Nursing Assistant Certification: Roles, Responsibilities, and Regulations in California

Work Settings for the nursing Assistant

• Acute Care (Hospital)

  • Provides short-term care to residents who have an immediate illness or injury.

  • The primary goal is to address the patient’s immediate healthcare needs.

  • These facilities are accredited and surveyed by the Joint Commission every $3$ years.

  • Preferences and traits for this setting include flexibility, the ability to work in a fast-paced setting, and an enjoyment of meeting new people and having new experiences.

  • Nursing Assistant responsibilities in acute care:

    • Monitoring vital signs.

    • Assisting with ambulation.

    • Measuring intake and output.

    • Caring for residents before and after surgery.

    • Bathing and repositioning residents.

• Sub-Acute Care Facilities

  • Designed to treat residents who still require $24$-hour skilled nursing care but are more medically stable.

  • These are also referred to as rehabilitation facilities.

  • Governance of the unit depends on its location:

    • If the unit is located in a hospital, it is governed by the Joint Commission.

    • If the unit is housed within a Long-Term Care (LTC) facility, it is governed by state regulators.

  • Nursing Assistant responsibilities in sub-acute care:

    • Responsibilities depend upon the specific focus of the unit but do not vary as much as those in a hospital.

    • Assisting with personal needs and ambulation.

    • Guiding strengthening exercises.

    • Supporting and encouraging resident rehabilitation and independence.

• Long-Term Care (LTC) Facilities

  • Commonly known as nursing homes or skilled nursing facilities (SNFs).

  • The goal is to provide skilled nursing care for extended periods of time.

  • Governed by federal legislation: the Omnibus Budget Reconciliation Act (OBRA) of $1987$.

  • Regulated by the state, which enforces the federal laws governing them.

  • Surveyed at least every $1$ year.

  • Residents have access to an ombudsman, who helps protect residents’ rights.

  • Funding sources include Medicaid, Medicare, insurance, and private funds.

  • Preferences and traits for this setting include enjoying a fast-paced environment, the ability to bond with residents on a long-term basis, and an affinity for working in a home-like atmosphere with a daily routine.

  • Nursing Assistant responsibilities in LTC settings:

    • Personal care such as bathing and grooming.

    • Assisting with eating.

    • Positioning and ambulating residents.

    • Providing restorative care, such as range-of-motion exercises.

    • Caring for the social and emotional needs of residents.

• Assisted-Living Facilities

  • Bridge the gap between living independently and living in a healthcare facility such as a nursing home.

  • Regulated by the state.

  • Provide basic help with bathing, cooking, and cleaning.

  • These facilities do not offer $24$-hour skilled nursing care.

  • Nursing Assistant responsibilities in assisted-living:

    • Help with activities of daily living (ADLs).

    • Preparation and servicing of meals.

    • Light housekeeping.

    • Medication administration after receiving on-the-job training.

• Other Work Settings

  • Home healthcare.

  • Private home settings.

  • Hospice care.

  • Respite care or adult daycare services.

Members of the Healthcare Team

• The nursing assistant is a vital member of the healthcare team.

• Being a nursing assistant can open various opportunities for the individual.

• Members of the healthcare team are diverse and vary depending upon the specific work setting. Team members include:

  • Physicians and Nurse Practitioners.

  • RNs (Registered Nurses), LPNs (Licensed Practical Nurses), and Nursing Assistants.

  • Imaging staff.

  • Medical Assistants.

  • Activity staff.

  • Physician Assistants.

  • Respiratory Therapists.

  • Nutritionists.

  • Social workers.

  • Management.

  • Support, office, and billing staff.

  • Physical, Occupational, and Speech Therapists.

Scope of Practice for the Nursing Assistant

• The scope of practice refers to the responsibilities, skills, and actions that a nursing assistant is permitted and expected to follow once training is complete.

• Nursing assistant programs are regulated by state and federal codes to ensure training consistency.

• The nursing assistant is personally responsible for knowing their scope of practice.

• The scope of practice may be altered with additional training.

• Included in Scope of Practice:

  • Providing basic personal care.

  • Offering emotional support to residents and families.

  • Assisting with activities of daily living (ADLs).

• NOT Included in Scope of Practice:

  • Delivering medications.

  • Putting in catheters or IVs.

  • Developing or changing a resident’s care plan.

  • Teaching.

  • Delegation.

Chain of Command and Delegated Tasks

• Chain of Command

  • Refers to the hierarchical route of communication from one member of the healthcare team to the next.

  • Must always be followed to help reduce medical errors and confusion.

  • In a typical chain of command, the nursing assistant receives delegated tasks from the nurse.

• Delegated Tasks

  • A delegated task is an action or job that a supervisor asks a nursing assistant to complete.

  • Tasks may be communicated verbally or through a care plan.

  • If a task is within the nursing assistant’s scope of practice, it must be accepted.

  • Once a task is accepted, the supervisor assumes it will be completed.

  • Once the task is completed, the nursing assistant must document the action.

  • If a task is outside the scope of practice, the task needs to be declined.

• Refusing a Delegated Task

  • First, determine if the task is truly outside your scope of practice.

  • You cannot simply say “No” or ignore the request.

  • Remain professional and respectful during the refusal.

  • Always follow the chain of command when addressing the issue.

• Teaching vs. Reinforcing

  • Teaching is not within the nursing assistant’s scope of practice; it is the responsibility of the nurse.

  • Teaching begins as soon as a resident is admitted to the facility.

  • The nursing assistant can reinforce what was originally taught by the nurse.

Professionalism, Time Management, and Employee Rights

• Time Management and Organization Principles

  • Set clear goals.

  • Write down or visualize accomplishing those goals.

  • Identify and prioritize tasks to be completed.

  • Formulate a game plan.

  • Ask coworkers for suggestions.

• Rights and Responsibilities Definitions

  • Rights are certain beliefs or laws that determine our freedoms.

  • Responsibilities are what hold us accountable for our choices and actions.

• Employee Rights and OSHA

  • The Occupational Safety and Health Administration (OSHA) was created by the Occupational Safety and Health Act of $1970$.

  • OSHA ensures that all employees have safe and healthy working conditions.

  • Examples of protections include appropriate Personal Protective Equipment (PPE) and the Hepatitis B vaccine.

• Professionalism Characteristics

  • Dependability.

  • Promptness.

  • Customer service.

  • Flexibility.

  • Hygiene.

Title 22, Education, and Certification Requirements

• Title 22

  • A set of California state laws that govern healthcare facilities, nurse aide training programs, and minimum standards of care for long-term care residents.

  • Nursing assistant candidates must:

    • Complete an approved training program.

    • Pass both a written and skill exam to be certified.

    • Have criminal record clearance at the time of initial certification and then every $2$ years at recertification.

• Education and Certification Requirements

  • Federal law sets the minimum number of training hours at $60$.

  • The State of California requires students to complete at least $60$ hours of classroom training and at least $100$ hours of clinical training.

  • Initial certification requirements:

    • Be at least $18$ years old.

    • Complete an approved state of California training program.

    • Complete certification testing (knowledge and skills).

    • Obtain criminal clearance via fingerprinting and a background check.

  • Recertification is required every $2$ years.

• Continuing Education

  • The State of California requires nursing assistants to complete $48$ hours of in-service training during a $24$-month timeframe to maintain certification.

  • A minimum of $12$ hours must be completed in each year of the $2$-year certification period.

  • No more than $24$ of the required hours may be completed online.

• Nurse Aide Registry

  • A database for employers to verify if a person is a CNA in good standing.

  • CNAs convicted of abuse, neglect, or misappropriation of belongings are flagged in this registry.

Ethics and Confidentiality

• Employee Responsibilities and Ethics

  • Abide by privacy regulations at all times.

  • Follow current standards of practice.

  • Take continuing education courses.

  • Complete delegated tasks in a timely fashion.

  • Safeguard the client and follow the care plan.

  • Prevent, identify, and stop abuse or other law violations.

  • Act as a mandated reporter.

• Resident Rights

  • Receiving care that is unbiased regarding race, culture, and creed.

  • Being treated with respect.

  • Accessing their own medical records.

  • Making informed choices.

  • Keeping medical records and information private.

• Health Insurance Portability and Accountability Act (HIPAA)

  • Protects all healthcare information that can be linked to an individual.

  • Includes any identifying information that is spoken, read, heard, or written.

  • Protected Information includes: an individual’s past, present, and future medical or mental condition; any healthcare service received; and any payment of healthcare services.

• Informed Consent

  • The right to know what treatment options are available and the risks associated with those treatments.

  • It is the physician's or nurse's role to inform the resident of options.

  • The nursing assistant’s role is to honor the resident’s choices and report choices that conflict with the care plan to the nurse.

Questions & Discussion

• Question: California Code of Regulations, Title 22 establishes?

  • A. Salary for certified Nurse Assistant’s

  • B. Minimum standards of patient care

  • C. The certified Nurse Assistant’s work schedule

  • D. Maximum standards of patient care

• Question: The role of the ombudsman is to?

  • A. Drive the buses for special outings

  • B. Listen to and resolve patient/resident problems

  • C. Serve snacks

  • D. Bring newspapers and magazines

• Question: HIPAA refers to?

  • A. Hepatitis A

  • B. Confidentiality

  • C. Standard precautions

  • D. Nutrition

• Question: A mandated reporter?

  • A. Must report suspected abuse

  • B. Must report actual abuse

  • C. Must report abuse told to them by a visitor

  • D. All of the above

• Question: The overall purpose of OBRA is to?

  • A. Set hours when clinical training may be done

  • B. Improve quality of life for patients/residents in nursing facilities

  • C. Keep safety records up to date

  • D. Prevent injuries

• Question: What should the Nurse Assistant do if asked to do something he or she doesn’t know how to do?

  • A. Ask another Nurse Assistant to do the task

  • B. Tell the nurse he or she is uncertain and ask for help

  • C. Refrain from doing the task

  • D. Do the task anyway