Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 2Chapter 2

The Nursing AssistantThe Nursing Assistant

Slide 2 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

To protect patients and residents from To protect patients and residents from harm, you need to know:harm, you need to know:

What you can and cannot doWhat you can and cannot do Your legal limitsYour legal limits

The following shape your work:The following shape your work: LawsLaws Job descriptions Job descriptions The person’s condition The person’s condition The amount of supervision you needThe amount of supervision you need

Slide 3 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

HISTORY AND CURRENT TRENDSHISTORY AND CURRENT TRENDS Until the 1980s, training was not required by Until the 1980s, training was not required by

law.law. Before the 1980s, team nursing was common.Before the 1980s, team nursing was 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 to reduce health care costs include:Efforts to reduce health care costs include:

• Hospital closingsHospital closings• Hospital mergersHospital mergers• Health care systemsHealth care systems• Managed careManaged care• Staffing mixStaffing mix• Patient-focused carePatient-focused care

Slide 4 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

FEDERAL AND STATE LAWSFEDERAL AND STATE LAWS Each state has a nurse practice act which:Each state has a nurse practice act which:

• Defines RN and LPN/LVNDefines RN and LPN/LVN Some acts also define nursing assistant.Some acts also define nursing assistant.

• Describes the scope of practice for RNs and Describes the scope of practice for RNs and LPNs/LVNsLPNs/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 denying, revoking, and suspending a Allows for denying, revoking, and suspending a nursing licensenursing license

Slide 5 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing assistantsNursing assistants• Some nurse practice acts also regulate nursing Some nurse practice acts also regulate nursing

assistant roles, functions, education, and certification assistant roles, functions, education, and certification requirements.requirements.

• In other states, there are separate laws for nursing In other states, there are separate laws for nursing assistants.assistants.

• If you do something beyond the legal limits of your If you do something beyond the legal limits of your role, you could be practicing nursing without a license.role, you could be practicing nursing without a license.

Slide 6 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

The Omnibus Budget Reconciliation Act of 1987 The Omnibus Budget Reconciliation Act of 1987 (OBRA) is a federal law.(OBRA) is a federal law.

• Its purpose is to improve the quality of life of nursing Its purpose is to improve the quality of life of nursing center residents.center residents.

• This law sets minimum training and competency This law sets minimum training and competency evaluation requirements for nursing assistants.evaluation requirements for nursing assistants.

• Each state must have a nursing assistant training and Each state must have a nursing assistant training and competency evaluation program (NATCEP).competency evaluation program (NATCEP).

Slide 7 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

The training programThe training program• OBRA requires at least 75 hours of instruction.OBRA requires at least 75 hours of instruction.• There must be at least 16 hours of supervised practical There must be at least 16 hours of supervised practical

training.training. Competency evaluationCompetency evaluation

• The competency evaluation has a written test and a The competency evaluation has a written test and a skills test.skills test.

• OBRA allows at least 3 attempts to successfully OBRA allows at least 3 attempts to successfully complete the evaluation.complete the evaluation.

Slide 8 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

OBRA requires a nursing assistant registry in OBRA requires a nursing assistant registry in each state.each state.

• It is an official record or listing of persons who have It is an official record or listing of persons who have successfully completed that state’s state-approved successfully completed that state’s state-approved NATCEP.NATCEP.

• The registry has information about each nursing The registry has information about each nursing assistant.assistant.

• 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.• You can correct wrong information.You can correct wrong information.

Slide 9 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Other OBRA requirementsOther OBRA requirements• Retraining and a new competency evaluation program Retraining and a new competency evaluation program

are required for nursing assistants who have not are required for nursing assistants who have not worked for 24 months.worked for 24 months.

• Agencies covered under OBRA must provide 12 hours Agencies covered under OBRA must provide 12 hours of educational programs to nursing assistants every of educational programs to nursing assistants every year.year.

• Performance reviews also are required.Performance reviews also are required.

Slide 10 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

ROLES AND RESPONSIBILITIESROLES AND RESPONSIBILITIES 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 scope of practice.In some states, this is called scope of practice. The National Council of State Boards of Nursing The National Council of State Boards of Nursing

(NCSBN) calls it range of functions.(NCSBN) calls it range of functions. Licensed nurses supervise your work.Licensed nurses supervise your work.

• You assist them in giving care.You assist them in giving care.

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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 soYour state allows nursing assistants to do so• It is in your job descriptionIt is in your job description• You have the necessary education and trainingYou 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 yousupervise you You must know what you can do in the state in You must know what you can do in the state in

which you are working.which you are working.• State laws and rules limit nursing assistant functions.State laws and rules limit nursing assistant functions.• No agency or nurse can expand your range of No agency or nurse can expand your range of

functions beyond what is allowed by your state’s laws functions beyond what is allowed by your state’s laws and rules.and rules.

Slide 12 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

The job description:The job description:• Describes what the agency expects you to doDescribes what the agency expects you to do• States educational requirementsStates educational requirements

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

• Ask questions about it during your job interview.Ask questions about it during your job interview. Before accepting a job:Before accepting a job:

• Tell the employer about functions you did not learnTell the employer about functions you did not learn• Advise the employer of functions you cannot do for Advise the employer of functions you cannot do for

moral or religious reasonsmoral or religious reasons• Clearly understand what is expected Clearly understand what is expected

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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

You need to know:You need to know:• What you can safely doWhat you can safely do• 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 Delegate means to authorize another person to Delegate means to authorize another person to

perform a nursing task in a certain situation.perform a nursing task in a certain situation.• The person must be competent to perform a task in a The person must be competent to perform a task in a

given situation.given situation.

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Who can delegateWho can delegate• RNs can delegate nursing tasks to LPNs/LVNs and RNs can delegate nursing tasks to LPNs/LVNs and

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

assistants.assistants.• Delegation decisions must protect the person’s health Delegation decisions must protect the person’s health

and safety.and safety.• The delegating nurse is legally accountable for the The delegating nurse is legally accountable for the

nursing task.nursing task.• The RN is accountable for all nursing care.The RN is accountable for all nursing care.• Nursing assistants cannot delegate.Nursing assistants cannot delegate.

Slide 16 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

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

• Step 1—Assess and Plan is done by the nurse.Step 1—Assess and Plan is done by the nurse.• Step 2—Communication involves the nurse and you.Step 2—Communication involves the nurse and you.• Step 3—Surveillance and Supervision (the nurse Step 3—Surveillance and Supervision (the nurse

observes the care you give).observes the care you give).• Step 4—Evaluation and Feedback is done by the Step 4—Evaluation and Feedback is done by the

nurse.nurse.

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The NCSBN’s The NCSBN’s Five Rights of DelegationFive Rights of Delegation is is another way to view the delegation process.another way to view the delegation process.

• 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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Your role in delegationYour role in delegation• You must protect the person from harm.You must protect the person from harm.• You either agree or refuse to do a delegated task.You either agree or refuse to do a delegated task.

Accepting a taskAccepting a task• When you agree to perform a task, you are responsible When you agree to perform a task, you are responsible

for your own actions.for your own actions.• You must complete the task safely.You must complete the task safely.• Report to the nurse what you did and the observations Report to the nurse what you did and the observations

you made.you made.

Slide 19 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

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 You do not know how to use the supplies or

equipment.equipment.• Directions are not ethical or legal.Directions are not ethical or legal.• Directions are against agency policies.Directions are against agency 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.

Slide 20 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Never ignore an order or a request to do Never ignore an order or a request to do something.something.

• Tell the nurse about your concerns.Tell the nurse about your concerns.• You must have sound reasons for refusing a task.You must have sound reasons for refusing a task.