Nursing Assistant

Introduction

Federal & State Regulations

California Code of Regulations (CCR) Title 22w, Division 5– CA state laws establishing

• Licensing & Certification standards• MINIMUM standards of care for residents• CNA training regulations• CNA certification requirements

– Licensing of Skilled Nursing Facilities

California Code of Regulations

Skilled nursing facilities must have policies & procedures ensuring resident rights & safety– Ombudsman can evaluate

Violations may lead to state citation & fine

Omnibus Budget Reconciliation Act of 1987 (OBRA)

Federal law requiring nurse aides receive training & pass competency exam within 4 months of employment

Establishes standards of care for Medicare & Medi-Cal reimbursement

Improves resident quality of life Authorizes onsite surveys

OBRA

Violation of federal regs may lead to:– Loss of ability to provide training programs– Monetary penalties– Directed inservices– Payment denial– State monitoring– Termination of facility license

CNA Requirements-CCR, OBRA

Training course approved by DHS– Minimum 50 hours theory plus 10

recommended hours of Alzheimers Disease & Elder Abuse

– Minimum 100 hours clinical in SNF– Course content must comply with Title 22 &

OBRA– Criminal screening upon enrollment

CNA Requirements (cont)

Students who are employees of SNF must be paid hourly wage while in training

History & Physical, TB clearance DHS 283B Initial application form

CNA Requirements

Successfully complete competency test– Written & skills test– Three opportunities to pass– Must be taken within 2 years of

successfully completing course– Competency test fee ($90 for ARC)– Facility must pay test fee if student is an

employee or is hired within a year of passing the test

CNA Requirements

2 Vendors give state competency exam– Chancellor’s office, CA Community Colleges– American Red Cross

Criminal clearance prior to certification Certification renewal requirements

– DHS renewal form 283C form– Complete 48 hours of continuing education in 2

years– Verify 8 hours of paid work as CNA in last 2 years

Certification Renewal (cont)

Criminal clearance – fingerprinting NOT required

Renewal fee payment

Qualities of a Successful CNA

Dependable Considerate Pleasant Empathetic Flexible Honest Compassionate & Caring Sensitive to others

Qualities of a Successful CAN

Responsible Respectful Cooperative Team player Observant Well groomed Organized

Qualities of a Successful CNA

When providing care:– Wash hands– Gather supplies– Knock on door– Introduce self– Check identification– Explain procedures– Obtain permission– Provide privacy

Role/Responsibility of CNA

Member of the health care team which includes:– Resident & family– RN, LVN, CNA– Physician, RNP, PA– PT, OT, Speech therapist– Dietician, Activities Director, Social worker– Clergy, Ombudsman

Role & Responsibility of CNA

Health care settings where employed– SNF, Acute care hospitals, Intermediate

care facilities– Hospice– Assisted living, Residential care– Psychiatric facilities– Clinics– Prisons

Role & Responsibility of CNA

CNA responsible to:– Licensed nurse– DSD – RN Supervisor– Director of Nursing– Facility/Agency Administrator– Physician if in a clinic setting

Responsibility in Resident Care

Provide a safe environment– Proper use of equipment/protective

devices– Awareness of potential hazards (spills, etc)– Provide personal hygiene/cleanliness– Care for resident’s personal property– Adhere to standard precautions

Responsibility in Resident Care

Meet the resident’s physical needs– Assist with ADLs in a timely manner– Assisting with medical & rehab activities

(VS, turning, specimen collection, ambulation, etc)

– Maintaining clean environment

Responsibility in Resident Care

Assist resident’s to meet psychosocial, spiritual, & cultural needs– RESIDENT RIGHTS– Treated with dignity & respect– Feel secure & recognized as individual– Love & be loved– Feel sense of accomplishment & good about

themselves– Follow personal beliefs

Fulfill Responsibility to Employer

Reporting to work on time Reliably fulfilling assignments Notifying supervisor when ill Working as a team member Doing one’s job to the best of his/her

ability according to JOB DESCRIPTION Conserving supplies/equipment

Professionalism for CNA

Carrying out resident care in a manner that:– Ethical & Competent– Knowledgeable & Caring– Committed & Giving of dignity– Representative of high standards

Professionalism for CNA

Professional behaviors or attitudes– Skilled & caring when giving care– Responsible, trustworthy, truthful (reports change

of address to DHS, keeps record of inservices)– Attending inservices, maintaining state certification– Following chain of command & scope of practice– Being a team player– Asking for assistance if needed (from who?)– Being a mandated reporter

Ethical Behavior for CNA

Ethical Behavior for Resident Care– Protect life & promote health– Keep personal info confidential– Respect each person as an individual– Give care based on need, not gratuities

Ethical Behavior for CNA

Ethical behavior for work– Working assigned shift– Arriving on time– Being absent only when necessary– Notifying employer prior to necessary absences– Following instructions within scope of practice– Being loyal, flexible, & cooperative – a team

member

Ethical Behavior for CNA

Unacceptable behavior which may result in dismissal:– Abuse– Stealing or willfully damaging property– Insubordination & neglecting duties– Altering or falsifying records– Working under influence of drugs/alcohol– Dishonesty & breech of confidentiality

Confidentiality

Maintained by discussing personal info only with appropriate health team members at appropriate times & places

Examples –– Adhering to HIPAA guidelines (Health

Insurance Portability & Accountability Act) which limits sharing of information without patient consent

Examples of Confidentiality cont.

Discussing observations with nurse or physician

Discussing resident’s care while participating in team conferences or planning

Examples of Breeching Confidentiality

Discussing personal information with– Another resident– Concerned friends or visitors– Members of the news media– Members of the CNA’s family– Persons in the community– Health team members not directly involved

with resident care