1.01

Unit A
Nurse Aide Workplace Fundamentals
Essential Standard 1.00
Understand the range of function, legal and ethical responsibilities of the nurse aide within the healthcare system.
Indicator 1.01
Understand healthcare facilities and organizational structure with focus on LTC.
11.01 Nursing Fundamentals HN43
UnderstandUnderstand
healthcarehealthcare facilitiesfacilities
andand organizationalorganizational
structure withstructure with
focus onfocus on LTCLTC..

FF YY II -- Intentional RepeatIntentional Repeat
There is intentional repeat of some HSIIThere is intentional repeat of some HSII
course content in Nursing Fundamentals.course content in Nursing Fundamentals.
Repeating course content distributes learningRepeating course content distributes learning
over time and increases long term memory.over time and increases long term memory.
Academic and skill competence must beAcademic and skill competence must be
maintained at amaintained at a very high level for directvery high level for direct
resident careresident care..

BRAIN STORMBRAIN STORM
3
ThinkThink
Where do you think Nurse Aides work?Where do you think Nurse Aides work?
ActAct
Raise your hand and share yourRaise your hand and share your
thoughts!thoughts!

Provide care for individuals of allProvide care for individuals of all
ages with a broad range of healthages with a broad range of health
problemsproblems
HospitalsHospitals

HospitalsHospitals
Services varied and extensiveServices varied and extensive
• DiagnosticDiagnostic
• TherapeuticTherapeutic
• MedicalMedical
• SurgicalSurgical
• EmergencyEmergency

So what doesSo what does
DiagnosticDiagnostic mean?mean?
7
Remind me from HSII…Remind me from HSII…
Pertaining to thePertaining to the IdentificationIdentification ofof
a medical condition or disease asa medical condition or disease as
determined by a physician. Adetermined by a physician. A
statement of what is wrong with astatement of what is wrong with a
resident.resident.

TherapeuticTherapeutic mean?mean?
8
aaaand….aaaand….
Pertains to treating,Pertains to treating,
fixingfixing, or correcting a, or correcting a
medical or surgicalmedical or surgical
problemproblem

MedicalMedical mean?mean?
9
• Pertaining to the science of treatment thatPertaining to the science of treatment that
includes drugs, diet, exercise and otherincludes drugs, diet, exercise and other
non-surgical means.non-surgical means.
aaaaaaaand ….aaaaaaaand ….

Surgical …
10
Pertains to the treatment of injury,Pertains to the treatment of injury,
deformity, and disease by manualdeformity, and disease by manual
andand instrumentalinstrumental
operationsoperations..

EmergencyEmergency mean?mean?
11
and last but not least….
Sudden occurrence of aSudden occurrence of a
serious and urgent natureserious and urgent nature
that demands immediatethat demands immediate
attention.attention.

Stick diagnostics
12
Open your mouth and say aaaaaanswer
 DiagnosticDiagnostic
 TherapeuticTherapeutic
 MedicalMedical
 SurgicalSurgical
 EmergencyEmergency

BRAIN STORMBRAIN STORM
13
ThinkThink
Consider situations that areConsider situations that are NOTNOT
emergenciesemergencies that may be consideredthat may be considered
emergencies by some people.emergencies by some people.
ActAct
Raise your hand and share yourRaise your hand and share your
thoughts! Wait to be called on.thoughts! Wait to be called on.

HospitalsHospitals

AcuteAcute mean?mean?
15
OK so…..remind meOK so…..remind me
• An acute illness has aAn acute illness has a sudden onsetsudden onset fromfrom
which the resident is expected to recover.which the resident is expected to recover.
• Acute therapy isAcute therapy is short-termshort-term medicalmedical
treatment, usually in a hospital, for patientstreatment, usually in a hospital, for patients
having an acute illness or injury or recoveringhaving an acute illness or injury or recovering
from surgery.from surgery.

ChronicChronic means….means….
16
Then…Then…
• A chronic illness has slow or gradual on set, forA chronic illness has slow or gradual on set, for
which there is no known cure, the illness can bewhich there is no known cure, the illness can be
controlled and complications prevented.controlled and complications prevented.
• Chronic care is medical and nursing services thatChronic care is medical and nursing services that
focus on long term care of people with chronicfocus on long term care of people with chronic
diseases or conditions, either at home or in adiseases or conditions, either at home or in a
medical facility. It includes measures specific to themedical facility. It includes measures specific to the
problem, as well as others to encourage self-care,problem, as well as others to encourage self-care,
promote health, and prevent loss of function.promote health, and prevent loss of function.

What doesWhat does TerminalTerminal mean?mean?
17
An illness from whichAn illness from which
the resident is notthe resident is not
expected to recover andexpected to recover and
will die.will die.
Residents with terminalResidents with terminal
illnesses are givenillnesses are given
PalliativePalliative
(comfort) care instead of(comfort) care instead of
curative care.curative care.

Acute
18
Open your mouth and say aaaaaanswer
 AcuteAcute
 ChronicChronic
 TerminalTerminal
 PalliativePalliative

LONG TERM CARE FACILITIESLONG TERM CARE FACILITIES
Referred to as:Referred to as:
•Extended care facilitiesExtended care facilities
•Skilled care facilitiesSkilled care facilities
•Nursing homesNursing homes
•CCRC – continuing careCCRC – continuing care
retirement community (includesretirement community (includes
skilled nursing)skilled nursing)

LONG TERM CARE FACILITIESLONG TERM CARE FACILITIES
Provide healthcare services toProvide healthcare services to
individuals unable to care forindividuals unable to care for
themselves:themselves:
• elderly personselderly persons
• disabled or handicappeddisabled or handicapped
personspersons
• people with chronic illnesspeople with chronic illness

Long term care…
Have we got it?
Let’s check and see
22
Stick diagnostics
Student Name A
Student Name B

ADULT CARE HOMES / HOMES FOR THE AGEDADULT CARE HOMES / HOMES FOR THE AGED
HHOMES FOR THEOMES FOR THE AAGEDGED LLICENSEICENSE (HAL)(HAL)
Formerly called:Formerly called:
•Rest homeRest home
•Assisted livingAssisted living

ADULT CARE HOMES / HOMES FOR THE AGED
Types:
•Family Care HomeFamily Care Home –– serves 2-6serves 2-6
unrelated personsunrelated persons
•Adult Care HomeAdult Care Home –– serves 7 or moreserves 7 or more
unrelated personsunrelated persons
•Group HomeGroup Home –– for developmentalfor developmental
disabled adultsdisabled adults
•Multi unit housing with servicesMulti unit housing with services

ADULT CARE HOMES / HOMES FOR THE AGEDADULT CARE HOMES / HOMES FOR THE AGED
• Assists resident with medicationAssists resident with medication
administrationadministration
• Assists with personal care, dressing, orAssists with personal care, dressing, or
groominggrooming
• Provides three meals a dayProvides three meals a day
• Provides housekeepingProvides housekeeping
• 24 hour supervision24 hour supervision

HOMES FOR THE AGED
• Monitored byMonitored by Adult HomeAdult Home
Specialist within CountySpecialist within County
Department of Social Services.Department of Social Services.
Do most of complaintDo most of complaint
investigations.investigations.
26
• Licensed andLicensed and
inspected byinspected by

Homes for the AGED
Have we got it?
27
Stick diagnostics
What are other names for homes for the aged?What are other names for homes for the aged?
How much medical supervision is given in HAs?How much medical supervision is given in HAs?
What agency issues licenses to HAs?What agency issues licenses to HAs?
What agency monitors HAs?What agency monitors HAs?

HOME CARE AGENCIES
Provide care in theProvide care in the
homehome for peoplefor people
needing health services,needing health services,
but not hospitalizationbut not hospitalization

HOME CARE AGENCIESHOME CARE AGENCIES
Services provided include:Services provided include:
29
• Nursing / CNA / PCANursing / CNA / PCA
• Physical therapyPhysical therapy
• Occupational therapyOccupational therapy
• Speech therapySpeech therapy
• Social servicesSocial services
• Nutritional and food servicesNutritional and food services
• Respiratory therapyRespiratory therapy
• Homemaker servicesHomemaker services

Home Care Agencies
Have we got it?
30
Stick diagnostics
Student Name A
Student Name B

HEALTHCARE FACILITYHEALTHCARE FACILITY
ORGANIZATIONAL STRUCTUREORGANIZATIONAL STRUCTURE
• DisplaysDisplays chain ofchain of
commandcommand
• ShowsShows lines of authoritylines of authority
• Identifies health careIdentifies health care
worker’s positionworker’s position
• Identifies immediateIdentifies immediate
supervisorsupervisor

• Responsible for provision of safeResponsible for provision of safe
and adequate care at a reasonableand adequate care at a reasonable
costcost
• Makes facility policiesMakes facility policies
• Delegates management to anDelegates management to an
administratoradministrator
Governing bodyGoverning body = (Board of Directors)

Department headsDepartment heads
– Have specific areas of responsibilitiesHave specific areas of responsibilities
– Supervise department staffSupervise department staff
• FinanceFinance
• Ancillary servicesAncillary services
• NursingNursing

HEALTHCARE FACILITHEALTHCARE FACILITYY
Medical DirectorMedical Director
Supervises medical staffSupervises medical staff
activitiesactivities
• PhysiciansPhysicians
• ResidentsResidents
• InternsInterns

HEALTHCARE FACILITY
ORGANIZATIONAL STRUCTURE
Director of Nursing andDirector of Nursing and
Assistant DONAssistant DON
• Supervises nursing staffSupervises nursing staff
activitiesactivities
• Responsible for safeResponsible for safe
nursing carenursing care
• Registered nursesRegistered nurses

HEALTHCARE FACILITY
ORGANIZATIONAL STRUCTURE
Nursing supervisorNursing supervisor
• Assists director of nursingAssists director of nursing
• Licensed nurseLicensed nurse
• Assigned areas ofAssigned areas of
responsibilityresponsibility
• Assigned to specific shiftAssigned to specific shift

Charge NurseCharge Nurse
–Has specific areas ofHas specific areas of
responsibilityresponsibility
–Responsible for residentResponsible for resident
care in specific areacare in specific area

Charge NurseCharge Nurse
Supervises staff in specificSupervises staff in specific
areaarea
• Registered nurses (RNs)Registered nurses (RNs)
• Licensed practicalLicensed practical
nurses (LPNs)nurses (LPNs)
• Nurse aides (NAs)Nurse aides (NAs)

LTC Healthcare
organization structure…
Have we got it?
39
Stick diagnostics

LTC FACILITIES REGULATIONLTC FACILITIES REGULATION
40
Federal Level
State Level

41
Federal Level
• Federal agency that worksFederal agency that works
with state agencieswith state agencies
• Runs two national careRuns two national care
programsprograms
MedicareMedicare
MedicaidMedicaid

42
Federal Level
• Helps pay for health careHelps pay for health care
including nursing home careincluding nursing home care
• Sets quality standards forSets quality standards for
long term care facilitieslong term care facilities
• Nursing homes must beNursing homes must be
certified to receive Medicarecertified to receive Medicare
and Medicaid fundsand Medicaid funds

43
Federal Level
Nursing Home Compare for Consumers
http://www.cms.gov/CertificationandComplianc/Downloads/consumerppt.pdf
•Five Star rating systemFive Star rating system
•Quality of care informationQuality of care information
•Characteristics of nursing homesCharacteristics of nursing homes

44
State Level
Two Sections of DHSR:Two Sections of DHSR:
•Nursing Home Licensure and
Certification Section
•Health Care Personnel Registry
Section

LTC FACILITIES REGULATION
45
Nursing Home Licensure andNursing Home Licensure and
Certification SectionCertification Section
•Determines location and number of nursing homesDetermines location and number of nursing homes
needed in NCneeded in NC
•Issues licenses to nursing homes giving permissionIssues licenses to nursing homes giving permission
to operate and provide careto operate and provide care
•"Surveyors" conduct inspections to find out whether"Surveyors" conduct inspections to find out whether
the nursing home meets federal rulesthe nursing home meets federal rules
 Routine inspections take place in nursing homesRoutine inspections take place in nursing homes
that receive payment through Medicare andthat receive payment through Medicare and
Medicaid every 9 to 15 monthsMedicaid every 9 to 15 months
 Surveys take three days on averageSurveys take three days on average

46
Responsibilities of the nurse aide during the
survey process
• Provide quality careProvide quality care
• Protect residents rightsProtect residents rights
• Provide for resident and personal safetyProvide for resident and personal safety
• Keep center clean and safeKeep center clean and safe
• Conduct yourself in a professionalConduct yourself in a professional
mannermanner
• Demonstrate good work ethicsDemonstrate good work ethics
• Follow center policies and proceduresFollow center policies and procedures
• Answer surveyor questions honestlyAnswer surveyor questions honestly
and completelyand completely

47
LTCs can be put onLTCs can be put on
““SANCTION”SANCTION” becausebecause
of:of:
• Substandard careSubstandard care
• CMPCMP –– CCivilivil MMoneyoney PPenaltyenalty

CMP-Civil Money PenaltyCMP-Civil Money Penalty
48
• Fines collected as a result ofFines collected as a result of
nursing home violationsnursing home violations
• Fines are redirected back in theFines are redirected back in the
nursing home industry to improvenursing home industry to improve
the quality of carethe quality of care
• In NC – Win A Step Up is funded byIn NC – Win A Step Up is funded by
CMPCMP

49
Health Care Personnel RegistryHealth Care Personnel Registry
SECTIONSECTION
There are two branches:There are two branches:
1.1. Investigations BranchInvestigations Branch
2.2. Center for Aide Regulation andCenter for Aide Regulation and
Education (CARE) BranchEducation (CARE) Branch

50
Health Care Personnel Registry SECTIONHealth Care Personnel Registry SECTION
InvestigationsInvestigations BRANCHBRANCH
responsible for:responsible for:
1.1. Health Care Personnel RegistryHealth Care Personnel Registry
2.2. Receiving reports from health careReceiving reports from health care
facilitiesfacilities
3.3. Unlicensed health care workerUnlicensed health care worker
investigationsinvestigations
4.4. Listing "Pendings" and "Findings"Listing "Pendings" and "Findings"
on the Nurse Aide I and Health Careon the Nurse Aide I and Health Care
Personnel RegistriesPersonnel Registries

51
Health Care Personnel Registry SECTION
CCenter forenter for AAideide RRegulation andegulation and
EEducationducation (CARE)(CARE) BRANCH isBRANCH is
responsible forresponsible for
1.1.Nurse Aide I Registry, training and competencyNurse Aide I Registry, training and competency
programsprograms
2.2.Medication Aide Registry and competencyMedication Aide Registry and competency
programsprograms
3.3.Geriatric Aide Registry and trainingGeriatric Aide Registry and training
4.4.Feeding assistant training curriculumFeeding assistant training curriculum
5.5.Providing registry access and listingProviding registry access and listing
verificationverification

52
NC New Organizational Vision Award
~NC NOVA~
http://www.ncnova.org/index.html
NC Special State License that honors
excellence in the workplace for
people employed by home care
agencies, adult care homes, and
nursing homes.

53
NC NOVA facilities have the
following:
1.Well trained staff, satisfied and
loyal workers helping families by
caring for their loved ones;
2.Stronger links among workers,
residents, families, and management;

54
NC NOVA facilities have the
following:
3.Chances for staff to better their
skills and advance their careers;
4.Stable, quality worker available
now and for the future.

LONG TERM CARE REGULATIONS – SO WHAT?
55
Nurse AidesNurse Aides mustmust
provideprovide good caregood care
andand comply withcomply with
state and federalstate and federal
and regulations.and regulations.

Consequences of inappropriate actions by the NurseConsequences of inappropriate actions by the Nurse
Aide Student or CNAAide Student or CNA
Name of the Nurse Aide will be
listed on the Health Care
Personnel Registry for a "pending"
allegation or substantiated
allegation "finding(s)".

Consequences of inappropriate actions by the NurseConsequences of inappropriate actions by the Nurse
Aide Student or CNAAide Student or CNA
Nursing homes and other facilities must access
the NC DHSR Health Care Personnel Registry
before they hire unlicensed staff. Listings
include:
•Name of the Nurse AideName of the Nurse Aide
•Nature of the finding or allegationNature of the finding or allegation
•Status of the investigationStatus of the investigation
•Listings on the NC Health Care Personnel Registry will also beListings on the NC Health Care Personnel Registry will also be
listed on the National Practitioner Data Banklisted on the National Practitioner Data Bank

58
NPDB-HIPDB – National PractitionerNPDB-HIPDB – National Practitioner
Data Bank / Healthcare Integrity andData Bank / Healthcare Integrity and
Protection Data BankProtection Data Bank
• Nurse AidesNurse Aides are consideredare considered “practitioners”“practitioners”
• Substantiated negative “Findings” for nurseSubstantiated negative “Findings” for nurse
aides will appear in this national data bank!aides will appear in this national data bank!
http://www.npdb-hipdb.hrsa.gov/

Consequences of inappropriate actions byConsequences of inappropriate actions by
the Nurse Aide Student or CNAthe Nurse Aide Student or CNA
Deficiencies may be cited against
the LTC where the Nurse Aide is
employed

Prevent ProblemsPrevent Problems 
• Good resident careGood resident care
• Given with a good heartGiven with a good heart
• Using Good standardsUsing Good standards
• Each and every dayEach and every day
• Equals aEquals a GREAT CNAGREAT CNA who has nothing towho has nothing to
fear and everything to gain.fear and everything to gain.

Prevent ProblemsPrevent Problems 

• Understand healthcareUnderstand healthcare facilitiesfacilities andand
organizational structure with focusorganizational structure with focus
onon LTCLTC..
62
 ENDEND 
1.011.01

1.01

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