Facilities and C.N.A. Roles

1. Facilities and C.N.A. Roles Denise Morris, RN MSN Taylor Hudson, CNA

2. Introduction • Population is aging quickly • Population over 80 y/o is the fast growing • 1990 – Life expectancy was 49 y/o • 2004 – Life expectancy was 74 y/o • 1/6 jobs is in health care • LTC, Hospice, Homes, Dr. Office, Assisted Living

3. The Law • Federal, State and Agency Policy govern rules and Fx • Law • Job description • Person’s condition • Amount of supervision

4. The Law • You need to know: • What you can do • What you can’t do • What is right and what is wrong

5. History and Current Trends • Prior to 1980 • Training not required by lay • RN gave OJT training • 1980 • Team Nursing common – RN team leader assigned care according to need and skill • Primary Nursing common mid 1980’s - RN gave all care in hospitals, CNA used in nursing homes

6. History and Trends • Criteria motivating change in training Program • Caused rise in RN use • Increasing cost • Prospective payment limited hospital stay • Reduction in quality • Nurse Practice Act – Defines Scope

7. State and Federal Law • 1987 Omnibus Reconciliation Act • Funded by Medicare at Federal Level • Funded by Medicaid at State Level

8. State and Federal Law • Nurse Practice Acts • Define RN/LPN/CAN roles • Describe scope of practice and license requirements • Protects the public from practicing without a license • Allows for Revocation • Convicted of a crime • Selling/distributing drugs • Using person’s drugs for yourself • Placing a person in danger from overuse of drugs • Negligence • Aiding or assisting another to violate practice rules • Making medical diagnosis

9. Omnibus Budget Reconciliation Act (OBRA) • Applies in all 50 states • Purpose • Decrease cost • Increase quality • Sets minimum training and competency training • Requires each state to have CNA training program to include: • 75 classroom hours • 12 days of clinical experience

10. Omnibus Budget Reconciliation Act (OBRA) • Areas of Study • Communication • Infection Control • Safety • Resident Rights • Basic Nursing • Personal Care • Feeding • Skin care • Elimination • Transferring and turning • Dressing • Ambulation • ROM • S&S of common diseases • Caring for cognitively impaired

11. Omnibus Budget Reconciliation Act (OBRA) • Competency Evaluation • Written exam • Practical Test • Nursing Assistant Registry • OBRA requires state to keep list of CNA’s for 5 years • Any agency can access registry

12. Roles and Responsibilities • Vary from state to state, but generally: • ADL’s • Special Procedures • Support Services • Documentation

13. Roles and Responsibilities • Professionalism • Characteristics of professional behavior: attitude, appearance, confidentiality, advocacy, security • Personal characteristics necessary for CNA: sensitive, mature, dependable, empathetic,

14. Roles and Responsibilities • Delegation • Nurse practice act only allows nurse to delegate tasks that don’t require special skills (i.e. ADL’s) • RN still accountable • Who can delegate? • RN to LPN/CNA • LPN to CNA • CNA can’t delegate

15. Roles and Responsibilities • Delegation Process • Must be within legal limits of provider • Task in job description and OK in state • Have had training and competent • Experience in doing task independently

16. Roles and Responsibilities • 5 Rights of Delegation • Right Task • Right Person • Right Directions/Communication • Right Supervision • Right Circumstances