Federal and state laws and agency policies combine to define the roles and functions of each health team member.
Everyone must protect patients and residents from harm.
With team nursing, care was assigned according to each person’s needs and condition. It also depended on the staff member’s education and experiences. With primary nursing, registered nurses (RNs) planned and gave care. Many hospitals only hired RNs. Nursing homes relied on nursing assistants for resident care. Prospective payment systems limit health care payments. Patients are discharged earlier than in the past. Often they are still quite ill and need home care.
Nurse practice acts protect the public’s welfare and safety. The law protects the public from unsafe nurses.
Legal and advisory opinions about nursing assistants are based on the state’s nurse practice act. State laws about nursing assistant roles and functions are based on the state’s nurse practice act. Nursing assistants must be able to function with reasonable skill and safety. Nursing assistants can have their certification, license, or registration denied, revoked, or suspended.
The nursing assistant training and competency evaluation program must be successfully completed by nursing assistants working in nursing centers, hospital long-term care units, and home care agencies receiving medicare funds.
Some states require more than 75 hours. Students perform nursing care and procedures on another person during the practical training. A nurse supervises this practical training. The written test has multiple-choice questions. The number of questions varies from state to state. The skills test involves performing nursing skills. There is a fee for the evaluation. If you work in a nursing center, the employer pays this fee.
States can require: A new competency evaluation Both retraining and a new competency evaluation These requirements help ensure that nursing assistants have current knowledge and skills to give safe, effective care. Each state NATCEP (Nurse Aide Training and Competency Evaluation Program) must meet OBRA (Omnibus Budget Reconciliation Act of 1987) requirements. If you want to work in another state, contact the state agency responsible for NATCEPs and the nursing assistant registry.
A nursing task is the nursing care or a nursing function, procedure, activity, or work that can be delegated to nursing assistants when it does not require an RN’s professional knowledge or judgment. Review the rules in Box 2-1 on p. 16 in the textbook.
Review the contents of Box 2-2 on p. 17 in the textbook. Review the Focus on Long-Term Care and Home Care: Roles and Responsibilities Box on p. 17 in the textbook. OBRA defines the basic range of functions for nursing assistants. All NATCEPs include those functions. Some states allow other functions. Review the contents of Box 2-3 on p. 17 in the textbook.
No one can force you to do something beyond the legal limits of your role.
Nurse practice acts give nurses: Certain responsibilities Legal authority to perform nursing actions A responsibility is the duty or obligation to perform some act or function.
RNs and licensed practical nurses (LPNs)/licensed vocational nurses (LVNs) can only delegate: Tasks within their scope of practice Tasks that are in the nursing assistant’s job description The delegating nurse must make sure that the task was completed safely and correctly.
To make delegation decisions, the nurse follows a process. The person’s needs, the nursing task, and the staff member doing the task must fit. Delegation decisions must result in the best care for the person. The nurse may face serious legal problems for a bad decision. If you perform a task that places the person at risk, you also can face serious legal problems. Review the Focus on Long-Term Care and Home Care: Communication Box on p. 23 in the textbook.
Can the task be delegated? What are the person’s physical, mental, emotional, and spiritual needs at this time? Do you have the training and experience to safely perform the task for this person? Did the nurse give clear directions? Is the nurse available to guide, direct, and evaluate the care you give?
Use the Five Rights of Delegation in Box 2-4 on p. 24 in the textbook to decide to agree or refuse to do a delegated task.
You have the right to say “no.”
Share your concerns about a delegated task with the nurse. The nurse can: Answer your questions Demonstrate the task Show you how to use supplies and equipment Help you as needed Observe you while you perform the task Check on you often Arrange for needed training