Ethical and Legal Responsibilities for Nurse Assistants

Ethical Responsibilities and Decision-Making

  • Ethics is defined as a set of moral principles and values, addressing what is good and bad as well as moral duty and obligation.

  • Ethical decision-making involves evaluating choices to ensure alignment with professional guidelines (Code of Ethics) and facility policies and procedures.

The PLUS Model and Six-Step Decision-Making Process

  • The PLUS Model serves as an ethical filtering tool:

    • P = Policies and Procedures: Assesses whether the decision aligns with company policies.

    • L = Legal: Checks if the decision violates any laws or regulations.

    • U = Universal: Determines if the decision aligns with the core values of the facility.

    • S = Self: Evaluates if the decision meets personal standards of fairness and honesty.

  • Six Steps for Ethical Decision-Making:

    • Step One: Define the Problem using PLUS Model questions.

    • Step Two: Seek Out Resources, such as mentors, co-workers, professional guidelines, and organizational policies.

    • Step Three: Brainstorm a List of Potential Solutions while remaining open to new ideas.

    • Step Four: Evaluate Alternatives by weighing positive and negative consequences alongside their likelihood.

    • Step Five: Make Your Decision, and Implement It transparently, sharing proposals with team members when necessary.

    • Step Six: Evaluate Your Decision to verify if the problem was resolved and address any unforeseen consequences.

Workplace Ethical Scenarios

  • Scenario 1: Missed Team Deadline

    • Prompt: A team misses a deadline and considers falsely informing the supervisor that the deadline was met.

    • Resolution: Concealing the truth prevents identifying and solving the underlying issue, destroys professional reputation, and neglects the supervisor as a supportive resource.

  • Scenario 2: Unperformed Routine Vital Signs

    • Prompt: A Certified Nurse Assistant (CNA) fabricates routine vital signs, submits them to the charge nurse, and asks a co-worker not to report it to protect her job.

    • Resolution: Fabricating vitals violates all elements of the PLUS Model and the professional nursing code. Unperformed vitals put residents at risk for undetected medical issues, severe harm, stroke, or death. Failure to report the co-worker fails to safeguard resident health and safety, placing equal responsibility on the silent observer.

CNA Code of Ethics

  • Purpose: Aids in easing suffering, restoring health, and preserving life across physical, spiritual, emotional, and social well-being.

  • Key Responsibilities:

    • Serve all residents equally regardless of religious or ethnic background.

    • Maintain loyalty to the employer, residents, co-workers, and the facility.

    • Uphold high standards of professionalism and proper patient care.

Resident Rights and Regulatory Framework

  • Resident Rights: Residents have the right to be free from abuse, neglect, misappropriation of property, exploitation, corporal punishment, involuntary seclusion, and unnecessary physical or chemical restraints.

  • Centers for Medicare and Medicaid Services (CMS) Requirements:

    • Regulates long-term care facilities.

    • Requires facilities to maintain a seven-part abuse prevention policy.

    • Mandates staff education on abuse prevention upon hire, during orientation, and at least annually thereafter.

  • Enforcement: Surveyors enforce federal and state rules, including definitions of abuse and neglect under §483.