Chapter 3
The Nursing Assistant
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Introduction
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To protect patients and residents from harm,
you need to know:
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What you can and cannot do
Your legal limits
The following shape your work:
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Laws
Job descriptions
The person’s condition
The amount of supervision you need
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 2
History and Current Trends
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Prior to the 1980s
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Training was not required by law.
Team nursing was common.
During the 1980s
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Primary nursing was common.
Home care increased.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 3
History and Current Trends (cont’d)
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Efforts to reduce health care costs include:
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Hospital closings
Hospital mergers
Health care systems
Managed care
Staffing mix
Patient-focused care
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 4
Federal and State Laws
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Each state has a nurse practice act that:
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Defines RN and LPN/LVN
• Some acts also define nursing assistants.
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
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 5
Federal and State Laws (cont’d)
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Nursing assistants
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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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 6
Federal and State Laws (cont’d)
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The Omnibus Budget Reconciliation Act of
1987 (OBRA) is a federal law.
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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).
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 7
Federal and State Laws (cont’d)
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The training program
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OBRA requires at least 75 hours of instruction.
 Includes classroom and at least 16 hours of
supervised practical training
 Provides the knowledge and skills needed to give
basic nursing care
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Competency evaluation
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Includes a written test and a skills test
OBRA allows at least 3 attempts to successfully
complete the evaluation.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 8
Federal and State Laws (cont’d)
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Nursing Assistant Registry
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Official record or listing of persons who have
successfully completed that state’s 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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 9
Federal and State Laws (cont’d)
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Other OBRA requirements
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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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 10
Certification
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Each State’s NATCEP must meet OBRA
requirements.
Nursing assistants can have their certification
(licenses, registration) denied, revoked, or
suspended.
To work in another state you must meet that
state’s NATCEP requirements:
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Apply to the state agency responsible for NATCEPs
and the nursing assistant registry.
 Your application is reviewed.
 Certification (a license, registration) is granted if
requirements are met.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 11
Roles and Responsibilities
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Scope of practice/Range of functions
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Legal limits of your role
Varies among states and agencies
Protects persons from harm
Licensed nurses supervise your work.
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You assist them in giving care.
You perform nursing tasks.
• Before performing a task, make sure it is allowed by
your state, it is in your job description, you have the
necessary education and training, and a nurse is
available to supervise and answer questions.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 12
Roles and Responsibilities (cont’d)
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Nursing Assistant Standards
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OBRA defines a basic range of functions.
• All NATCEPs include these functions.
• NATCEPs prepare nursing assistants to meet the
standards.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 13
Roles and Responsibilities (cont’d)
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Job description
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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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 14
Roles and Responsibilities (cont’d)
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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
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 15
Delegation
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Delegate means to authorize another person
to perform a nursing task in a certain situation.
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The person must be competent to perform a task in
a given situation.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 16
Delegation (cont’d)
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Who can delegate
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RNs can delegate nursing tasks to LPNs/LVNs
and nursing assistants.
• In some states, LPNs/LVNs can delegate tasks to
nursing assistants.
Delegation must protect health and safety.
•
 Nursing assistants cannot delegate.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 17
Delegation (cont’d)
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The National Council of State Boards of
Nursing (NCSBN) describes four steps in the
delegation process.
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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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 18
Delegation (cont’d)
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The NCSBN’s Five Rights of Delegation is
another way to view the delegation process.
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The right task
 The right circumstances
 The right person
 The right directions and communication
 The right supervision
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 19
Delegation (cont’d)
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Your role in delegation
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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
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•
for your own actions.
You must complete the task safely.
Report to the nurse what you did and the observations
you made.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 20
Delegation (cont’d)
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Refusing a task
• 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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 21
Delegation (cont’d)
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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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 22