Chapter 2

1. Chapter 2 The Nursing Assistant

2. To protect patients and residents from harm, you need to know: • What you can and cannot do • Your legal limits • The following shape your work: • Laws • Job descriptions • The person’s condition • The amount of supervision you need

3. HISTORY AND CURRENT TRENDS • Until the 1980s, training was not required by law. • Before the 1980s, team nursing was common. • Primary nursing was common in the 1980s. • Home care increased during the 1980s. • Efforts to reduce health care costs include: • Hospital closings • Hospital mergers • Health care systems • Managed care • Staffing mix • Patient-focused care

4. FEDERAL AND STATE LAWS • Each state has a nurse practice act which: • Defines RN and LPN/LVN • Some acts also define nursing assistant. • Describes the scope of practice for RNs and LPNs/LVNs • Describes education and licensing requirements for RNs and LPNs/LVNs • Protects the public from persons practicing nursing without a license • Allows for denying, revoking, and suspending a nursing license

5. Nursing assistants • Some nurse practice acts also regulate nursing assistant roles, functions, education, and certification requirements. • In other states, there are separate laws for nursing assistants. • If you do something beyond the legal limits of your role, you could be practicing nursing without a license.

6. The Omnibus Budget Reconciliation Act of 1987 (OBRA) is a federal law. • Its purpose is to improve the quality of life of nursing center residents. • This law sets minimum training and competency evaluation requirements for nursing assistants. • Each state must have a nursing assistant training and competency evaluation program (NATCEP).

7. The training program • OBRA requires at least 75 hours of instruction. • There must be at least 16 hours of supervised practical training. • Competency evaluation • The competency evaluation has a written test and a skills test. • OBRA allows at least 3 attempts to successfully complete the evaluation.

8. OBRA requires a nursing assistant registry in each state. • It is an official record or listing of persons who have successfully completed that state’s state-approved NATCEP. • The registry has information about each nursing assistant. • All information stays in the registry for at least 5 years. • Any agency can access registry information. • You receive a copy of your registry information. • You can correct wrong information.

9. Other OBRA requirements • Retraining and a new competency evaluation program are required for nursing assistants who have not worked for 24 months. • Agencies covered under OBRA must provide 12 hours of educational programs to nursing assistants every year. • Performance reviews also are required.

10. ROLES AND RESPONSIBILITIES • To protect persons from harm, you must understand: • What you can do • What you cannot do • The legal limits of your role • In some states, this is called scope of practice. • The National Council of State Boards of Nursing (NCSBN) calls it range of functions. • Licensed nurses supervise your work. • You assist them in giving care.

11. Before you perform a nursing task, make sure that: • Your state allows nursing assistants to do so • It is in your job description • You have the necessary education and training • A nurse is available to answer questions and to supervise you • You must know what you can do in the state in which you are working. • State laws and rules limit nursing assistant functions. • No agency or nurse can expand your range of functions beyond what is allowed by your state’s laws and rules.

12. The job description: • Describes what the agency expects you to do • States educational requirements • Always obtain a written job description when you apply for a job. • Ask questions about it during your job interview. • Before accepting a job: • Tell the employer about functions you did not learn • Advise the employer of functions you cannot do for moral or religious reasons • Clearly understand what is expected

13. Do not take a job that requires you to: • Act beyond the legal limits of your role • Function beyond your training limits • Perform acts that are against your morals or religion • You need to know: • What you can safely do • The things you should never do • Your job description • The ethical and legal aspects of your role

14. DELEGATION • Delegate means to authorize another person to perform a nursing task in a certain situation. • The person must be competent to perform a task in a given situation.

15. Who can delegate • RNs can delegate nursing tasks to LPNs/LVNs and nursing assistants. • In some states, LPNs/LVNs can delegate tasks to nursing assistants. • Delegation decisions must protect the person’s health and safety. • The delegating nurse is legally accountable for the nursing task. • The RN is accountable for all nursing care. • Nursing assistants cannot delegate.

16. The National Council of State Boards of Nursing (NCSBN) describes four steps in the delegation process. • Step 1—Assess and Plan is done by the nurse. • Step 2—Communication involves the nurse and you. • Step 3—Surveillance and Supervision (the nurse observes the care you give). • Step 4—Evaluation and Feedback is done by the nurse.

17. The NCSBN’s Five Rights of Delegation is another way to view the delegation process. • The right task • The right circumstances • The right person • The right directions and communication • The right supervision

18. Your role in delegation • You must protect the person from harm. • You either agree or refuse to do a delegated task. • Accepting a task • When you agree to perform a task, you are responsible for your own actions. • You must complete the task safely. • Report to the nurse what you did and the observations you made.

19. You should refuse to perform a task when: • The task is beyond the legal limits of your role. • The task is not in your job description. • You were not prepared to perform the task. • The task could harm the person. • The person’s condition has changed. • You do not know how to use the supplies or equipment. • Directions are not ethical or legal. • Directions are against agency policies. • Directions are unclear or incomplete. • A nurse is not available for supervision.

20. Never ignore an order or a request to do something. • Tell the nurse about your concerns. • You must have sound reasons for refusing a task.