Chapter One: The Nursing Assistant

Long term care

Care designed to meet the needs of individuals requiring ongoing assistance, ranging from simple to complex.

Individuals in long-term care facilities are often called…

Residents or clients

The main purpose of long-term care centers

Promoting physical health and maintain the highest possible level of function

Who’s involved in care planning in long term-care?

Health team members, the resident, and the family.

The main types of long term care centers

Board and care homes, assisted living residences, and nursing centers.

Chronic illness

Long-term illnesses

Acute illness

short-term and often sudden illness

communicable diseases

illnesses that can be spread from person to person

rehabilitation/restorative care

care focused on function and independence

Deconditioning

Loss of muscle mass and function due to inactivity or illness.

additional services long-term care centers may provide

Hospice care, Alzheimer/dementia units, rehabilitation, and subacute care.

Owners of nursing centers

Individuals, corporations, government agencies, or non-profit organizations

What regulations must nursing centers follow?

Local, state, and federal regulations

Key administrative roles in a nursing center

Personnel administrator, department directors, and medical director.

Director of Nursing

oversees nursing care and staff

Who supervises daily nursing activities on units?

Charge nurses or unit managers.

Who provides direct nursing care?

RNs, LPNs, and nursing assistants

Education required to become an RN

2-4 year program and a passing licensing exam

RN responsibilities

• Carry out physician orders

• Develop care plans

• Evaluate care

• Delegate tasks

Can RNs prescribe medications?

No, unless they are Advanced Practice Registered Nurses (APRNs).

Education required for LPNs/LVNs

1-2 year program and licensure exam

LPN/LVN responsibilities

Assist in patient care and report to an RN.

The role of a nursing assistant

Providing basic nursing care under RN or LPN supervision.

Interdisciplinary team

A group of healthcare professionals working together to provide care.

Five members of the interdisciplinary team

1. RN

2. MD

3. Social worker

4. Physical Therapist

5. Pharmacist

Common ways to pay for long-term care

Private insurance, group insurance, Medicare, Medicaid, and self-pay

Licensure

Permission issued by the state to operate

Certification

Required to receive Medicare and Medicaid funding

Accreditation

A voluntary process indicating quality and excellence.

Nursing assistant’s role during surveys

• Providing quality care

• protect resident’s rights

• Ensure safety

• Act professionally

The State Nurse Practice Act

law that governs nursing practice at the state level

Omnibus Budget Reconciliation Act (1987)

A law improving quality of life for nursing center residents

What training does OBRA require for nursing assistants?

At least 75 hours, including 16 hours in a facility.

What does OBRA require after training?

Competency evaluation and placement on the Nursing Assistant Registry.

Who supervises nursing assistants?

Licensed nurses

Nursing assistants are not allowed to…

Administer medications, insert/remove tubes, take physician orders, disclose diagnoses, supervise staff.

Can nursing assistants ignore requests or orders?

No.

Job description

clarifies duties and expectations

The five rights of delegation

1. Right Task

2. Right Circumstances

3. Right Person

4. Right Directions

5. Right Supervison

Accountability

Taking responsibility for actions and ensuring safe task completion.

When should a nursing assistant seek help?

When unsure or uncertain about a task.

Do nursing assistants have the right to refuse tasks?

Yes, if the task is unsafe or beyond their scope.