Chapter 2: The Nursing Assistant
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Chapter 2: The Nursing Assistant Pages14-30 Health Tech Prep 1 Lancaster High School Shelly Carpenter. Objectives. Define the key terms listed in this chapter Explain the history and current trends affecting nursing assistants Explain the laws that affect nursing assistants

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Chapter 2: The Nursing AssistantPages14-30HealthTech Prep 1Lancaster High School Shelly Carpenter


  • Define the key terms listed in this chapter

  • Explain the history and current trends affecting nursing assistants

  • Explain the laws that affect nursing assistants

  • Explain what nursing assistants can do and their role limits

  • Explain why you need a job description

  • Describe the educational requirements for nursing assistants

The nursing assistant
The Nursing Assistant

Federal and state laws and agency policies combine to define the roles and functions of each health team member.

As NA You need to know:

1. What you can and cannot do

2. What is right and wrong conduct

3. Your legal limits

-determined by

1.Laws-local, state, and federal

2. Job descriptions-lists tasks expected of you on the job site

3. The patients condition

4. supervision you need

Protecting persons from harm involves a complex set of rules and

standards of conduct that form the legal and ethical aspects of care.

History and current trends

  • nursing assistants have helped nurses with basic nursing care.

  • Until the 1980s, training was not required by law.

  • RNs gave on-the-job training.

  • Some facilities offered nursing assistant courses

Home care
Home care

-increased during the 1980s.

1. Hospital stays are limited.

2. Patients are discharged earlier

3. Patients often still quite ill.

Reducing health care costs
Reducing Health Care Costs

  • Efforts to reduce health care costs include:

    • Hospital closings

    • Hospital mergers

    • Health care systems

    • Managed care

    • Staffing mix

      ** Most hospitals require a state-approved nursing assistant training program for employment of nursing assistants.

State and federal laws

  • Tasks performed by nursing assistants Vary from state to state and among and within agencies

  • State nurse practice acts and the Omnibus Budget Reconciliation Act of 1987 (OBRA) provide direction.

  • Nurse practice acts

    • Each state has a nurse practice act to regulate nursing practice

    • purpose

      • Defines RN and LPN/LVN

      • 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

Nurse practice act cont
Nurse Practice Act-cont’

  • Allows for revoking or suspending a nurse’s license due to

    • Being convicted of a crime in any state

    • Selling or distributing drugs

    • Using the person’s drugs for oneself

    • Placing a person in danger from use of alcohol or drugs

    • Demonstrating grossly negligent nursing practice

    • Being convicted of abuse or neglect of children or elderly

    • Violating the nurse practice act

    • Demonstrating incompetent behaviors

    • Aiding or assisting another person to violate the nurse practice act

    • Making medical diagnoses

    • Prescribing drugs and treatments

  • A state’s nurse practice act is also used to decide what nursingassistants can do.

The omnibus reconciliation act of 1987 obra
The Omnibus Reconciliation Act of 1987 (OBRA)

  • OBRA applies to all 50 states.

  • purpose of OBRA

    1. improve the quality of life of nursing center residents.

    2. Set minimum training and competency evaluation requirements for na

    3. Requires each state to have a NATCEP

    4. home care requirements for many states.

    *** If the agency receives Medicare funds, workers must meet OBRA’s requirements***

Obra the training program
OBRA-The training program

  • requires at least 75 hours of instruction/16 practical training

  • A nurse supervises this practical training.

  • Specific Areas of study

    • Communication

    • Infection control

    • Safety and emergency procedures

    • Resident rights

    • Basic nursing skills

    • Personal care skills

    • Feeding methods

    • Elimination procedures

    • Skin care

    • Transferring, positioning, and turning methods

    • Dressing

    • Ambulating the person

    • Range-of-motion exercises

    • Signs and symptoms of common diseases

    • How to care for cognitively impaired persons

Obra the test
OBRA-the test

  • A written test and a skills test are included.

    • multiple-choice questions -the number of varies

    • The skills test involves performing nursing skills.

  • You take the competency evaluation after your training program.

  • See Appendix A on page 821 in the textbook.

  • OBRA allows at least three attempts to successfully complete the evaluation.

  • Nursing assistant registry.

  • Nursing assistant registry
    Nursing Assistant Registry

    • nursing assistant registry

      • required by OBRA

      • has information about each nursing assistant,

        (1) Full name, including maiden name and any married names

        (2) Last known home address

        (3) Registration number and its expiration date

        (4) Date of birth

        (5) Last known employer, date hired, and date employment ended

        (6) Date the competency evaluation was passed

        (7) Information about findings of abuse, neglect, or dishonest use of property

    Nursing assistant registry1
    Nursing Assistant Registry

    • information stays in the registry for at least 5 years.

    • Any agency can access registry information.

    • a copy of your registry information to correct wrong information.

    • Other OBRA requirements

      • Retraining and a new competency evaluation program are required for nursing assistants who have not worked for 2 consecutive years as a nursing assistant.

      • Regular in-service education

      • performance reviews while on the job

    Other obra requirements
    Other OBRA Requirements

    • Must work one 8 hour shift within 2 years to keep on the registry.

    • Can require

      • New competency evaluation (retesting)

      • Retraining and new testing

    Working in another state
    Working in Another State

    • Edorsement

    • Reciprocity

    • Equivalency

    Roles and responsibilities

    • Directed by

      • Nurse practice acts

      • OBRA

      • state laws

      • legal and advisory opinions

        To protect persons from harm, you must understand:

      • What you can do

      • What you cannot do

      • The legal limits of your role

        • In some states, this is called scope of practice.

    Roles and responsibilities1

    • functions and responsibilities vary among states and agencies.

    • Before you perform a procedure, make sure that:

      • Your state allows nursing assistants to perform the procedure.

      • The procedure is in your job description.

      • You have the necessary training and education.

      • A nurse is available to answer questions and to supervise you.

    Roles and responsibilities2

    • Perform tasks and procedures that

      • meet hygiene, safety, comfort,

      • nutrition, exercise, and elimination needs

      • Lift and move persons

      • Collect specimens

      • Observe the person

      • includes measuring temperatures, pulses, respirations, and blood pressures.

      • Assist with admitting and discharging patients and residents

      • Promote psychological comfort

    Roles and responsibilities in home care
    Roles and Responsibilities in Home Care

    • Services may include:

      (1) Laundry

      (2) Shopping for groceries and household items

      (3) Preparing and serving meals

      (4) Light housekeeping

    Job description
    Job description

    • job descriptions reflect state laws and rules.

    • is a list of responsibilities and functions that the agency expects you to perform

    • must know what you can do in the state in which you are working.

    Job description con t

    • Do not take a job that:

      • Causes you to Act beyond the legal limits of your role

      • Function beyond your training limits

      • Perform acts that are against your morals or religion

    Chapter 3

    Ethics and the Law

    Lancaster High School

    Mrs. Carpenter


    • Explain how to prevent negligent acts

    • Give examples of false imprisonment, defamation, assault, battery, and fraud

    • Describe how to protect the right to privacy

    • Explain the purpose of informed consent

    • Explain your role in relation to wills

    • Describe child, elder, and domestic abuse

    Ethical aspects

    • Ethical behavior involves not being prejudiced or biased.

    • make judgments and have views before knowing the facts.

    • Judgments and views are based on the person’s

      • Culture

      • Religion

      • Education

      • experiences.

    Think about it

    • How can prejudices or biases affect the care YOU provide?

    • How can YOU deal with YOUR prejudices and biases when providing care?

    Legal aspects

    • Laws tell you what you can and cannot do.

    • A law is a rule of conduct made by a government body.

    • Enforced by the government, laws protect the public welfare.

    Legal aspects1

    • Criminal laws are concerned with offenses against the public and against society in general.

    • An act that violates a criminal law is called a crime.

      • Murder

      • Robbery

      • Assault and battery

    Legal aspects2

    • Civil laws are concerned with relationships between people.

    • Torts

      • Torts are part of civil law.

      • wrong committed against a person or the person’s property.

    Legal aspects3

    • Unintentional torts

      • Negligence

        • The negligent person failed to act in a reasonable and careful manner.

        • harm was caused to the person or property of another.

        • The person did not mean or intend to cause harm.

      • Malpractice

        • negligence by a professional person professional status because of training, education, and the service provided.

    Legal aspects4

    • Intentional Tort

      • Defamation

        • injuring a person’s name or reputation by

          making false statements to a third person.

      • Libel

        • making false statements in print, writing, or through pictures or drawings.

      • Slander

        • making false statements orally

    Legal aspects5

    • Intentional Tort –con’t

      • False imprisonment

        • the unlawful restraint or restriction of a person’s freedom of movement.

        • involves:

          • Threatening to restrain a person

          • Restraining a person

          • Preventing a person from leaving the agency

    Legal aspects6

    • Intentional Tort –con’t

      • Invasion of privacy

        • violating a person’s right not to have his or her name, picture, or private affairs exposed or made public without giving consent.

        • The Health Insurance Portability and Accountability

          Act of 1996 (HIPAA)

        • protects the privacy and security of a patient’s health information.

        • You must follow agency policies and procedures.

    Legal aspects7

    • Intentional Tort –con’t

    • Fraud

      • saying or doing something to trick, fool, or deceive

        a person.

        -is fraud if it does or may cause harm to a person or the person’s property.

    Legal aspects8

    • Intentional Tort –con’t

      • Assault and battery

        • may result in both civil and criminal charges.

        • Assault

          • intentionally attempting or threatening to touch a person’s body without the person’s consent.

        • Battery

          • touching a person’s body without his or her consent.

    • The person must consent to any procedure,

      treatment, or other act that involves touching the


    Informed consent
    Informed consent

    • the person clearly understands:

      • The reason for a treatment

      • What will be done

      • How it will be done

      • Who will do it

      • The expected outcomes

      • Other treatment options

      • The effects of not having the treatment

        ****Persons under legal age and mentally incompetent persons cannot give consent.

    Informed consent1
    Informed Consent

    • the person clearly understands:

      • The reason for a treatment

      • What will be done

      • How it will be done

      • Who will do it

      • The expected outcomes

      • Other treatment options

      • The effects of not having the treatment

        ****Persons under legal age and mentally incompetent persons cannot give consent.

    Reporting abuse

    • Abuse

      • mistreatment or harm of another person.

  • Abuse is a crime.

  • one or more of the following elements present

    • Willful causing of injury

    • Unreasonable confinement

    • Intimidation

    • Punishment

    • Depriving the person of goods or services needed for physical, mental, or psychosocial well being

  • Reporting abuse1
    Reporting Abuse

    • Abuse causes physical harm, pain, or mental anguish

    • Protection against abuse extends to persons in a coma

    Reporting abuse2

    • Elder abuse

    • Elder abuse can take the following forms

    • Physical abuse

      (1) Grabbing, hitting, slapping, kicking, pinching, hairpulling, or beating

      (2) Corporal punishment

      • Punishment inflicted directly on the body

    Reporting abuse3

    • Neglect

      • The person is deprived of needed health care or treatment.

      • Failure to provide food, clothing, hygiene, and other needs

    Reporting abuse4

    • Verbal abuse

      • Using oral or written words or statements that speak badly of, sneer at, criticize, or condemn the person

      • Unkind gestures

    • Involuntary seclusion

      • Confining the person to a certain area

    Reporting abuse5

    • Financial abuse

      • The person’s money is stolen or used by another person.

      • A person’s property is misused.

    • Mental abuse

      • Humiliation, harassment, ridicule, and threats of punishment

    Reporting abuse6

    • Financial abuse

      • The person’s money is stolen or used by another person.

      • A person’s property is misused.

    • Mental abuse

      • Humiliation, harassment, ridicule, and threats of punishment

    Signs of abuse

    • Box 2-7 on page 28

    Child abuse
    Child abuse

    • Risk factors for child abuse include:

      • Stress

      • Family crisis

      • Drug or alcohol abuse

      • Abuser history of being abused as a child

      • Discipline beliefs that include physical punishment

      • Lack of emotional attachment to the child

      • A child with birth defects or chronic illness

      • A child with a personality or behaviors that the abuser considers “different” or unacceptable

      • Unrealistic expectations for the child’s behavior or performance

      • Families that move often and do not have other family members or friends nearby


    • Abuse differs from neglect.

    • Types of child abuse

      • Physical neglect

        • to deprive the child of food, clothing, shelter, and medical care.

      • Emotional neglect

        • not meeting the child’s need for affection and attention.

      • Physical abuse

        • injuring the child on purpose.

      • Sexual abuse

        • using, persuading, or forcing a child to engage in sexual conduct.


    • Rape

      • forced sexual intercourse with a person who is not of legal age to give consent.

    • Molestation

      • sexual advances toward a child.

    • Incest

      • sexual activity between family members.

    • Child pornography

      • taking pictures or video taping a child involved in sexual acts.

    • Child prostitution

      • forcing a child to engage in sexual activity for money.


    • The health team must be alert for signs and symptoms of child abuse.

    • State laws require the reporting of suspected child abuse.

    • If you suspect child abuse, share your concerns with the RN.

    • The RN contacts health team members and child protection agencies as needed.

    Assignment workbook 1 81