Chapter 2: Nursing Assistant
Historical Overview of Nursing
Florence Nightingale (–):
Recognized as a pioneer who started formal training programs for nurses.
Established core practices that remain foundational in modern healthcare, specifically focusing on cleanliness and patient care standards.
Evolution of the Nursing Assistant Role:
In the early days of nursing, individuals in these roles were referred to as "aides" or "orderlies."
In contemporary healthcare, nursing assistants are recognized as well-trained, essential members of the medical team holding significant responsibilities.
Education and Certification Requirements
Omnibus Budget Reconciliation Act (OBRA) Requirements:
OBRA mandates specific standards for the certification of nursing assistants.
Training Hours: A minimum of hours of training is required.
Practical Training: At least hours of the training must be practical (clinical) training.
Competency Evaluation: To become certified, a candidate must pass a competency evaluation consisting of two parts:
A Written examination.
A Skills demonstration.
The Nursing Assistant Registry
OBRA Mandate: Per OBRA regulations, an official database known as The Registry must be maintained.
Registry Contents: The database contains the following information for every certified nursing assistant:
Full legal name, including maiden name and any previous married names.
The last known home address.
Date of birth ().
The specific date on which the competency evaluation was successfully passed.
A unique Registry number and its date of expiration.
Documented reports of resident abuse, neglect, or the theft of resident property.
The identity of the last known employer and the inclusive dates of employment.
Professional Qualifications and Growth
The Principle of Reciprocity:
A nursing assistant's certificate may be recognized as valid in states other than the one where they originally received training.
If a nursing assistant moves to a state requiring more training hours than they previously completed, they can obtain additional training to meet that state’s requirements.
Individuals must go through a formal process to have their certification approved in a new state.
Continuing Education:
Nursing assistants are required to complete a minimum of hours of continuing education every year.
In-service training is utilized to provide assistants with updated knowledge and new clinical skills.
Roles and Responsibilities of the Nursing Assistant
Core Duties:
Assisting licensed nurses in the delivery of care to patients and residents.
Meeting the basic physical needs of patients and residents.
Meeting the emotional and psychological needs of patients and residents.
Serving as a critical observer and communicator within the healthcare team.
The Nursing Team and Hierarchy
The Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN):
A licensed nurse who provides care within a specific scope of practice.
The Registered Nurse (RN):
Requires a -year degree.
Possesses a different level of education and more advanced training than LPNs or nursing assistants.
Maintains a broader scope of practice and is authorized to perform more complex medical tasks.
Administrative and Specialized Nursing Jobs:
Charge Nurse.
Unit Manager.
Director of Nursing (DON) or Chief Nursing Officer (CNO).
Coordinator (or Director) of In-Service Education or Staff Development.
Quality Assurance (QA) or Quality Improvement (QI) Nurse.
Registered Nurse Assessment Coordinator (RNAC).
Certified Registered Nurse Practitioner (CRNP).
Nursing Care Models
Team Nursing: A model where a team of professionals (RNs, LPNs, and nursing assistants) works together to provide care for a group of patients.
Patient-Centered or Patient-Focused Care: A model revolving specifically around the needs and preferences of the patient.
Scope of Practice and Limitations
Definition: Scope of practice describes the specific range of tasks that a nursing assistant is legally permitted to perform.
Function: It serves to restrict unauthorized tasks and clearly define the legal responsibilities of the nursing assistant.
Tasks Beyond the Scope of Practice: Nursing assistants are prohibited from performing the following:
Administering medications or oxygen.
Receiving verbal orders directly from physicians.
Diagnosing illnesses or prescribing medications.
Supervising other nursing assistants.
Performing sterile procedures.
Inserting or removing tubes from a patient's body.
Conducting clinical assessments or exercising independent nursing judgment.
The Five Rights of Delegation
Definition of Delegation: The act of giving permission for someone else to complete a task that the delegator is legally responsible for.
Development: Guidelines developed by the National Council of State Boards of Nursing (NCSBN).
The Right Task: Determining if the task can legally be delegated based on the nursing assistant's scope of practice and job description.
The Right Circumstance: Evaluating the patient’s condition (is it stable?), the predictability of the outcome, the safety of the performance, and the availability of proper equipment and a suitable environment.
The Right Person: Ensuring the individual has the necessary skills, competency, experience, and training to complete the task.
The Right Direction: Providing clear instructions and expected outcomes. This includes instructions on how to report back and what to do if findings are abnormal. Closed-loop communication (repeating instructions back) is used here.
The Right Supervision: Ensuring the nurse is available to provide oversight, feedback, and evaluate the final outcome.
Guidelines for Accepting or Refusing an Assignment
Communication Standards:
Always ask the nurse for clarification if any part of an assignment remains unclear.
Nursing assistants have a responsibility to maintain open communication with the nurse.
An assignment should never be ignored just because the assistant is unsure how to perform it or believes it exceeds their scope; they must speak up.
Valid Reasons to Refuse an Assignment:
The task is not in the job description.
The task may result in harm to the patient or resident.
The task is illegal or unethical.
A nurse is not available to provide required supervision.
The proper equipment is not available.
The directions provided are not clear.
The nursing assistant has not received adequate training for that specific task.
Invalid Reason for Refusal: Never refuse an assignment simply because you do not want to do it.
Questions & Discussion
Question #1: OBRA mandates a minimum of _______ hours of training to become a certified nursing assistant although some states may require more.
A.
B.
C.
D.
Answer: B. . OBRA mandates a minimum of hours of training. States must meet that minimum, but many require more hours.
Question #2: Ensuring the patient’s or resident’s needs are properly met requires teamwork from all members of the health care team. Which of the following is a good rule of thumb to use when asked to do something you are not familiar with?
A. Take a class to learn how to do it
B. Ask another nursing assistant to help you
C. See if it is listed in your job description
D. Tell the nurse you don’t know how to do it
Answer: C. See if it is listed in your job description. A good general rule to keep in mind is that you should not perform any task that is not listed in your job description. Ask your supervisor about anything you do not understand. This is important to protect yourself, as well as your patients or residents.