Chapter 3

Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 3Chapter 3

The Nursing Assistant in The Nursing Assistant in Long-Term CareLong-Term Care


Nursing Assistant DutiesNursing Assistant Duties

To protect residents from harm, you need to To protect residents from harm, you need to know:know: What you can and cannot doWhat you can and cannot do What is right conduct and wrong conductWhat is right conduct and wrong conduct Your legal limitsYour legal limits

Your work is shaped by:Your work is shaped by: LawsLaws Job descriptionsJob descriptions The person’s conditionThe person’s condition The amount of supervision you needThe amount of supervision you need

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History and Current TrendsHistory and Current Trends

Until the 1980s, nursing assistant training was Until the 1980s, nursing assistant training was not required by law.not required by law.

Before the 1980s, team nursing was Before the 1980s, team nursing was common.common.

Primary nursing was common in the 1980s.Primary nursing was common in the 1980s. Home care increased during the 1980s.Home care increased during the 1980s.

Efforts were made to reduce health care costs.Efforts were made to reduce health care costs.

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Federal and State LawsFederal and State Laws

You must know the state and federal laws that You must know the state and federal laws that affect your work.affect your work.

Each state has a nurse practice act that:Each state has a nurse practice act that: Defines RN and LPN/LVNDefines RN and LPN/LVN Describes the scope of practice for RNs and Describes the scope of practice for RNs and

LPNs/LVNs LPNs/LVNs Describes education and licensing requirements for Describes education and licensing requirements for

RNs and LPNs/LVNsRNs and LPNs/LVNs Protects the public from persons practicing nursing Protects the public from persons practicing nursing

without a licensewithout a license Allows for revoking or suspending a nurse’s licenseAllows for revoking or suspending a nurse’s license

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Nursing assistantsNursing assistants A state’s nurse practice act is used to decide what nursing A state’s nurse practice act is used to decide what nursing

assistants can do.assistants can do. The Omnibus Budget Reconciliation Act of 1987 The Omnibus Budget Reconciliation Act of 1987

(OBRA) applies to all states.(OBRA) applies to all states. It sets minimum training and competency evaluation It sets minimum training and competency evaluation

requirements for nursing assistants.requirements for nursing assistants. It requires each state to have a nursing assistant training It requires each state to have a nursing assistant training

and competency evaluation program (NATCEP).and competency evaluation program (NATCEP). The training programThe 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.

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Competency evaluationCompetency evaluation The competency evaluation has a written test and a skills test.The competency evaluation has a written test and a skills test. The written test has multiple choice questions.The written test has multiple choice questions. The skills test involves performing nursing skills.The skills test involves performing nursing skills.

Nursing assistant registry is an official record of persons who Nursing assistant registry is an official record of persons who have successfully completed a state-approved NATCEP.have successfully completed a state-approved NATCEP.

All information stays in the registry for at least 5 years.All information stays in the registry for at least 5 years. Any agency can access registry information.Any agency can access registry information. You receive a copy of your registry information.You receive a copy of your registry information.

Other OBRA requirementsOther OBRA requirements Retraining and a new competency evaluation program for nursing assistants who have Retraining and a new competency evaluation program for nursing assistants who have

not worked for 24 monthsnot worked for 24 months 12 hours of educational programs for nursing assistants every year12 hours of educational programs for nursing assistants every year Performance reviewsPerformance reviews

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CertificationCertification

After successfully completing your state’s After successfully completing your state’s NATCEP, you have the title used in your NATCEP, you have the title used in your state. state. Certified nursing assistant (CNA) or certified nurse Certified nursing assistant (CNA) or certified nurse

aide (CNA) aide (CNA) Licensed nursing assistant (LNA) Licensed nursing assistant (LNA) Registered nurse aide (RNA)Registered nurse aide (RNA)

Nursing assistants can have their certification Nursing assistants can have their certification (licenses, registration) denied, revoked, or (licenses, registration) denied, revoked, or suspended.suspended.

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Working in Another StateWorking in Another State

To work in another state, you must meet that To work in another state, you must meet that state’s registry requirements.state’s registry requirements.

To do so, contact the state agency To do so, contact the state agency responsible for NATCEPs and the nursing responsible for NATCEPs and the nursing assistant registry.assistant registry.

Then apply to the state agency to be a CNA Then apply to the state agency to be a CNA (LNA, RNA).(LNA, RNA).

Your application is reviewed to see if you Your application is reviewed to see if you meet the state’s requirements.meet the state’s requirements.

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Roles and ResponsibilitiesRoles and Responsibilities

The following direct what you can do:The following direct what you can do: Nurse practice actsNurse practice acts OBRAOBRA State lawsState laws Legal and advisory opinionsLegal and advisory opinions

To protect persons from harm, you must To protect persons from harm, you must understand:understand: What you can doWhat you can do What you cannot doWhat you cannot do The legal limits of your roleThe legal limits of your role

• In some states, this is called In some states, this is called scope of practice.scope of practice.• The National Council of State Boards of Nursing (NSCBN) The National Council of State Boards of Nursing (NSCBN)

calls it calls it range of functions.range of functions.Slide 9


Nursing Assistant StandardsNursing Assistant Standards

OBRA defines the basic range of functions for OBRA defines the basic range of functions for nursing assistants.nursing assistants.

All NATCEPs include those functions. Some All NATCEPs include those functions. Some states allow other functions. states allow other functions.

NATCEPs also prepare nursing assistants to NATCEPs also prepare nursing assistants to meet those standards.meet those standards.

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Licensed nurses supervise your work.Licensed nurses supervise your work. You assist in giving care. You assist in giving care. You also perform nursing tasks.You also perform nursing tasks. Before you perform a nursing task, make sure Before you perform a nursing task, make sure

that: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 A nurse is available to answer questions and to

supervise you.supervise you.

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The job description:The job description: Is a list of responsibilities the center expects you to Is a list of responsibilities the center expects you to

performperform States educational requirementsStates educational requirements

Always request a written job description when Always request a written job description when you apply for a job.you apply for a job.

Do not take a job that requires you to:Do not take a job that requires you to: Act beyond the legal limits of your roleAct beyond the legal limits of your role Function beyond your training limitsFunction beyond your training limits Perform acts that are against your morals or religionPerform acts that are against your morals or religion

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No one can force you to do something No one can force you to do something beyond the legal limits of your role. beyond the legal limits of your role.

You must understand:You must understand: Your roles and responsibilitiesYour roles and responsibilities The functions you can safely performThe functions you can safely perform The things you should never doThe things you should never do Your job descriptionYour job description The ethical and legal aspects of your roleThe ethical and legal aspects of your role

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DelegationDelegation

DelegateDelegate means to authorize another person means to authorize another person to perform a nursing task in a certain to perform a nursing task in a certain situation.situation. The person must be competent to perform a task The person must be competent to perform a task

in a given situation.in a given situation. Who can delegate?Who can delegate?

RNs can delegate tasks to LPNs/LVNs and RNs can delegate tasks to LPNs/LVNs and nursing assistants.nursing assistants.

In some states, LPNs/LVNs can delegate tasks to In some states, LPNs/LVNs can delegate tasks to nursing assistants.nursing assistants.

Nursing assistants cannot delegate.Nursing assistants cannot delegate.

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The National Council of State Boards of Nursing (NCSBN) The National Council of State Boards of Nursing (NCSBN) describes the delegation process in four steps.describes the delegation process in four steps.

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 Surveillance and supervision: the nurse has to make sure that you

complete the task correctly.complete the task correctly. Evaluation and feedback: the nurse decides if the delegation was Evaluation and feedback: the nurse decides if the delegation was

successful.successful. The Five Rights of Delegation (according to the NCSBN)The Five Rights of Delegation (according to the NCSBN)

The right taskThe right task The right circumstancesThe right circumstances The right personThe right person The right directions and communicationThe right directions and communication The right supervisionThe right supervision

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When you agree to perform a task: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 You must ask for help when you are unsure or

have questions about a task.have questions about a task. You must report to the nurse what you did and the You must report to the nurse what you did and the

observations you made.observations you made.

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You should refuse to perform a task when: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.

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Quality of LifeQuality of Life

The work you do is important for the person’s The work you do is important for the person’s quality of life. quality of life.

Your current training is just the start of a Your current training is just the start of a lifetime of learning and possibilities.lifetime of learning and possibilities.

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