Chapter One: The Nursing Assistant

The Nursing Assistant: Working in Long-Term Care

Long-Term Care Centers

  • Care may range from simple to complex.

  • Long-term care facilities may refer to their clients as "residents" or "clients".

  • Purpose: Designed to meet the needs of individuals requiring long-term care.

Objectives of Long-Term Care Centers

  • Purpose: To promote physical and mental health.

  • Assist individuals in maintaining the highest possible level of function.

  • Involvement of health team members along with the resident and family in care planning.

Types of Long-Term Care Centers

  • Board and Care Homes

  • Assisted Living Residences

  • Nursing Centers

Understanding Illness

  • Types of Illness:

    • Chronic versus acute

    • Communicable diseases

    • Rehabilitation or restorative care

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

Other Services Provided

  • Hospice care

  • Alzheimer Units/Dementia Care Units

  • Rehabilitation and Subacute Care

Organization of Nursing Centers

  • Ownership can be by an individual, corporation, government agency, or non-profit agency.

  • Must adhere to local, state, and federal regulations.

  • Key roles in the nursing center structure:

    • Personnel Administrator

    • Department Directors

    • Nursing, therapy, dietary, housekeeping, maintenance, laundry, human resources, finance, social services, activities

    • Medical Director

Nursing Team Structure

  • Director of Nursing (DON)

  • Nurse Managers

  • Charge Nurses/Unit Managers

  • Staff Nurses (RNs, LPNs)

  • Nursing Education/Staff Development

Overview of Nursing Roles

  • Registered Nurses (RNs):

    • Require a 2-4 year program and must pass a licensing examination.

    • Responsibilities include:

    • Carry out physician's orders

    • Develop care plans and evaluate effectiveness

    • Delegate care/tasks to LPNs/nursing assistants (do not prescribe medications/treatments unless APRN).

  • Licensed Practical Nurses (LPNs)/Licensed Vocational Nurses (LVNs):

    • Complete a 1-2 year program and pass a licensure examination.

    • Responsibilities include:

    • Reporting to the supervising RN

    • Assisting in patient care

  • Nursing Assistants:

    • Provide basic nursing care under the supervision of an RN or LPN.

    • Must have formal training and pass a competency examination.

Interdisciplinary Team Composition

  • Comprises various health care workers:

    • Registered Nurse (RN)

    • Medical Doctor (MD)

    • Clergy/Pastor

    • Licensed Practical Nurse (LPN)

    • Medical Records Staff

    • Activities Director

    • Physical Therapist (PT) and assistant

    • Occupational Therapist (OT) and assistant

    • Pharmacist

    • Respiratory Therapist

    • Social Worker

    • Speech Therapist

Paying for Health Care

  • Various payment options include:

    • Private insurance

    • Group insurance

    • Medicare

    • Medicaid

    • Self-pay

Regulatory Standards

  • Standards are set by federal/state governments and accrediting agencies:

    • Relate to center policies/procedures, budget/finances, and quality of care.

    • Licensure: Issued by the state.

    • Certification: Required to receive Medicare and Medicaid funds.

    • Accreditation: Voluntary process, signifies quality and excellence.

Survey - Your Role and Responsibilities

  • Provide quality care and protect the rights of residents.

  • Ensure safety for both the individual and staff members.

  • Maintain cleanliness and safety in the center.

  • Act in a professional manner with good work ethics.

  • Adhere to center policies and procedures.

  • Answer questions honestly and completely.

Key Legal Framework

  • Federal and State Laws that govern practice:

    • State Nurse Practice Act

    • The Omnibus Budget Reconciliation Act (OBRA) of 1987:

    • Aims to improve the quality of life for nursing center residents.

    • Establishes minimum training for nursing assistants: 75 hours (16 of which must be in facility training).

    • Requires competency evaluation (state exam) and inclusion in Nursing Assistant Registry.

Roles and Responsibilities of Nursing Assistants

  • Understand the scope of practice:

    • Know what tasks are within your capabilities.

    • Work under the supervision of a licensed nurse.

    • Perform assigned nursing tasks.

    • Assist the nurse in reporting observations.

    • Request supervision if uncertain.

Limitations of Nursing Assistants

  • Prohibited from:

    • Administering medications.

    • Inserting or removing tubes/objects from body openings.

    • Taking oral or phone orders from physicians.

    • Disclosing diagnoses or treatment plans to families or patients.

    • Supervising other staff, including other nursing assistants.

    • Ignoring requests or orders for action.

Employment Guidelines

  • Always obtain and refer to a written job description for clarity on expectations.

The Five Rights of Delegation

  1. The right task

  2. The right circumstances

  3. The right person

  4. The right directions and communications

  5. The right supervision

Ethics and Accountability in Delegation

  • Agree to Responsibility:

    • Acknowledge responsibility for actions taken.

    • Ensure tasks are completed safely.

    • Seek assistance if uncertain or have queries.

    • Notify the supervising nurse of actions taken and observations noted.

  • Right to Refuse:

    • Understand that it is your right and duty to refuse unsafe tasks.

    • Never ignore requests or orders.

    • Refusing should not be based solely on personal preference for the task.