Documentation for Certified Nursing Assistants: Legal Aspects, Ethics and
Legal Issues
Course Contents
Purpose
Objectives
Introduction
Florida Statutes/Scope of
Practice
Standards of Care
Ethics
Knowledge of Malpractice
is Important!
Abuse, Neglect and
Abandonment
Legal Documentation
Conclusion
References
Purpose
The purpose of this program is to ensure that Certified Nursing
Assistants stay within their scope of practice, and to be aware of ethics.
Objectives
Describe the CNA role in Long Term and Home Health Care
Discuss Florida Statutes/Scope of Practice
Define Standards of Care
Clarify Scope of Practice
Define Ethics
Explain why knowledge of malpractice is so important
Discuss abuse, neglect, abandonment
Discuss legal documentation
Introduction
Certified Nursing Assistants (CNAs) play a very important role in Long
Term and Home Health care. CNAs work closely with their residents,
giving personal care, listening to their life stories and having access to
private health care issues. CNAs are required to work closely with the
Registered Nurses and the Licensed Practical Nurses, working within
their scope of practice.
According to Florida State regulations, a nursing assistant means
providing care and assisting persons with tasks relating to the activities
of daily living. These include personal care, residents’ or patient rights
and documentation of nursing assistant services (Florida Legislature,
2009). When the laws are not obeyed, the CNA can be held liable, and
may lose their license to practice.
Florida Statutes/Scope of Practice
The Florida Statutes (Laws) are very specific about the role of the CNA
in long term and home health care. They can only work under the direct
supervision of a licensed nurse. Direct supervision means the physical
presence within the patient care unit of a healthcare facility or physical
presence within a healthcare agency of a program instructor who
assumes responsibility for the practice of the certified nursing assistant
(Nurse Practice Act, 2009). All this means is that the certified nursing
assistant can not work alone or make any nursing decisions regarding
resident care.
The Nurse Practice Act, and Standards of Care, defines what the
certified nursing assistant can and can not do, even with supervision.
The tasks associated with Activities of Daily Living (ADLs) are
maintaining mobility, tasks regarding feeding, elimination, and
information gathering (Nurse Practice Act, 2009). The information a CNA
collects may be how much the resident has eaten, bowel movements,
height and weight, temperature, pulse, respirations. You must know what
is normal and what must be reported to your nurse. As you can see, this
information is very important to the nurse. You are the eyes and ears of
the nurse you are working with. Just remember to stay within your
guidelines (scope of practice) to ensure you will not get into legal trouble.
All healthcare facilities have policy and procedure books readily available
to the staff. CNAs should look at these books if there are any
unanswered questions.
Standards of Care
Standards of care explain what a nursing assistant should do, both
legally and ethically. The nursing assistant must report any changes
seen in their residents. For example, if the resident has lost or gained
five pounds, it must be reported to the nurse. All facilities and home
health care agencies have policy and procedure manual. It is the CNA’s
duty to be familiar with these manuals. It is also the CNA’s duty to ask
questions if they are not sure of the right thing to do. Unprofessional
behavior is when the CNA does not follow the rules. This may include
coming to work after drinking alcohol or using illegal drugs. You may not
do harm, but you are still putting the resident at risk for harm because
your judgment is impaired.
Ethics
Ethics is the knowledge of right and wrong (Alvare, S., Fuzy, J., &Rymer,
S., 2009). All residents and patients have the right to:
Respect and dignity
Privacy
Confidentiality
Freedom from abuse and neglect
Control over their own money
Have their personal property
Know about their medical condition and treatments
Choose their own doctor(s)
Make decisions about their medical care
All residents and patients have the right to be respected and treated with
dignity. Dignity affords the resident pride and self-respect (Webster’s
New World College Dictionary, 2009). We must remember that your
residents have been fully functional beings before getting frail and sick.
They do not need to be talked to with “baby talk.” This is disrespectful not
only to the resident, but to the family as well.
Dignity is an important issue when working with residents and patients.
Be sure to knock on the door before entering a room. Keeping the
resident covered during care is very important. Think about how you
would want to be treated. Maintaining privacy means pulling the curtain
between beds and closing the curtains or blinds in the window.
Confidentiality is one of the most important issues in resident care. CNAs
must keep private things private. You are not allowed to talk about
anything to family and friends, only to your nurse and health care team. If
you see a person in the grocery store, and they ask about one of your
residents, you can not even say they are in your facility. HIPAA laws are
very specific about privacy. You can be fined from $50,000 to $250,000 if
you talk about your resident’s and/or patient’s private matters (HIPAA
training, 2009).
Knowledge of Malpractice is Important!
It is very important to know what malpractice is, and what can happen to
the nursing assistant if malpractice is alleged. Malpractice is injury to a
person due to professional misconduct through negligence, carelessness
or lack of skill (Alvare, S., Fuzy, J., & Rymer, S., 2009). Malpractice is
treating the residents poorly. It may be that the CNA did not feed
someone, did not bathe someone, treated someone roughly or did not
speak to someone politely and with respect. You have to be aware of
everything you do and say. The consequences of malpractice are; you
personally can be sued, as well as the facility, and the nursing
department. If you lose your license, you will not be able to work in the
nursing field again. Every facility does a screening background check,
looking for abuse and negligence.
Abuse, Neglect and Abandonment
Abuse is a serious accusation, and never taken lightly. If you are
accused of abuse, whether or not you are guilty, you are escorted off the
premises. The abuse may not be intentional, but it is still abuse. The
types of abuse include physical, verbal, sexual, psychological and
financial. Using restraints is also a form of abuse. It is easy to dupe the
elderly, especially with their money and belongings. Never take money
from your residents, even as a gift.
Physical abuse is obvious, with bruising and excessive skin tears. It is
either intentional or not. This includes slapping, cutting, burning, pushing
and shoving, restraining or even rough handling (Alvare, S., Fuzy, J., &
Rymer, S., 2009). This is a very serious offense. It is often difficult to take
care of the elderly, and it is easy to lose your temper. Just make sure
you do not take your ill feelings out on your residents.
Verbal abuse includes talking back, using offensive language and using
“baby talk.” It is demeaning to the elderly. Using offensive language
makes the resident feel bad. Verbal abuse has no physical signs, but the
effects can be felt for a long time.
Sexual abuse is another serious issue. Sexual abuse is unwanted sexual
contact with an elder including touching, sexual assault and rape
(Brayton & Purcell, 2009). Many times the resident is unable to report the
abuse, but physical signs are there. Sometimes the resident will not
report the abuse because they feel ashamed and humiliated. It is
everyone’s duty to report suspicions of sexual abuse. Talk to your charge
nurse as soon as you realize or suspect that abuse has occurred. If you
do not report abuse, you can be held responsible along with the abuser.
Neglect is causing harm to the resident by NOT doing a needed task.
Some things that may be considered as negligence include poor
hygiene, not providing privacy, not feeding the resident and soiled
clothing. Neglect is as serious as any other kind of abuse.
Abandonment is when the CNA does not finish an assignment and/or
leaves work early without attending to their resident’s needs. The elderly
depend on others to help them do their Activities of Daily Living.
Exploitation, another form of abuse, is when money or property is taken
from the resident. Never take or ask for money. There have been cases
of nursing assistants asking for a “loan.” This is illegal!
Legal Documentation
Legal documentation involves careful charting. The old saying “If it is not
charted, it is not done” is very important. CNAs are usually responsible
for charting on bathing, grooming, eating, elimination and mobility.
Learning to chart the facts, just what you SEE, and not what you feel, is
difficult.
If you have poor handwriting, then print. If it can not be read, it is not
credible. Attorneys look at charting by the nursing staff. They consider
the chart the most reliable source of information. So, be careful and
prudent in what you are charting. And, do not ever chart an activity you
have not completed. If you are asked to chart for someone else, do not
do it! If this person continues to insist, tell your charge nurse. It is illegal
to chart for someone else.
Never use abbreviations, even if you run out of room on the paper. In no
way are you to make up your own abbreviations. Charts are legal
documents. Everything you write can be used in a court of law. This is
why it is so important to be honest, and to have no feelings interjected
into your charting.
Let us do some charting:
Resident refused shower, reported to charge nurse. She looked like
she did not want to take a shower, so I left the room.
Is this the right way to chart? The first half of the statement is written
well, but the second part is not correct. Remember! Do not put your own
thoughts and feelings into your charting. Just chart what you see, and
what you do!
Conclusion
CNAs play a very important role in Long Term Care, and have access to
private information about their residents. CNAs must work within their
scope of practice and be mindful of the Nurse Practice Act. Ethics is
treating the residents with respect and dignity. Dignity is an important
issue. Residents must be covered during care and have privacy. The
residents must have freedom from abuse, neglect and abandonment.
Even if the alleged abuse is unintentional, it is still abuse. If the CNA
works within the legal boundaries and takes good care of their residents
in a dignified manner, the residents will be safe.
References
Alvare, S, Fuzy, J., & Rymer, S. (2009). Nursing assistant care.
Albuquerque. Hartman Publishing, Inc.
Brayton & Purcell (2009). Seniors may become victims of sexual abuse.
December 15, 2009 from:
http://www.elder-abuse-information.com/abuse/abuse_sexual_ptr.htm
Florida Legislature, 2009). Regulation of professions and occupations
from
www.leg.state.fl.us/statutes/index.cfm?App_mose=Display_Statute
Hipaa Training, 2009). December 17, 2009 from
www.training-hipaa.net/hipaa_resources/Violation_Penalties.htm
MQA (2009).Nurse practice act. December 17, 2009 from
www.doh.stae.fl.us/mqa/nursing.info_practiceAct.pdf
Respect (2009)..In Merriam Webster on line dictionary. December 17,
2009 from
www.merriam-webster.com/dictionary/respect
Florida Heart CPR
Documentation for CNA’s assessment
1. The CNA’s scope of practice includes:
a. Doing the job of the RN when she isn’t able
b. Feeding the resident
c. Providing care and assisting persons with daily tasks
d. Changing diapers as needed
2. CNA’s in Florida can only work:
a. Under the direction of the RN
b. Under the direction of the medical director
c. Under the direct supervision of a licensed nurse
d. Independent of other staff
3. Tasks associated with ADL’s are usually mobility, elimination, temperature,
pulse, respirations and feeding
a. TRUE
b. FALSE
4. Standards of care are:
a. Working hours
b. Training practices
c. Continuing education
d. Legal and ethical issues related to the patient
5. Ethics subjects include:
a. Confidentiality, respect and dignity
b. Knowledge of their medical condition and care
c. Freedom from abuse and neglect
d. All of the above
6. Two of the most important issues when dealing with patients are:
a. Feeding and elimination
b. Mobility and rehabilitation
c. Privacy and confidentiality
d. Medical care and doctors visits
7. Types of abuse can include:
a. Screaming at the resident (verbal)
b. Physical ( slapping, cutting, shoving )
c. Restraining or sexual abuse
d. All of the above
8. Neglect is causing harm by NOT doing a needed task:
a. TRUE
b. FALSE
9. Asking for favors or money from the patient or resident is a form of
a. Legal abuse
b. Exploitation
c. Verbal abuse
d. None of the above
10. One of the most important aspects of your job as a CAN is:
a. Feeding the patient
b. Ambulating the patient daily
c. Reporting to the other CNA’s who relieve you
d. Proper documentation and charting