ch 3 the nursing assistant Flashcards
To protect patients and residents from harm, you need to know:
- What you can and cannot do
- What is right conduct and wrong conduct
- Rules and standards of conduct affecting your work
- Your legal limits
The following shape your work:
- Laws
- Job descriptions
- The person’s condition
- The amount of supervision you need
Nurse Practice Acts
Each state has a nurse practice act. A nurse practice act:
- Defines RN and LPN/LVN and their scope of practice
- Describes education and licensing requirements for RNs and LPNs/LVNs
Nurse Practice Acts
Protects the public from
- persons practicing nursing without a license
- Persons who do not meet the state’s requirements cannot perform nursing functions.
nurse practice act
nurse practice act
- The law allows for denying, revoking, or suspending a nursing license.
- The intent is to protect the public from unsafe nurses.
Nursing Assistants
A state’s nurse practice act is used to decide what nursing assistants
- can do
- Other states have separate laws for nursing assistants.
- If you do something beyond the legal limits of your role, you could be practicing nursing without a license.
Nursing Assistants
Some nurse practice acts regulate:
- Nursing assistant roles
- Functions
- Education
- Certification requirements
Nursing Assistants
other states have seperate laws for
nursing assistants
nursing assistants
if you do something beyond the legal limits of your role you could be
practicing nursing without a license
OBRA requirements
the Omnibus Budget Reconcilitation Act of 1987 (OBRA) is what kind of law
federal law
OBRA requirements
each state MUST have a
nursing assistant training and competency evaluation program (NATCEP)
OBRA requirements
the NATCEP must be SUCCESSFULLY COMPLETED by nursing assistant working in
- nursing centers
- hospital long-term care units
- home care agencies receiving medicare funds
the training program
OBRA requires at least
- 85 hours of instruction provided by a nurse
- 24 hours are supervised practical training
- some states require more than 75 hours of instruction
- instruction includes the knowledge and skills needed to give basic nursing care
- the supervised pratical training occurs in a lab or clinical setting
OBRA requirements
competency evaluation
has a written test and a skills test
OBRA requirements
nursing assistant registry
- each state must have a nursing assistant registry
- this is an offical list of persons who have successfully completed a NATCEP
- certification, license, or registration denied, revoked, or suspended
- the registry has information about each nursing assistant
- any agency can access registry information, you receive a copy of your registry information
- you can correct wrong info
certification
after successfully completing your state’s NATCEP you have the title used in your state
- certified nursing assistant (CNA) or certified nurse aide (CNA. CNA is used in most states
- licensed nursing assistant (LNA)
- registered nurse aide (RNA)
- state tested nurse aide (STNA)
Maintaining Competence
Retraining and a new competency evaluation program are required for nursing assistants who have not worked for 24 months.
States can require:
- A new competency evaluation (written/oral/skills)
- Both re-training and a new competency evaluation
- NCSBN-can deny, revoke, suspend certifications (see box 3-1, pg. 20)
- It does not matter how long you worked as a nursing assistant before. What matters is how long you did not work.
- Agencies must provide 12 hours of educational programs to nursing assistants every year.
- Performance reviews also are required
Roles and Responsibilities
The following direct what you can do: (the nurse practice acts, OBRA, state laws, and legal and advisory opinions)
- OBRA: says each state must have NATCEP, must complete to work in a nursing center with Medicare funds.
- State laws
- Legal and advisory opinions
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 (scope of practice or Range of Practice-NCSBN)
Roles and Responsibilities
Licensed nurses supervise
your work.
Roles and Responsibilities, cont’d.
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
- Your roles is to perform delegated task
Roles and Responsibilities, cont’d.
You perform nursing task to :
Meet the person’s hygiene
Safety
Comfort
Nutrition
Exercise
Elimination needs
Move and transfer persons
Make observation
Measure/record vital signs
Help promote the person’s mental comfort
Roles Limits
Roles Limits
Never give drugs
Never insert tubes or objects into body openings or remove them (exceptions enemas)
Never take oral or phone orders from doctors
Never perform procedures that require sterile technique
Never tell the person or family the person’s diagnosis or medical or surgical treatments
Never diagnose or prescribe treatments or drugs for anyone
Never supervise others including other nursing assistants
Never ignore an order or request to do something
Nursing Assistant Standards
OBRA defines the basic
range of functions for nursing assistants.
All NATCEPs include those functions.
Some states allow other functions.
Delegation Process
The National Council State Board of Nursing (NCSBN) describes four steps in the delegation process:
Step 1—assess and plan
Step 2—communication
Step 3—surveillance (keep a close watch) and supervision (oversee, direct, manage)
Step 4—evaluation (judge) and feedback
Delegation Process
The NCSBN’s Five Rights of Delegation are:
The right task
The right circumstances (pt. physical, mental, emotional and spiritual needs)
The right person (training an experience)
The right directions and communication (the nurse tells you what to do and when to do it)
The right supervision (nurse guides, directs and evaluates care given)
