Nursing Assistant

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

Nursing Assistant