Intro to OBRA and the Nursing Assistant

INTRODUCTION  You need to know:  What you can and cannot do  What conduct is right & wrong  Your legal limits  Defined / shaped by:  Federal & state laws  Patient’s condition  The amount of supervision you need

HISTORY OF CNA’S  Worked for decades helping nurses  Until the 1980s, training was not required by law  On-the-job training by RN’s  Some schools and hospitals offered training

TRENDS  Before 1980’s team nursing used  RN directed care of CNA (who gave most of care)  So…. What do you think the typical hospital “room” looked like then?  In 1980’s primary nursing introduced  RN’s gave care in hospitals  CNA’s gave care in nursing homes

TRENDS  Home care increased in 1980’s  Insurance caused decrease in length of hospital stays  Reducing medical costs became political issue  Hospital closings & mergers  Managed care  Staffing changes  CNA’s joined RN’s at hospitals  CNA’s required more training

STATE & FEDERAL LAWS  Tasks CNA’s able to perform vary from state to state & within agencies  Attempt to regulate nursing practice  Nurse practice acts  The Omnibus Budget Reconciliation Act (OBRA) of 1987  Applies to all 50 states

NURSE PRACTICE ACTS  Defines RN’s and LPN’s  Describes their scope of practice  Lists education and licensing requirements  Protects public from nurse practicing without license  Allows license to be revoked

NURSE PRACTICE ACT  Also defines what the Nursing Assistant may do guilty  If perform act beyond scope of CNA, can be found guilty of practicing nursing without a license

REASONS TO REVOKE A LICENSE  Convicted of crime in any state  Sell / distribute drugs  Using patient drugs for self  Place person in danger from overuse of drugs / alcohol  Convicted of abuse or neglect of child or elderly person  Violating or assisting someone else to violate the nurse practice act  Incompetent behaviors  Making medical diagnosis  Prescribing drugs or treatments

OBRA  Omnibus Budget Reconciliation Act of 1987  Federal law that regulates nursing facilities and Nursing Assistant training facilities  Intent  Intent is to improve quality of life for residents in nursing homes

OBRA  Purpose: improve quality of life of nursing home residents and competency evaluation requirements for nursing assistants  Training program: length and content  Competency evaluation: what is needed to pass the exam  Nursing assistant registry: to enforce standards and protect patients  If agency receives Medicare funds for home health care, then those workers must meet OBRA’s requirements as well

REMIND ME AGAIN….  What was the intent of the OBRA Act of 1987???

OBRA  OBRA Facility Regulations  Focus on resident rights, restorative care, psychosocial care, and preventative care to maintain maximum physical and mental wellness of residents  State inspections of facilities for compliance with regulations (penalties for non-compliance)  Facilities must assure that nurse aides complete and approved Nurse Aide Training program and be placed on the nurse Aide Registry within 4 months of their date of hire.

CNA CURRICULUM  OBRA requires at least 75 hours of instruction prior to taking the certification exam:  Introduction:16 hrs. (Safety, Emergency Measures, Infection, Communication)  Personal Care: 17 hrs.  Basic Skills: 8 hrs.  Restorative Services: 4 hrs.  Mental Health: 6 hrs.

CNA TRAINING PROGRAM REGULATIONS  24 hrs clinical training in nursing home following the first 16 hrs of classroom curriculum  Must pass the skills test and the written test before being placed on the Registry. The Nurse Aide has 3 opportunities to pass each test  Competency Evaluation or Certification Exam (fee = $93)  Demonstration of 5 randomly chosen skills  Written (or oral) 70 question multiple choice exam

Tell me….  How does the training previously mentioned benefit residents, the nurse aide themselves, and the LTC facility??

NURSING ASSISTANT REGISTRY  OBRA requires Nursing Assistant’s to register in each state (keep info for 5 years)  Keep registry informed of current address and phone number  Submit verification of paid employment prior to the end of 24 months after being entered into the Registry or certification will expire.

OTHER OBRA REQUIREMENTS  After certification evaluation:  Must not discontinue working for 2 years – or retraining and new evaluation may be required  Must have continuous inservice / continuing education and performance reviews

ROLES & RESPONSIBILITIES  Nurse practice acts, OBRA, state laws, as well as legal and advisory opinions direct what you can do in your role as a CNA:  Must understand what you are able or unable to do  Follow job description – called “scope of practice”  Must have had education and training to perform task  RNs supervise (LPN’s may in some states)  Must be available for questions

ROLE LIMITS FOR CNA’S:

DELEGATION  Authorize another person to perform a task  Delegation decisions must protect person’s health and safety  Person must be competent to perform task  RN legally accountable (responsible) for all nursing care-decide what is best for patient  Decision is based upon pt’s circumstances  Must make sure it is done correctly  NA’s can’t delegate roles or responsibilities

5 RIGHTS OF DELEGATION  Right task  Right circumstances  Right directions and communication  Right person  Right supervision