1. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 3 The Nursing Assistant in Long-Term Care

2. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Assistant Duties  To protect residents from harm, you need to know:  What you can and cannot do  What is right conduct and wrong conduct  Your legal limits  Your work is shaped by:  Laws  Job descriptions  The person’s condition  The amount of supervision you need Slide 2

3. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. History and Current Trends  Until the 1980s, nursing assistant training was not required by law.  Before the 1980s, team nursing was common.  Primary nursing was common in the 1980s.  Home care increased during the 1980s.  Efforts were made to reduce health care costs. Slide 3

4. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Federal and State Laws  You must know the state and federal laws that affect your work.  Each state has a nurse practice act that:  Defines RN and LPN/LVN  Describes the scope of practice for RNs and LPNs/LVNs  Describes education and licensing requirements for RNs and LPNs/LVNs  Protects the public from persons practicing nursing without a license  Allows for revoking or suspending a nurse’s license Slide 4

5. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Nursing assistants  A state’s nurse practice act is used to decide what nursing assistants can do.  The Omnibus Budget Reconciliation Act of 1987 (OBRA) applies to all states.  It sets minimum training and competency evaluation requirements for nursing assistants.  It requires each state to have a nursing assistant training and competency evaluation program (NATCEP).  The training program OBRA requires at least 75 hours of instruction. OBRA requires at least 75 hours of instruction. There must be 16 hours of supervised practical training. There must be 16 hours of supervised practical training. Slide 5

6. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Competency evaluation  The competency evaluation has a written test and a skills test.  The written test has multiple choice questions.  The skills test involves performing nursing skills.  Nursing assistant registry is an official record of persons who have successfully completed a state-approved NATCEP.  All information stays in the registry for at least 5 years.  Any agency can access registry information.  You receive a copy of your registry information.  Other OBRA requirements  Retraining and a new competency evaluation program for nursing assistants who have not worked for 24 months  12 hours of educational programs for nursing assistants every year  Performance reviews Slide 6

7. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Certification  After successfully completing your state’s NATCEP, you have the title used in your state.  Certified nursing assistant (CNA) or certified nurse aide (CNA)  Licensed nursing assistant (LNA)  Registered nurse aide (RNA)  Nursing assistants can have their certification (licenses, registration) denied, revoked, or suspended. Slide 7

8. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Working in Another State  To work in another state, you must meet that state’s registry requirements.  To do so, contact the state agency responsible for NATCEPs and the nursing assistant registry.  Then apply to the state agency to be a CNA (LNA, RNA).  Your application is reviewed to see if you meet the state’s requirements. Slide 8

9. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Roles and Responsibilities  The following direct what you can do:  Nurse practice acts  OBRA  State laws  Legal and advisory opinions  To protect persons from harm, you must understand:  What you can do  What you cannot do  The legal limits of your role In some states, this is called scope of practice. In some states, this is called scope of practice. The National Council of State Boards of Nursing (NSCBN) calls it range of functions. The National Council of State Boards of Nursing (NSCBN) calls it range of functions. Slide 9

10. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Assistant Standards  OBRA defines the basic range of functions for nursing assistants.  All NATCEPs include those functions. Some states allow other functions.  NATCEPs also prepare nursing assistants to meet those standards. Slide 10

11. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Licensed nurses supervise your work.  You assist in giving care.  You also perform nursing tasks.  Before you perform a nursing task, make sure that:  Your state allows nursing assistants to do so.  It is in your job description.  You have the necessary education and training.  A nurse is available to answer questions and to supervise you. Slide 11

12. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  The job description:  Is a list of responsibilities the center expects you to perform  States educational requirements  Always request a written job description when you apply for a job.  Do not take a job that requires you to:  Act beyond the legal limits of your role  Function beyond your training limits  Perform acts that are against your morals or religion Slide 12

13. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  No one can force you to do something beyond the legal limits of your role.  You must understand:  Your roles and responsibilities  The functions you can safely perform  The things you should never do  Your job description  The ethical and legal aspects of your role Slide 13

14. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Delegation  Delegate means to authorize another person to perform a nursing task in a certain situation.  The person must be competent to perform a task in a given situation.  Who can delegate?  RNs can delegate tasks to LPNs/LVNs and nursing assistants.  In some states, LPNs/LVNs can delegate tasks to nursing assistants.  Nursing assistants cannot delegate. Slide 14

15. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  The National Council of State Boards of Nursing (NCSBN) describes the delegation process in four steps.  Assess and plan: the nurse needs to understand the person’s need.  Communication: the nurse must provide clear and complete directions.  Surveillance and supervision: the nurse has to make sure that you complete the task correctly.  Evaluation and feedback: the nurse decides if the delegation was successful.  The Five Rights of Delegation (according to the NCSBN)  The right task  The right circumstances  The right person  The right directions and communication  The right supervision Slide 15

16. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  When you agree to perform a task:  You are responsible for your own actions.  You must complete the task safely.  You must ask for help when you are unsure or have questions about a task.  You must report to the nurse what you did and the observations you made. Slide 16

17. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  You should refuse to perform a task when:  The task is beyond the legal limits of your role.  The task is not in your job description.  You were not prepared to perform the task.  The task could harm the person.  The person’s condition has changed.  You do not know how to use the supplies or equipment.  Directions are not ethical or legal.  Directions are against center policies.  Directions are unclear or incomplete.  A nurse is not available for supervision. Slide 17

18. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Quality of Life  The work you do is important for the person’s quality of life.  Your current training is just the start of a lifetime of learning and possibilities. Slide 18