This study examines registered nurse perceptions of changes in the role of the registered nurse and registered nurse satisfaction with the use of unlicensed assistive personnel in acute hospital care delivery systems. Six major functional areas were examined: leadership, communication patterns, health teaching, evaluation activities, care management responsibilities, and unit tasks. Moderate to profound changes were reported in areas relating to the team leader role. Registered nurses reported dissatisfaction with unlicensed assistive personnel's ability to perform delegated nursing tasks, communicate pertinent information, and provide more time for professional nursing activities.