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The Nursing Assistant. Chapter 2, part A. HOW THEY WORK A. Diagnoses disease or disability & prescribes treatment B. Administers therapy in the form of heat, cold, massage, ultrasound, electricity, & exercise to muscles, bones, & joints.

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The Nursing Assistant

Chapter 2, part A



A. Diagnoses disease or disability & prescribes treatment

B. Administers therapy in the form of heat, cold, massage, ultrasound, electricity, & exercise to muscles, bones, & joints.

C. Teaches exercises to help the resident improve or overcome speech problems.

D. Trains residents to compensate for disabililities during ADLs & other activities.

E. Creates diets for residents with special needs.

F. Helps residents get support services, such as counseling.

G. Helps residents socialize & stay active.


  • ____ Medical Social Worker (MSW)
  • ____ Occupational Therapist (OT)
  • _____ Physical Therapist (PT)
  • _____ Physician or Doctor
  • _____ Registered Dietitian (RD)
  • _____ Speech-Language Pathologist (SLP)
  • _____ Activities Director

Nursing Care Team Providers

How they work together to provide nursing care

A. The care team revolves around this person & his or her condition, treatment, & progress.

B. Performs delegated tasks, such as taking vital signs, providing personal care, & reporting observations to other team members.

C. Licensed professional who has completed 1 -2 years of education & is able to administer medications & give treatments.

D. Licensed professional who has completed 2 - 4 years of education who coordinates, manages, & provides skilled nursing care.

  • ___ Registered Nurse (RN)
  • ___ Licensed Practical Nurse (LPN/LVN)
  • ___ Nursing Assistant (NA or CNA)
  • ___ Resident
    • Until the 1980s, training was not required by law.
    • Before the 1980s, team nursing was common.
    • Primary nursing was common in the 1980s.
    • Home care increased during the 1980s.
    • Efforts to reduce health care costs include:
      • Hospital closings
      • Hospital mergers
      • Health care systems
      • Managed care
      • Staffing mix
      • Patient-focused care
    • Each state has a nurse practice act which:
      • Defines RN and LPN/LVN
        • Some acts also define nursing assistant.
      • Describes the scope of practice for RNs and LPNs/LVNs
      • Describes education and licensing requirements for RNs and LPNs/LVNs
      • Protects the public
        • from persons practicing nursing without a license
        • Allows for denying, revoking, and suspending a nursing license
Role of nursing assistants
    • Some nurse practice acts also regulate nursing assistant roles, functions, education, and certification requirements.
    • In other states, there are separate laws for nursing assistants.
    • If you do something beyond the legal limits of your role, you could be practicing nursing without a license.





Act of 1987



  • Remember: OBRA, NOT OPRA, OBRA Omnibus Budget Reconciliation Act
  • Omnibus Budget Reconciliation Act


  • Its purpose is to improve the quality of life of nursing center residents.
  • This law sets minimum training and competency evaluation requirements for nursing assistants.
  • Each state must have a nursing assistant training and competency evaluation program (NATCEP).
The training program
    • OBRA requires at least 75 hours of instruction.
        • National minimum requirement: 75
        • Illinois requires 80
    • There must be at least 16 hours of supervised practical training.
      • National minimum requirement:16
      • Illinois requires 40
  • Competency evaluation
    • The competency evaluation has a written test and a skills test.
    • OBRA allows at least 3 attempts to successfully complete the evaluation.
Retraining and a new competency evaluation program are required for nursing assistants who have not worked for 24 months.
  • Agencies covered under OBRA must provide 12 hours of educational programs to nursing assistants every year.
  • Performance reviews also are required.
OBRArequires a nursing assistant registry in each state.
    • It is an official record or listing of persons who have successfully completed that state’s state-approved NATCEP.
    • The registry has information about each nursing assistant.
    • All information stays in the registry for at least 5 years.
    • Any agency can access registry information.
    • You receive a copy of your registry information.
    • You can correct wrong information.
To protect persons from harm, you must understand:
    • What you can do
    • What you cannot do
    • The legal limits of your role
      • This is also called scope of practice.
      • The National Council of State Boards of Nursing (NCSBN) calls it range of functions.
  • Licensed nurses supervise your work.
    • You assist them in giving care.
    • The following are a list of tasks that are generally considered within the scope of a CNA practice:
Serving meal trays and feeding residents
  • Helping residents dress and undress
  • Helping residents with mouth care, bathing, shaving, & backrubs
  • Keeping living areas clean & neat; making beds
  • Assisting residents to move around safely
  • Taking vital signs
  • Caring for supplies & equipment
Before you perform a nursing task, make sure that:
    • Your state allows nursing assistants to do so
    • It is in your job description
    • You have the necessary education & training
    • A nurse is available to answer questions and to supervise you
You must know what you can do in the state in which you are working.
    • State laws and rules limit nursing assistant functions.
    • No agency or nurse can expand your range of functions beyond what is allowed by your state’s laws and rules.
    • “The nurse told me to do it” won’t stand up in a court of law.
A job description describes what the agency expects you to do
    • Identifies educational requirements
  • Always obtain a written job description when you apply for a job.
    • Ask questions about it during your job interview.
  • Before accepting a job:
    • Tell the employer about functions you did not learn
    • Advise the employer of functions you cannot do for moral or religious reasons
    • Clearly understand what is expected
Do not take a job that requires you to:
    • Act beyond the legal limits of your role
    • Function beyond your training limits
    • Perform acts that are against your morals or religion
  • You need to know:
    • What you can safely do
    • The things you should never do
    • Your job description
    • The ethical and legal aspects of your role
Delegatemeans to authorize another person to perform a nursing task in a certain situation.
    • The person must be competent to perform a task in a given situation.
RNs can delegate nursing tasks to LPNs/LVNs and nursing assistants.
    • In some states, LPNs/LVNs can delegate tasks to nursing assistants.
    • Delegation decisions must protect the person’s health and safety.
    • The delegating nurse is legally accountable for the nursing task.
  • The RN is accountable for all nursing care.
  • Nursing assistants cannotdelegate.

Assessment: getting info

Evaluation: observations, unexpected outcomes, & changes

Diagnosis: id problems & needs

Implementa-tion: steps in care plan

Planning: id goal of care

Nursing care

planning process


Care plan - should identify all of the following:

Resident’s diagnosis & treatment

Resident’s health & physical condition

Resident’s goals & expectations


Chain of command

  • Describes the line of authority & helps ensure that residents receive proper care.
  • Also protects employees & employer from liability(being held responsible for harming someone else).
    • If a resident is harmed by a CNA who is doing what was in the care plan & according to policy & procedure, the CNA may not be held responsible.
    • If a resident is harmed by a CNA who is not following the care plan, he could be held responsible.
Which of the following statements is true of the chain of command?
    • It describes the line of authority in a facility.
    • It is the same as the care team.
    • It details the survey process for a facility.
    • Nursing assistants are at the top of the chain.
  • Liability is a legal term that means
    • the line of authority in a facility.
    • ignoring a resident’s call light.
    • someone who can be held responsible for harming someone else.
    • a task that a person was not trained for.
Why is it important not to do tasks that are not assigned to you?
    • You may be assigned more work if you perform additional tasks.
    • You may put yourself or someone else in danger.
    • You may need to pay for additional training.
    • You may have to start arriving at work earlier.
What is one reason that other members of the care team will show great interest in the work that you do?
    • They may not trust you.
    • You will be working under the authority of other’s licenses.
    • They may not have much respect for nursing assistants.
    • To avoid having to pay you if you make a mistake.


  • ___ The purpose of the care plan is to give suggestions for care, which the CNA can customize for each resident.
  • ___ Activities that are not listed on the care plan should not be performed.
  • ___ Care planning does not involve the resident’s input or feelings.
  • ___ Sometimes even simple observations that CNAs make about residents are very important.

Nursing process


A. Deciding if goals were met

B. Getting information about the resident & reviewing this information

C. Identifying health problems & resident needs

D. Putting the plan into action

E. Resident’s needs are met

F. Setting goals & creating a care plan

  • ___Assessment
  • ___Diagnosis
  • ___Planning
  • ___Implementation
  • ____Evaluation
  • ___Goal
The NCSBN’s Five Rights of Delegation is another way to view the delegation process.
    • The right task - Is there a match between the resident’s needs & the CNA’s skills, abilities, & experience?
    • The right circumstances –Is the resident stable?
    • The right person – Is the CNA the right person for the job?
    • The right directions and communication – Can the nurse give appropriate direction & communication?
    • The right supervision – Is the nurse available for to give supervision, support, & help that the CNA needs?
Your role in delegation
    • You must protect the person from harm.
    • You either agree or refuse to do a delegated task.
  • Accepting a task
    • When you agree to perform a task, you are responsible for your own actions.
    • You must complete the task safely.
    • Report to the nurse what you did and the observations you made.
  • Asking questions and asking for help when you need it will help you to provide better care.
Refuse to perform a task when:
    • The task is beyond the legal limits of your role.
    • The task is not in your job description.
    • You were not prepared to perform the task.
    • The task could harm the person.
    • The person’s condition has changed.
    • You do not know how to use the supplies or equipment.
    • Directions are not ethical or legal.
    • Directions are against agency policies.
    • Directions are unclear or incomplete.
    • A nurse is not available for supervision.

Things a CNA should never do.

*Memorize this list for the certification exam

  • Never take oral or telephone orders from doctors. (Find a nurse promptly.)
  • Never perform sterile procedures. (You can assist by opening packages, but can’t perform sterile procedures)
  • Never tell a person or family a diagnosis or treatment plan(doctor’s responsibility, nurse can clarify what the doctor said).
Never diagnose or prescribe treatments or drugs for anyone (only doctors can diagnose & prescribe)
  • Never supervise other nursing assistants or assistive personnel (this is a nurse’s responsibility).
  • Never ignore an order or request to do something you can’t do (You must inform the nurse promptly why you can’t do it. You cannot neglect the person’s care)
Never, ever, ever GIVE MEDICATIONS: not orally, not rectally, not rectally or vaginally or by injection. Not by application to skin either.
  • Never insert or remove tubes or objects into body openings.
    • No catheters into a person’s bladder
    • No feeding tube into a person’s nose or esophagus
    • No breathing tubes into a person’s trachea
    • No blood draws or IV starts
    • No enemas or suppositories or rectal tubes unless specified in your job description & legal in your state
Never, ever ignore an order or a request to do something.
    • Tell the nurse about your concerns.
    • You must have sound reasons for refusing a task.
    • Failing to provide needed care is a violation of law, know asneglect.