Chapter 3- The Nursing Assistant

Key Abbreviations

  • BON: Board of Nursing

  • CNA: Certified Nursing Assistant

  • LNA: Licensed Nursing Assistant

  • LPN/LVN: Licensed Practical/Vocational Nurse

  • NATCEP: Nursing Assistant Training and Competency Evaluation Program

  • OBRA: Omnibus Budget Reconciliation Act of 1987

  • RN: Registered Nurse

  • RNA: Registered Nurse Aide

  • SRNA/STNA: State Registered/Tested Nurse Aide

Laws and Safe Care

  • Roles are defined by laws/policies.

  • Safe care: know what you can/cannot do, rules, and role limits.

  • Laws, job descriptions, and patient condition shape work/supervision.

History and Trends

  • Nursing assistants aided nurses with basic care without required training until the 1980s.

  • Team nursing was common.

  • Home care increased in the 1980s.

  • Cost management led to staffing mixes (RNs, LPN/LVNs, nursing assistants).

Federal and State Laws

  • U.S. Congress makes federal laws, state legislatures make state laws.

  • You must know the federal and state laws affecting your work.

Nurse Practice Acts

  • Each state has a nurse practice act.

  • Defines RN and LPN/LVN scope, education, and licensing.

  • Protects the public from people performing healthcare without a license, enforced by the BON.

  • BON (Board of Nursing) can deny, revoke, or suspend licenses for reasons like: crimes, drug issues, endangering patients, negligent practice, abuse, violating the act, incompetence, aiding violations.

  • Making diagnoses or prescribing.

Nursing Assistants

  • Some nurse practice acts regulate nursing assistant roles, or states have separate laws enforced by BONs.

  • Practicing beyond legal limits can lead to issues.

  • Certification can be denied, revoked, or suspended for unsafe practices.

Omnibus Budget Reconciliation Act of 1987

  • OBRA is a federal law applying to all states.

  • Sets minimum requirements for nursing assistant training and evaluation via NATCEP for facilities receiving Medicare funds.

The Training Program

  • OBRA mandates at least 75 hours of instruction (classroom/practical, at least 16 hours).

  • Program includes basic nursing care knowledge/skills.

  • Areas: communication, infection control, safety, residents' rights, basic/personal care, transfer/positioning, walking, ROM exercises, signs/symptoms, cognitive impairment care.

Competency Evaluation

  • Includes written and skills tests.

  • Employer pays if working in a nursing center; otherwise, you pay.

  • OBRA allows at least 3 attempts to pass.

Nursing Assistant Registry

  • OBRA requires a registry in each state with: full name, identifying information, evaluation date, and findings of abuse/neglect/misappropriation.

  • Findings stay for at least 5 years, or as required by the state. Federal findings are permanent.

  • Entries are removed after 24 months of not working (unless abuse, neglect, or dishonest use of property are present).

  • Health care agencies can access registry information.

Certification

  • Certification recognizes meeting state standards after NATCEP completion.

  • Titles vary (CNA, LNA, RNA, SRNA, STNA).

  • Certification can be disciplined for harmful actions.

Discipline Reasons

  • Violating boundaries; sexual conduct; abandoning patients; inaccurate recording; false entries; failing to protect safety or report risks; violating rights/privacy; neglect/abuse; financial exploitation; theft; unauthorized payment requests; substance use while on duty; performing untrained tasks; unauthorized removal of items; falsifying information; violent behavior; failure to cooperate with BON investigations.

Promoting Safety and Comfort

  • OBRA and state laws require background checks (including FBI fingerprint checks) in long-term care.

  • Abuse, neglect, mistreatment, or misappropriation may affect certification.

  • OBRA prohibits employing those convicted of such crimes in long-term care.

  • NATCEPs may require checks before enrollment.

Maintaining Competence

  • OBRA requires 12 hours of education yearly and performance reviews.

  • Those not working for 24 months may need a new evaluation or retraining.

Teamwork and Time Management

  • Educational programs are in-service programs.

  • Surveyors ensure competence by: checking NATCEP completion, asking about training/experience, observing skills.

Working in Another State

  • Contact that state's NATCEP agency for endorsement.

  • Requires: forms, training proof, registry verification, fingerprints, fees, and background checks.

  • False information can lead to denial or disciplinary action.

Roles and Responsibilities

  • OBRA, nurse practice acts, and opinions dictate what you can do.

  • Scope of practice is understanding your limits to protect patients.

  • Licensed nurses supervise your work.

Rules for Nursing Assistants

  • You are an assistant to the nurse.

  • A nurse assigns and supervises your work.

  • Report observations about the person's physical and mental status to the nurse. Report changes in the person's condition or behavior at once.

  • The nurse decides what is done or not done for a person; you do not make these decisions.

  • Review directions and the care plan with the nurse before going to the person.

  • Perform only the nursing tasks that you are trained to do.

  • Ask a nurse to guide and assist you if you are not comfortable performing a nursing task.

  • Perform only the nursing tasks that your state and job description allow.

Role Limits

  • NEVER give drugs, insert tubes, take oral/phone orders, tell diagnoses, prescribe treatments, supervise, or ignore orders.

  • Job descriptions reflect state laws; agencies and nurses can restrict but not expand beyond state laws.

Home Care

  • Involves personal care and home services (laundry, shopping, meal prep, light housekeeping).

Nursing Assistant Standards

  • Perform tasks within the state's nurse practice act, be honest, accept/refuse tasks based on training, be accountable, assist nurses in observing patients, communicate effectively, practice safety, respect rights, function as a team member, and protect confidentiality.

Job Description

  • Details agency expectations, educational requirements, and job title.

  • Obtain a written job description and clarify duties during the job interview.

  • Don't take a job if it requires acting beyond legal/training limits or against morals.

Nursing Assistant Job Titles

  • Include clinical technician, health care assistant/technician, nurse technician, nursing care partner.

Personal and Professional Responsibility

  • Requires qualities like communication, patience, compassion, and teamwork.

  • Respect patient rights to refuse care.

  • Practice skills to build confidence.

  • Value


Review Questions

  1. T

  2. F

  3. T

  4. F

  5. F

  6. F

  7. A

  8. A- D

  9. C

  10. A- C

  11. B

  12. A

  13. C

  14. B

  15. D


13/15= 86% = B