Ch 2 ppp, vol 7


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  • 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
  • Ch 2 ppp, vol 7

    1. 1. Chapter 2 The Nursing Assistant
    2. 2. <ul><li>To protect patients and residents from harm, you need to know: </li></ul><ul><ul><li>What you can and cannot do </li></ul></ul><ul><ul><li>Your legal limits </li></ul></ul><ul><li>The following shape your work: </li></ul><ul><ul><li>Laws </li></ul></ul><ul><ul><li>Job descriptions </li></ul></ul><ul><ul><li>The person’s condition </li></ul></ul><ul><ul><li>The amount of supervision you need </li></ul></ul>
    3. 3. <ul><li>HISTORY AND CURRENT TRENDS </li></ul><ul><ul><li>Until the 1980s, training was not required by law. </li></ul></ul><ul><ul><li>Before the 1980s, team nursing was common. </li></ul></ul><ul><ul><li>Primary nursing was common in the 1980s. </li></ul></ul><ul><ul><li>Home care increased during the 1980s. </li></ul></ul><ul><ul><li>Efforts to reduce health care costs include: </li></ul></ul><ul><ul><ul><li>Hospital closings </li></ul></ul></ul><ul><ul><ul><li>Hospital mergers </li></ul></ul></ul><ul><ul><ul><li>Health care systems </li></ul></ul></ul><ul><ul><ul><li>Managed care </li></ul></ul></ul><ul><ul><ul><li>Staffing mix </li></ul></ul></ul><ul><ul><ul><li>Patient-focused care </li></ul></ul></ul>
    4. 4. <ul><li>FEDERAL AND STATE LAWS </li></ul><ul><ul><li>Each state has a nurse practice act which: </li></ul></ul><ul><ul><ul><li>Defines RN and LPN/LVN </li></ul></ul></ul><ul><ul><ul><ul><li>Some acts also define nursing assistant. </li></ul></ul></ul></ul><ul><ul><ul><li>Describes the scope of practice for RNs and LPNs/LVNs </li></ul></ul></ul><ul><ul><ul><li>Describes education and licensing requirements for RNs and LPNs/LVNs </li></ul></ul></ul><ul><ul><ul><li>Protects the public from persons practicing nursing without a license </li></ul></ul></ul><ul><ul><ul><li>Allows for denying, revoking, and suspending a nursing license </li></ul></ul></ul>
    5. 5. <ul><ul><li>Nursing assistants </li></ul></ul><ul><ul><ul><li>Some nurse practice acts also regulate nursing assistant roles, functions, education, and certification requirements. </li></ul></ul></ul><ul><ul><ul><li>In other states, there are separate laws for nursing assistants. </li></ul></ul></ul><ul><ul><ul><li>If you do something beyond the legal limits of your role, you could be practicing nursing without a license. </li></ul></ul></ul>
    6. 6. <ul><ul><li>The Omnibus Budget Reconciliation Act of 1987 (OBRA) is a federal law. </li></ul></ul><ul><ul><ul><li>Its purpose is to improve the quality of life of nursing center residents. </li></ul></ul></ul><ul><ul><ul><li>This law sets minimum training and competency evaluation requirements for nursing assistants. </li></ul></ul></ul><ul><ul><ul><li>Each state must have a nursing assistant training and competency evaluation program (NATCEP). </li></ul></ul></ul>
    7. 7. <ul><ul><li>The training program </li></ul></ul><ul><ul><ul><li>OBRA requires at least 75 hours of instruction. </li></ul></ul></ul><ul><ul><ul><li>There must be at least 16 hours of supervised practical training. </li></ul></ul></ul><ul><ul><li>Competency evaluation </li></ul></ul><ul><ul><ul><li>The competency evaluation has a written test and a skills test. </li></ul></ul></ul><ul><ul><ul><li>OBRA allows at least 3 attempts to successfully complete the evaluation. </li></ul></ul></ul>
    8. 8. <ul><ul><li>OBRA requires a nursing assistant registry in each state. </li></ul></ul><ul><ul><ul><li>It is an official record or listing of persons who have successfully completed that state’s state-approved NATCEP. </li></ul></ul></ul><ul><ul><ul><li>The registry has information about each nursing assistant. </li></ul></ul></ul><ul><ul><ul><li>All information stays in the registry for at least 5 years. </li></ul></ul></ul><ul><ul><ul><li>Any agency can access registry information. </li></ul></ul></ul><ul><ul><ul><li>You receive a copy of your registry information. </li></ul></ul></ul><ul><ul><ul><li>You can correct wrong information. </li></ul></ul></ul>
    9. 9. <ul><ul><li>Other OBRA requirements </li></ul></ul><ul><ul><ul><li>Retraining and a new competency evaluation program are required for nursing assistants who have not worked for 24 months. </li></ul></ul></ul><ul><ul><ul><li>Agencies covered under OBRA must provide 12 hours of educational programs to nursing assistants every year. </li></ul></ul></ul><ul><ul><ul><li>Performance reviews also are required. </li></ul></ul></ul>
    10. 10. <ul><li>ROLES AND RESPONSIBILITIES </li></ul><ul><ul><li>To protect persons from harm, you must understand: </li></ul></ul><ul><ul><ul><li>What you can do </li></ul></ul></ul><ul><ul><ul><li>What you cannot do </li></ul></ul></ul><ul><ul><ul><li>The legal limits of your role </li></ul></ul></ul><ul><ul><ul><ul><li>In some states, this is called scope of practice. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>The National Council of State Boards of Nursing (NCSBN) calls it range of functions. </li></ul></ul></ul></ul><ul><ul><li>Licensed nurses supervise your work. </li></ul></ul><ul><ul><ul><li>You assist them in giving care. </li></ul></ul></ul>
    11. 11. <ul><ul><li>Before you perform a nursing task, make sure that: </li></ul></ul><ul><ul><ul><li>Your state allows nursing assistants to do so </li></ul></ul></ul><ul><ul><ul><li>It is in your job description </li></ul></ul></ul><ul><ul><ul><li>You have the necessary education and training </li></ul></ul></ul><ul><ul><ul><li>A nurse is available to answer questions and to supervise you </li></ul></ul></ul><ul><ul><li>You must know what you can do in the state in which you are working. </li></ul></ul><ul><ul><ul><li>State laws and rules limit nursing assistant functions. </li></ul></ul></ul><ul><ul><ul><li>No agency or nurse can expand your range of functions beyond what is allowed by your state’s laws and rules. </li></ul></ul></ul>
    12. 12. <ul><ul><li>The job description: </li></ul></ul><ul><ul><ul><li>Describes what the agency expects you to do </li></ul></ul></ul><ul><ul><ul><li>States educational requirements </li></ul></ul></ul><ul><ul><li>Always obtain a written job description when you apply for a job. </li></ul></ul><ul><ul><ul><li>Ask questions about it during your job interview. </li></ul></ul></ul><ul><ul><li>Before accepting a job: </li></ul></ul><ul><ul><ul><li>Tell the employer about functions you did not learn </li></ul></ul></ul><ul><ul><ul><li>Advise the employer of functions you cannot do for moral or religious reasons </li></ul></ul></ul><ul><ul><ul><li>Clearly understand what is expected </li></ul></ul></ul>
    13. 13. <ul><ul><li>Do not take a job that requires you to: </li></ul></ul><ul><ul><ul><li>Act beyond the legal limits of your role </li></ul></ul></ul><ul><ul><ul><li>Function beyond your training limits </li></ul></ul></ul><ul><ul><ul><li>Perform acts that are against your morals or religion </li></ul></ul></ul><ul><ul><li>You need to know: </li></ul></ul><ul><ul><ul><li>What you can safely do </li></ul></ul></ul><ul><ul><ul><li>The things you should never do </li></ul></ul></ul><ul><ul><ul><li>Your job description </li></ul></ul></ul><ul><ul><ul><li>The ethical and legal aspects of your role </li></ul></ul></ul>
    14. 14. <ul><li>DELEGATION </li></ul><ul><ul><li>Delegate means to authorize another person to perform a nursing task in a certain situation. </li></ul></ul><ul><ul><ul><li>The person must be competent to perform a task in a given situation. </li></ul></ul></ul>
    15. 15. <ul><ul><li>Who can delegate </li></ul></ul><ul><ul><ul><li>RNs can delegate nursing tasks to LPNs/LVNs and nursing assistants. </li></ul></ul></ul><ul><ul><ul><ul><li>In some states, LPNs/LVNs can delegate tasks to nursing assistants. </li></ul></ul></ul></ul><ul><ul><ul><li>Delegation decisions must protect the person’s health and safety. </li></ul></ul></ul><ul><ul><ul><li>The delegating nurse is legally accountable for the nursing task. </li></ul></ul></ul><ul><ul><ul><li>The RN is accountable for all nursing care. </li></ul></ul></ul><ul><ul><ul><li>Nursing assistants cannot delegate. </li></ul></ul></ul>
    16. 16. <ul><ul><li>The National Council of State Boards of Nursing (NCSBN) describes four steps in the delegation process. </li></ul></ul><ul><ul><ul><li>Step 1—Assess and Plan is done by the nurse. </li></ul></ul></ul><ul><ul><ul><li>Step 2—Communication involves the nurse and you. </li></ul></ul></ul><ul><ul><ul><li>Step 3—Surveillance and Supervision (the nurse observes the care you give). </li></ul></ul></ul><ul><ul><ul><li>Step 4—Evaluation and Feedback is done by the nurse. </li></ul></ul></ul>
    17. 17. <ul><ul><li>The NCSBN’s Five Rights of Delegation is another way to view the delegation process. </li></ul></ul><ul><ul><ul><li>The right task </li></ul></ul></ul><ul><ul><ul><li>The right circumstances </li></ul></ul></ul><ul><ul><ul><li>The right person </li></ul></ul></ul><ul><ul><ul><li>The right directions and communication </li></ul></ul></ul><ul><ul><ul><li>The right supervision </li></ul></ul></ul>
    18. 18. <ul><ul><li>Your role in delegation </li></ul></ul><ul><ul><ul><li>You must protect the person from harm. </li></ul></ul></ul><ul><ul><ul><li>You either agree or refuse to do a delegated task. </li></ul></ul></ul><ul><ul><li>Accepting a task </li></ul></ul><ul><ul><ul><li>When you agree to perform a task, you are responsible for your own actions. </li></ul></ul></ul><ul><ul><ul><li>You must complete the task safely. </li></ul></ul></ul><ul><ul><ul><li>Report to the nurse what you did and the observations you made. </li></ul></ul></ul>
    19. 19. <ul><ul><li>You should refuse to perform a task when: </li></ul></ul><ul><ul><ul><li>The task is beyond the legal limits of your role. </li></ul></ul></ul><ul><ul><ul><li>The task is not in your job description. </li></ul></ul></ul><ul><ul><ul><li>You were not prepared to perform the task. </li></ul></ul></ul><ul><ul><ul><li>The task could harm the person. </li></ul></ul></ul><ul><ul><ul><li>The person’s condition has changed. </li></ul></ul></ul><ul><ul><ul><li>You do not know how to use the supplies or equipment. </li></ul></ul></ul><ul><ul><ul><li>Directions are not ethical or legal. </li></ul></ul></ul><ul><ul><ul><li>Directions are against agency policies. </li></ul></ul></ul><ul><ul><ul><li>Directions are unclear or incomplete. </li></ul></ul></ul><ul><ul><ul><li>A nurse is not available for supervision. </li></ul></ul></ul>
    20. 20. <ul><ul><li>Never ignore an order or a request to do something. </li></ul></ul><ul><ul><ul><li>Tell the nurse about your concerns. </li></ul></ul></ul><ul><ul><ul><li>You must have sound reasons for refusing a task. </li></ul></ul></ul>