Facilities and C.N.A. Roles Denise Morris, RN MSN Taylor Hudson, CNA

Introduction Population is aging quickly Population over 80 y/o is the fast growing 1990 – Life expectancy was 49 y/o 2004 – Life expectancy was 74 y/o 1/6 jobs is in health care LTC, Hospice, Homes, Dr. Office, Assisted Living

The Law Federal, State and Agency Policy govern rules and Fx  Law  Job description  Person’s condition  Amount of supervision

The Law You need to know:  What you can do  What you can’t do  What is right and what is wrong

History and Current Trends Prior to 1980  Training not required by lay  RN gave OJT training 1980  Team Nursing common – RN team leader assigned care according to need and skill  Primary Nursing common mid 1980’s - RN gave all care in hospitals, CNA used in nursing homes

History and Trends Criteria motivating change in training Program  Caused rise in RN use  Increasing cost  Prospective payment limited hospital stay  Reduction in quality  Nurse Practice Act – Defines Scope

State and Federal Law 1987 Omnibus Reconciliation Act  Funded by Medicare at Federal Level  Funded by Medicaid at State Level

State and Federal Law Nurse Practice Acts 1. Define RN/LPN/CAN roles 2. Describe scope of practice and license requirements 3. Protects the public from practicing without a license 4. Allows for Revocation  Convicted of a crime  Selling/distributing drugs  Using person’s drugs for yourself  Placing a person in danger from overuse of drugs  Negligence  Aiding or assisting another to violate practice rules  Making medical diagnosis

Omnibus Budget Reconciliation Act (OBRA) Applies in all 50 states Purpose  Decrease cost  Increase quality  Sets minimum training and competency training  Requires each state to have CNA training program to include: a. 75 classroom hours b. 12 days of clinical experience

Omnibus Budget Reconciliation Act (OBRA) Areas of Study  Communication  Infection Control  Safety  Resident Rights  Basic Nursing  Personal Care  Feeding  Skin care  Elimination  Transferring and turning  Dressing  Ambulation  ROM  S&S of common diseases  Caring for cognitively impaired

Omnibus Budget Reconciliation Act (OBRA) Competency Evaluation  Written exam  Practical Test  Nursing Assistant Registry OBRA requires state to keep list of CNA’s for 5 years Any agency can access registry

Roles and Responsibilities Vary from state to state, but generally:  ADL’s  Special Procedures  Support Services  Documentation

Roles and Responsibilities Professionalism  Characteristics of professional behavior: attitude, appearance, confidentiality, advocacy, security  Personal characteristics necessary for CNA: sensitive, mature, dependable, empathetic,

Roles and Responsibilities Delegation  Nurse practice act only allows nurse to delegate tasks that don’t require special skills (i.e. ADL’s)  RN still accountable  Who can delegate? RN to LPN/CNA LPN to CNA CNA can’t delegate

Roles and Responsibilities Delegation Process  Must be within legal limits of provider  Task in job description and OK in state  Have had training and competent  Experience in doing task independently

Roles and Responsibilities 5 Rights of Delegation 1. Right Task 2. Right Person 3. Right Directions/Communication 4. Right Supervision 5. Right Circumstances