. p. 296,1117. Consulta: Marzo 24, 2025. Disponible en: https://www.dane.gov.co/files/sen/nomenclatura/cuoc/documento-clasificacion-unica-ocupaciones-colombia-CUOC-2025.pdf
International Council of Nurses (ICN). Current nursing definitions. Geneva: ICN. [Internet] 2025 [cited 2025 March 24]. Available from: https://www.icn.ch/resources/nursingdefinitions/current-nursing-definitions
Wagner CM, Butcher HK, Bulechek GM, Dochterman JM, Clarke MF, editors. Nursing Interventions Classification (NIC). 8th ed. St. Louis (MO): Elsevier; 2024.
Arrogante O. Sampling techniques and sample size calculation: How and how many participants should I select for my research? Enferm Intensiva. 2022;33(1):44-47. https://doi.org/10.1016/j.enfie.2021.03.004
Duffield C, Gardner G, Doubrovsky A, Wise S. Manager, clinician or both? Nurse managers’ engagement in clinical care activities. J Nurs Manag. 2019;27(7):1538-1545. https://doi.org/10.1111/jonm.12841
Espinosa A. Dataset_Cuidado básico y especializado de enfermería en un hospital universitario en Bogotá: correspondencia según formación. Mendeley Data V1, https://doi.org/10.17632/gf63vz9r24.1
Maghsoud F, Rezaei M, Asgarian FS, Rassouli M. Workload and quality of nursing care: the mediating role of implicit rationing of nursing care, job satisfaction and emotional exhaustion by using structural equations modeling approach. BMC Nurs. 2022;21:273. https://doi.org/10.1186/s12912-022-01055-1
Wilson NJ, Pracilio A, Morphet J, Kersten M, Buckley T, Trollor J, et al. A scoping review of registered nurses’ delegating care and support to unlicensed care and support workers. J Clin Nurs. 2023;32(17-18):6000-6011. https://pubmed.ncbi.nlm.nih.gov/37149737/
Shore CB, Maben J, Mold F, Winkley K, Cook A, Stenner K. Delegation of medication administration from registered nurses to non-registered support workers in community care settings: A systematic review with critical interpretive synthesis. Int J Nurs Stud. 2022;126:104121. https://pubmed.ncbi.nlm.nih.gov/34896760/
Stalpers D, Schoonhoven L, Dall’Ora C, Ball J, Griffiths P. “Entanglement of nursing care”: A theoretical proposition to understand the complexity of nursing work and division of labour Int J Nurs Stud. 2025;163:104995. https://doi.org/10.1016/j.ijnurstu.2025.104995
Kagonya VA, Onyango OO, Maina M, Gathara D, English M, Imam A. Characterising support and care assistants in formal hospital settings: a scoping review. Hum Resour Health. 2023;21:90. https://doi.org/10.1186/s12960-023-00877-7
Fitzgerald L, Gathara D, McKnight J, Nzinga J, English M. Are health care assistants part of the long-term solution to the nursing workforce deficit in Kenya? Hum Resour Health. 2020;18:79. https://doi.org/10.1186/s12960-020-00523-6
Achury Saldaña DM, Achury Beltrán LF, Rodríguez Colmenares SM, Alvarado Romero HR, Cavallo E, Ulloa AC, et al. Professional profile and work conditions of nurses working in intensive care units: A multicentre study. J Clin Nurs. 2022;31(11-12):1697-1708. https://doi.org/10.1111/jocn.16026
Campbell AR, Layne D, Scott E, Wei H. Interventions to promote teamwork, delegation and communication among registered nurses and nursing assistants: An integrative review. J Nurs Manag. 2020;28(7):1465-1472. https://pubmed.ncbi.nlm.nih.gov/32621342/
Hopkins U, Itty AS, Nazario H, Pinon M, Slyer J, Singleton J. The effectiveness of delegation interventions by the registered nurse to the unlicensed assistive personnel and their impact on quality of care, patient satisfaction, and RN staff satisfaction: a systematic review. JBI Libr Syst Rev. 2012;10(15):895-934. https://pubmed.ncbi.nlm.nih.gov/27820462/
Almost, J. Regulated nursing in Canada: The landscape in 2021. Canadian Nurses Association. 2021.
Imam A, Obiesie S, Gathara D, Aluvaala J, Maina M, English M. Missed nursing care in acute care hospital settings in low-income and middle-income countries: a systematic review. Hum Resour Health. 2023;21:19. https://doi.org/10.1186/s12960-023-00807-7
Nahasaram ST, Ramoo V, Lee WL. Missed nursing care in the Malaysian context: A crosssectional study from nurses’ perspective. J Nurs Manag. 2021;29(6):1848-1456. https://doi.org/10.1111/jonm.13281
Wieczorek‐Wojcik B, Gaworska‐Krzemińska A, Owczarek AJ, Kilańska D. In‐hospital mortality as the side effect of missed care. J Nurs Manag. 2020;28(8):2240-2246. https://doi.org/10.1111/jonm.12965
Kim CG, Bae KS. Relationship between nurse staffing level and adult nursing-sensitive outcomes in tertiary hospitals of Korea: Retrospective observational study. Int J Nurs Stud. 2018;80:155-164. https://doi.org/10.1016/j.ijnurstu.2018.01.001
Dubois CA, D’Amour D, Tchouaket E, Rivard M, Clarke S, Blais R. A taxonomy of nursing care organization models in hospitals. BMC Health Serv Res. 2012;12:286. https://doi.org/10.1186/1472-6963-12-286
Chen X, Tao Z, Tang Y, Yan X. Status and associations of nursing practice environments in intensive care units: A cross-sectional study in China. J Nurs Manag. 2022;30(7):2897-2905. https://doi.org/10.1111/jonm.13616
Morris ME, Brusco NK, McAleer R, Billett S, Brophy L, Bryant R, et al. Professional care workforce: a rapid review of evidence supporting methods of recruitment, retention, safety, and education. Hum Resour Health. 2023;21:95. https://doi.org/10.1186/s12960-023-00879-5
Jeong S. Forecast accuracy of demand for registered nurses and its determinants in South Korea. Hum Resour Health. 2024;22:44. https://doi.org/10.1186/s12960-024-00910-3
Instituto Nacional de Salud. COVID-19 en Colombia. [Internet]. Consulta: Noviembre 3, 2025. Disponible en: https://www.ins.gov.co/Noticias/Paginas/coronavirus-filtro.aspx
Datos Abiertos Bogotá. Porcentaje de ocupación de los servicios de hospitalización general, UCIM y UCI en Bogotá D.C. Bogotá: Datos Abiertos; 2022. Consulta: Noviembre 3, 2025. Disponible en: https://datosabiertos.bogota.gov.co/dataset/porcentaje-de-ocupacion-de-los-servicios-de-hospitalizacion-general-ucim-y-uci-en-bogota-d-c
SaluData – Observatorio de Salud de Bogotá. Porcentaje de ocupación de los servicios de urgencias en las instituciones adscritas a la red pública de Bogotá D.C. 2022. Consulta Noviembre 3, 2025. Disponible en: https://saludata.saludcapital.gov.co/osb/indicadores/porcentaje-de-ocupacion-de-los-servicios-de-urgencias-en-las-instituciones-adscritas-a-lared-publica-de-bogota-d-c/
Downloads
Published
How to Cite
Downloads
Issue
Section
Categories
License
Copyright (c) 2026 Revista Cuidarte
This work is licensed under a Creative Commons Attribution 4.0 International License.
Journal Cuidarte, scientific publication of open access, is licensed under a Creative Commons Attribution (CC BY-NC), which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Any other form of use such as reproduction, transformation, public communication or distribution, for profit, requires the prior authorization of the University of Santander UDES.
The names and e-mail addresses entered in the Journal Cuidarte will be used exclusively for the purposes stated by this magazine and will not be available for any other purpose or other person.
The articles published in the Journal Cuidarte represent the criteria of their authors and do not necessarily constitute the official opinion of the University of Santander UDES.
