The Nursing Assistant and the Care Team

Members of the Care Team

  • The care team is a multidisciplinary group composed of several individuals dedicated to providing resident care:   - Nursing Assistant (NA): Provides basic care and performs assigned nursing tasks.   - Registered Nurse (RN): A licensed professional who coordinates care, provides treatments, and supervises the nursing staff.   - Licensed Practical Nurse / Licensed Vocational Nurse (LPN/LVN): Provides nursing care and treatments as prescribed.   - Advanced Practice Registered Nurse (APRN): A nurse with post-graduate education in nursing.   - Physician or Doctor (MD or DO): Diagnoses medical conditions and prescribes treatment.   - Physician Assistant (PA): Performs many of the same tasks as a physician under their supervision.   - Physical Therapist (PT/DPT): Administers therapy to increase movement, promote healing, reduce pain, and prevent disability.   - Occupational Therapist (OT): Helps residents learn to adapt to disabilities and trains them to perform Activities of Daily Living (ADLs).   - Speech-Language Pathologist (SLP): Identifies communication disorders and swallowing problems and develops a plan of care.   - Registered Dietitian (RD/RDN): Manages dietary needs and nutritional planning.   - Medical Social Worker: Helps residents and families with social and financial issues related to illness.   - Activities Director: Plans and directs social activities for residents.   - Resident and Resident’s Family: These individuals are central members of the care team because the focus of all care is the resident; their preferences and family insights are vital to the care process.

Key Definitions and Concepts

  • Assistive Devices: Special equipment that helps a person who is ill or disabled to perform activities of daily living.
  • Charting: Documenting information and observations about residents.
  • Professional: Having to do with work or a job.
  • Personal: Relating to life outside one’s job, such as family, friends, and home life.
  • Professionalism: The act of behaving properly when working.
  • Compassionate: Being caring, concerned, considerate, empathetic, and understanding.
  • Empathy: Identifying with the feelings of others.
  • Sympathy: Sharing in the feelings and difficulties of others.
  • Tactful: Showing sensitivity and having a sense of what is appropriate when dealing with others.
  • Conscientious: Guided by a sense of right and wrong; principled.
  • Chain of Command: The line of authority within a facility or agency.
  • Liability: A legal term that means someone can be held responsible for harming someone else.
  • Scope of Practice: Defines the tasks that healthcare providers are legally allowed to do as permitted by state or federal law.
  • Delegation: Transferring responsibility to a person for a specific task.

The Nursing Assistant’s Role

  • There are two primary ways nursing assistants provide services:   - Performing assigned nursing tasks.   - Providing personal care or assisting with self-care.
  • The ‘Eyes and Ears’: Because NAs interact more closely and frequently with residents than any other team member, they are responsible for reporting changes in the resident’s condition.
  • Scenario Management: If a nursing assistant sees a resident who is not on her specific assignment sheet but needs help, she must still assist or ensure the resident's needs are met.
  • Prohibitions (Scope of Practice): Regardless of the state, NAs must never:   - Perform procedures requiring sterile technique.   - Make diagnoses.   - Communicate a diagnosis or treatment plan to the resident or family.

Professionalism and Ethics for NAs

  • Behaviors toward Residents:   - Providing person-centered care.   - Maintaining a positive attitude.   - Performing only assigned tasks.   - Keeping resident information confidential.   - Being polite at all times.   - Avoiding the discussion of personal problems.   - Refraining from the use of personal phones in care areas or rooms.   - Not using profanity.   - Active listening.   - Addressing residents by their proper or preferred names and pronouns.   - Refusing to give or accept gifts.   - Explaining the care being provided.   - Following established care practices.
  • Behaviors toward Employers:   - Completing all duties.   - Adhering to policies and procedures.   - Documenting and reporting care accurately.   - Reporting any issues or obstacles to completing duties.   - Asking questions when unsure.   - Taking directions and constructive feedback well.   - Maintaining clean and neat grooming/dress.   - Being punctual and notifying employers of absences.   - Following the chain of command.   - Participating in educational programs and modeling facility standards.
  • Qualities of a Great NA: Compassionate, honest, tactful, conscientious, dependable, patient, respectful, unprejudiced, and proactive.

The Chain of Command

  • Administrator: Manages non-medical aspects, finances, and coordinates policy in consultation with medical staff.
  • Medical Director (MD): Reviews and consults on medical care aspects and coordinates with attending physicians.
  • Director of Nursing (DON): Manages the entire nursing staff.
  • Assistant Director of Nursing (ADON): Assists the DON in management.
  • Staff Development Coordinator: Directs employee training.
  • Minimum Data Set (MDS) Coordinator/Resident Assessment Coordinator: A specialized nurse who manages resident assessments and care delivery.
  • Nursing Supervisor: Supports staff across the facility or multiple units.
  • Charge Nurse: Supervises staff on a specific unit.
  • Staff Nurses (RNs, LPN/LVNs): Provide prescribed nursing care.
  • Nursing Assistants (NAs, CNAs): Perform assigned tasks, assist with ADLs, and report changes.

The Resident Care Plan and Nursing Process

  • Care Plan: A personalized guide for each resident; NAs must never perform activities not listed on the plan.   - ADL Coding System:     - 00: No setup or physical help from staff.     - 11: Setup help only.     - 22: One person physical assist.     - 33: Two+ person physical assist.     - 44: Totally dependent on staff for all aspects of the function.     - 88: ADL activity itself did not occur.
  • The Nursing Process (Steps):   1. Assessment: Gathering information from various sources.   2. Diagnosis: Identifying health problems.   3. Planning: Setting goals and creating the care plan.   4. Implementation: Putting the plan into action.   5. Evaluation: Determining if goals were met.
  • The NA plays a critical role in assessment (observation) and implementation.

Delegation and Time Management

  • The Five Rights of Delegation:   - Right task   - Right circumstance   - Right person   - Right direction/communication   - Right supervision/evaluation
  • NA Assessment before Tasks: NAs should ask if they have enough information, skills, and supplies, and confirm who their supervisor is and how to reach them.
  • Time Management Strategies:   - Plan ahead.   - Prioritize.   - Make a schedule.   - Combine activities.   - Get help when needed (e.g., from peers, the charge nurse, or supervisors).