1. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 2 The Nursing Assistant in Long-Term Care

2. Slide 2 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  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

3. Slide 3 Copyright © 2007, 2003 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.

4. Slide 4 Copyright © 2007, 2003 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 Defines RN and LPN/LVN Describes the scope of practice for RNs and LPNs/LVNs Describes the scope of practice for RNs and LPNs/LVNs Describes education and licensing requirements 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 Protects the public from persons practicing nursing without a license Allows for revoking or suspending a nurse’s license Allows for revoking or suspending a nurse’s license

5. Slide 5 Copyright © 2007, 2003 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.

6. Slide 6 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Competency evaluation 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. 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 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

7. Slide 7 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  ROLES AND RESPONSIBILITIES  The following direct what you can do: Nurse practice acts Nurse practice acts OBRA OBRA State laws State laws Legal and advisory opinions Legal and advisory opinions  To protect persons from harm, you must understand: What you can do What you can do What you cannot do What you cannot do The legal limits of your role The legal limits of your role  In some states, this is called scope of practice.  The National Council of State Boards of Nursing calls it range of functions.

8. Slide 8 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. LICENSED NURSES SUPERVISE YOUR WORK.  Before you perform a nursing task, make sure that: Your state allows nursing assistants to do so. Your state allows nursing assistants to do so. It is in your job description. It is in your job description. You have the necessary education and training. You have the necessary education and training. A nurse is available to answer questions and to supervise you. A nurse is available to answer questions and to supervise you.

9. Slide 9 Copyright © 2007, 2003 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 Act beyond the legal limits of your role Function beyond your training limits Function beyond your training limits Perform acts that are against your morals or religion Perform acts that are against your morals or religion

10. Slide 10 Copyright © 2007, 2003 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 Your roles and responsibilities The functions you can safely perform The functions you can safely perform The things you should never do The things you should never do Your job description Your job description The ethical and legal aspects of your role The ethical and legal aspects of your role

11. Slide 11 Copyright © 2007, 2003 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. 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. RNs can delegate tasks to LPNs/LVNs and nursing assistants. In some states, LPNs/LVNs can delegate tasks to nursing assistants. In some states, LPNs/LVNs can delegate tasks to nursing assistants. Nursing assistants cannot delegate. Nursing assistants cannot delegate.

12. Slide 12 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. The Four Steps in the Delegation Process Assess and plan (The nurse needs to understand the person’s need.) Assess and plan (The nurse needs to understand the person’s need.) Communication (The nurse must provide clear and complete directions.) Communication (The nurse must provide clear and complete directions.) Surveillance and supervision (The nurse has to make sure that you complete the task correctly.) 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.) Evaluation and feedback (The nurse decides if the delegation was successful.)  The Five Rights of Delegation The right task The right task The right circumstances The right circumstances The right person The right person The right directions and communication The right directions and communication The right supervision The right supervision

13. Slide 13 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. When you agree to perform a task: You are responsible for your own actions. You are responsible for your own actions. You must complete the task safely. You must complete the task safely. You must ask for help when you are unsure or have questions about a task. 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. You must report to the nurse what you did and the observations you made.

14. Slide 14 Copyright © 2007, 2003 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 beyond the legal limits of your role. The task is not in your job description. The task is not in your job description. You were not prepared to perform the task. You were not prepared to perform the task. The task could harm the person. The task could harm the person. The person’s condition has changed. The person’s condition has changed. You do not know how to use the supplies or equipment. You do not know how to use the supplies or equipment. Directions are not ethical or legal. Directions are not ethical or legal. Directions are against center policies. Directions are against center policies. Directions are unclear or incomplete. Directions are unclear or incomplete. A nurse is not available for supervision. A nurse is not available for supervision.

15. Slide 15 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. ETHICAL ASPECTS  Ethics is knowledge of what is right conduct and wrong conduct.  An ethical person:  Behaves and acts in the right way  Does not cause a person harm  Ethical behavior also involves not being prejudiced or biased.

16. Slide 16 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. LEGAL ASPECTS  Laws tell you want you can and cannot do. Criminal laws are concerned with offenses against the public and society in general. Criminal laws are concerned with offenses against the public and society in general. Civil laws are concerned with relationships between people. Civil laws are concerned with relationships between people.

17. Slide 17 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Torts are part of civil law. Unintentional torts Unintentional torts  Negligence is an unintentional wrong.  Malpractice is negligence by a professional person.  You are legally responsible (liable) for your own actions. Intentional torts are acts meant to be harmful Intentional torts are acts meant to be harmful  Defamation  Libel  Slander  False imprisonment  Invasion of privacy  Fraud  Assault  Battery

18. Slide 18 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Informed consent Consent is informed when the person clearly understands: Consent is informed when the person clearly understands:  The reason for a treatment  What will be done  How it will be done  Who will do it  The expected outcomes  Other treatment options  The effects of not having the treatment Consent must be given: Consent must be given:  When the person enters the center  For general consent to treatment  Before admission to a secured Alzheimer’s unit  Before certain procedures You are never responsible for obtaining written consent. You are never responsible for obtaining written consent.

19. Slide 19 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Wills  You can ethically and legally: Witness the signing of a will Witness the signing of a will Refuse to witness the signing of a will Refuse to witness the signing of a will  You cannot prepare a will.  Know your center’s policy before you agree to witness a will.

20. Slide 20 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. REPORTING ABUSE  Abuse is a crime.  Abuse has one or more of these elements: Willful causing of injury Willful causing of injury Unreasonable confinement Unreasonable confinement Intimidation Intimidation Punishment Punishment Depriving the person of the goods or services needed for physical, mental, or psychosocial well-being Depriving the person of the goods or services needed for physical, mental, or psychosocial well-being

21. Slide 21 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Elder Abuse Physical abuse Physical abuse Neglect Neglect Verbal abuse Verbal abuse Involuntary seclusion Involuntary seclusion Financial exploitation Financial exploitation Emotional abuse Emotional abuse Sexual abuse Sexual abuse Abandonment Abandonment

22. Slide 22 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Federal and state laws require the reporting of elder abuse.  OBRA does not allow nursing centers to employ persons who were convicted of the abuse, neglect, or mistreatment of persons. The center must take certain actions if abuse is suspected within the center.

23. Slide 23 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Child Abuse  Child abuse occurs at every social and income level.  Types of child abuse Abuse differs from neglect. Abuse differs from neglect. Physical abuse Physical abuse Sexual abuse Sexual abuse  Child abuse is complex.  State laws require the reporting of suspected child abuse.  If you suspect child abuse, share your concerns with the nurse.

24. Slide 24 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Domestic Abuse  (Domestic violence) occurs in relationships.  Usually more than one type of abuse is present. Physical abuse Physical abuse Sexual abuse Sexual abuse Verbal abuse Verbal abuse Economic abuse Economic abuse Social abuse Social abuse  State laws vary about reporting domestic abuse.  If you suspect domestic abuse, share your concerns with the nurse.

25. Slide 25 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. QUALITY OF LIFE  Residents have the right to a comfortable and safe setting. What you do and how you do it affect their quality of life. What you do and how you do it affect their quality of life. You must always practice within the legal limits of your role. You must always practice within the legal limits of your role. Be alert for signs and symptoms of abuse. Be alert for signs and symptoms of abuse.