Role of the Nursing Role of the Nursing AssistantAssistant

Interdisciplinary TeamInterdisciplinary Team

•A group of professionals A group of professionals from different health care from different health care disciplines who each disciplines who each contribute their expertise contribute their expertise to the care of a single to the care of a single patientpatient

Interdisciplinary TeamInterdisciplinary Team

• MembersMembers– Physicians make a diagnosis and Physicians make a diagnosis and

prescribe medicationprescribe medication– RN’s plan and direct the nursing care RN’s plan and direct the nursing care

ordered by the physicianordered by the physician– CNA’s provide direct patient care under CNA’s provide direct patient care under

the supervision of an RN or LPNthe supervision of an RN or LPN– Aides, therapists, and support persons Aides, therapists, and support persons

all contribute to this teamall contribute to this team

The Nursing Team The Nursing Team

• RNRN– Licensed-pass a state board examLicensed-pass a state board exam– Assess, plan, evaluate and coordinate Assess, plan, evaluate and coordinate

aspects of patient careaspects of patient care– Educate patients and their familiesEducate patients and their families– Provide nursing care and supervise Provide nursing care and supervise

duties they delegate to othersduties they delegate to others– May specialize in any specific area of May specialize in any specific area of

nursing practicenursing practiceHS-NE-10bHS-NE-10b

The Nursing TeamThe Nursing Team

• LPN/LVNLPN/LVN– Licensed-passed state board exam Licensed-passed state board exam – Works under the supervision of a RN, Works under the supervision of a RN,

MD or DentistMD or Dentist– Provides most of the care when patient’s Provides most of the care when patient’s

nursing needs are not complexnursing needs are not complex– Assists the RN in more complicated Assists the RN in more complicated

situationssituationsHS-NE-10bHS-NE-10b

The Nursing TeamThe Nursing Team

• CNACNA– Trained to assist in the care of patients under Trained to assist in the care of patients under

the supervision of RN or LPNthe supervision of RN or LPN– May be called:May be called:

• Patient care attendantPatient care attendant• Nurse’s aideNurse’s aide• Clinical support associateClinical support associate• Nursing assistantNursing assistant• Health care aideHealth care aide• Patient care technicianPatient care technician• Personal care assistantPersonal care assistant

HS-NE-10bHS-NE-10b

Patient Focused CarePatient Focused Care

• Emphasizes the needs of the patient Emphasizes the needs of the patient above the convenience of other above the convenience of other departments involved with patient caredepartments involved with patient care– Limits the # of people involved in the careLimits the # of people involved in the care– Contains costContains cost– Meet patients’ needs efficientlyMeet patients’ needs efficiently

• Cross-trained workers are utilizedCross-trained workers are utilized

What can the CNA do to be an What can the CNA do to be an effective member of the team? effective member of the team? • Recognize the importance of all team membersRecognize the importance of all team members• Appreciate each others’ contributions to the teamAppreciate each others’ contributions to the team• Learn as much as you can about your patient’s Learn as much as you can about your patient’s

and their families to better understand their and their families to better understand their feelings and concernsfeelings and concerns

• Attend care plan conferences and give your Attend care plan conferences and give your observations/ideasobservations/ideas

• Attend in-service training sessionsAttend in-service training sessions• Become cross-trainedBecome cross-trained• Cooperate with other team members to provide Cooperate with other team members to provide

patient focused carepatient focused care

HS-NE-10a

Regulation of Nursing Assistant Regulation of Nursing Assistant PracticePractice

• 1987-Omnibus Budget Reconciliation Act1987-Omnibus Budget Reconciliation Act– Regulates CNA education and certificationRegulates CNA education and certification– Includes statements from the Dept of Health and Includes statements from the Dept of Health and

Human Services and the Center for Medicare and Human Services and the Center for Medicare and Medicaid Services (states the minimum Medicaid Services (states the minimum requirements for CNA training)requirements for CNA training)

– Nurse Aide Competency Evaluation Program was Nurse Aide Competency Evaluation Program was started to guide individual programs to meet the started to guide individual programs to meet the requirements of OBRArequirements of OBRA

– Georgia Medical Care Foundation is Georgia’s Georgia Medical Care Foundation is Georgia’s regulatory agency and must meet federal regulatory agency and must meet federal standardsstandards

HS-NE-6c

Certified Nursing Assistant Certified Nursing Assistant TrainingTraining

• Students must complete 85 hrs of Students must complete 85 hrs of classroom/lab time classroom/lab time plusplus clinical experience clinical experience

• Clinical skills must includeClinical skills must include– Basic nursing skillsBasic nursing skills– Basic restorative skillsBasic restorative skills– Mental health and social service needsMental health and social service needs– Personal care skillsPersonal care skills– Resident rightsResident rights– Safety and emergency careSafety and emergency care

Certified Nursing Assistant Certified Nursing Assistant TrainingTraining

• You are given 3 opportunities to You are given 3 opportunities to meet the requirements of testingmeet the requirements of testing

• You must work at least 8 hours for You must work at least 8 hours for pay in a LTCF within 24 months timepay in a LTCF within 24 months time

• You must receive 12 hours of You must receive 12 hours of continuing education every yearcontinuing education every year

• You must meet all requirements to You must meet all requirements to renew every 2 yrsrenew every 2 yrs

Line of AuthorityLine of Authority

• Health care facilities all have different lines Health care facilities all have different lines of authority or chain of commandof authority or chain of command

• LTCF’sLTCF’s– CNA, LPN, RN Charge Nurse, Director of Nursing, CNA, LPN, RN Charge Nurse, Director of Nursing,

AdministrationAdministration• HospitalsHospitals

– CNA, Nurse (RN, LPN), Charge Nurse, Nurse or CNA, Nurse (RN, LPN), Charge Nurse, Nurse or Unit Manager, Director of Nursing, Unit Manager, Director of Nursing, AdministrationAdministration

• As a SNA, your teacher or the person As a SNA, your teacher or the person designated as your supervisor (CNA) is your designated as your supervisor (CNA) is your immediate authorityimmediate authority

Line of AuthorityLine of Authority

• Know your facility’s organizational Know your facility’s organizational structurestructure

PhysicianRegistered Nurse

Charge NurseRN

Team LeaderRN or LPN

CNA

The Patient

Guidelines to FollowGuidelines to Follow

• Work with your line of authority when Work with your line of authority when solving problemssolving problems

• Always begin with your immediate Always begin with your immediate supervisor and work your way up if you hit supervisor and work your way up if you hit a roadblocka roadblock

• Only perform the tasks that you have been Only perform the tasks that you have been trained to do!!trained to do!!

• Always ask for help, even if it is related to Always ask for help, even if it is related to a skill you have been trained to do.a skill you have been trained to do.HS-NE-6b

Guidelines to FollowGuidelines to Follow

• Remain within your scope of practice.Remain within your scope of practice.

• Politely refuse and explain whyPolitely refuse and explain why

• CNA’s do not take orders from CNA’s do not take orders from physicians or discuss the patient’s physicians or discuss the patient’s status, medical record or results of status, medical record or results of any tests or vital signsany tests or vital signs

• Always be willing to learn new skills Always be willing to learn new skills that are within your scope of practice that are within your scope of practice

CNA Role and ResponsibilityCNA Role and Responsibility

• Works directly with the patient, giving Works directly with the patient, giving physical care and emotional supportphysical care and emotional support

• CNA’s are interested in others and CNA’s are interested in others and take pride in their worktake pride in their work

• CNA’s are willing to learn new skills to CNA’s are willing to learn new skills to care for those who are illcare for those who are ill

• CNA’s can contribute much to the CNA’s can contribute much to the patient’s safety and comfortpatient’s safety and comfort

CNA Role and ResponsibilityCNA Role and Responsibility

• CNA’s see the patient more than any other CNA’s see the patient more than any other member of the nursing teammember of the nursing team

• CNA’s make observations that can give CNA’s make observations that can give valuable insight into the patient’s illness valuable insight into the patient’s illness and attitudeand attitude

• Patient’s may make more “bonds” with you Patient’s may make more “bonds” with you than other members of the health care team than other members of the health care team and share with you “minor complaints” they and share with you “minor complaints” they may not tell their physician or nursemay not tell their physician or nurse

Personal Adjustments Personal Adjustments

• Accept constructive criticismAccept constructive criticism

• Follow rules and orders promptlyFollow rules and orders promptly

• Show dependability and accuracy be being Show dependability and accuracy be being on time and completing your assignmentson time and completing your assignments

• Respect your coworkers and the role you Respect your coworkers and the role you share on the health care teamshare on the health care team

• Be empathetic (not sympathetic), patient Be empathetic (not sympathetic), patient and tactful with others (patients and and tactful with others (patients and coworkers)coworkers)

Personal AdjustmentsPersonal Adjustments

• Develop good interpersonal Develop good interpersonal relationshipsrelationships– Be warm and pleasant to others Be warm and pleasant to others

• Your attitude is the most important Your attitude is the most important characteristic you bring to your jobcharacteristic you bring to your job– Caring, courtesy, cooperationCaring, courtesy, cooperation– Emotional control, tact, patienceEmotional control, tact, patience– EMPATHY or UNDERSTANDINGEMPATHY or UNDERSTANDING

Personal AdjustmentsPersonal Adjustments

• Develop good relationships with your Develop good relationships with your patientspatients

• Show empathy for the patient by being Show empathy for the patient by being eager to serve and by using a gentle eager to serve and by using a gentle touchtouch

• You may have patients with different You may have patients with different problems or concerns, but to a patient, problems or concerns, but to a patient, his/her own problems are the most his/her own problems are the most importantimportant

Personal AdjustmentsPersonal Adjustments• Not all patient responses are about YOU or Not all patient responses are about YOU or

your job performanceyour job performance• Patients may become irritable, complaining or Patients may become irritable, complaining or

uncooperative because ofuncooperative because of– Fear about their diagnosis, disability or deathFear about their diagnosis, disability or death– PainPain– Worries about family or the futureWorries about family or the future– Loss or lack of social support systemsLoss or lack of social support systems– Dependence on othersDependence on others– Financial concernsFinancial concerns

• A gentle touch and reassurance can helpA gentle touch and reassurance can help• Report these concerns to the nurseReport these concerns to the nurse

Personal AdjustmentsPersonal Adjustments

• You must also meet the family’s needsYou must also meet the family’s needs• They may also be uncooperative and They may also be uncooperative and

demanding because they are worried demanding because they are worried about their loved oneabout their loved one

• Patience and tact are most useful herePatience and tact are most useful here• Just listening can helpJust listening can help• Watch body language as it may give Watch body language as it may give

you clues as to the family’s feelingsyou clues as to the family’s feelings

Personal AdjustmentsPersonal Adjustments

• You are part of a team whose goal is You are part of a team whose goal is to help the patientto help the patient– Remember your roleRemember your role– Do not overstep your authorityDo not overstep your authority– Listen to instructions carefullyListen to instructions carefully– Watch your tone of voice and body Watch your tone of voice and body

languagelanguage– Promptly carry out orders and report Promptly carry out orders and report

unfinished workunfinished work– Offer to help others and accept help when Offer to help others and accept help when

you need ityou need it– Have a positive attitudeHave a positive attitude

Personal AdjustmentsPersonal Adjustments

• You are part of a team whose goal is to You are part of a team whose goal is to help the patienthelp the patient– Extend common courtesy and dignity to staff Extend common courtesy and dignity to staff – Keep the common goal in mind and recognize Keep the common goal in mind and recognize

coworkers as integral parts of the teamcoworkers as integral parts of the team– Understand and follow facility policies and Understand and follow facility policies and

procedures*procedures*– Treat all with respectTreat all with respect– Practice good hygiene, nutrition and stress Practice good hygiene, nutrition and stress

reductionreduction

HS-NE-6d

Personal HygienePersonal Hygiene

• Bathe dailyBathe daily

• Use deodorantUse deodorant

• Good oral hygieneGood oral hygiene

• Clean hair, pulled Clean hair, pulled backback

• Short, clean Short, clean natural nails-clear natural nails-clear polish onlypolish only

• Only stud Only stud earrings, wedding earrings, wedding band and watch band and watch are allowedare allowed

• Clean socks or Clean socks or stockingsstockings

• Well fitting shoesWell fitting shoes

UniformsUniforms

• LCCS requires white LCCS requires white with white shoeswith white shoes

• Clean, wrinkle freeClean, wrinkle free

• Repair torn hems Repair torn hems and missing buttonsand missing buttons

• Not worn when not Not worn when not on dutyon duty

• Remove inside out Remove inside out

• ID badge requiredID badge required

• Keep in mind that Keep in mind that your appearance your appearance says a lot about you says a lot about you in a patient’s eyesin a patient’s eyes

• A well-groomed A well-groomed appearance says you appearance says you have pride in have pride in yourself and your yourself and your workwork

Stress, Stress, StressStress, Stress, Stress• Avoid burnout by Avoid burnout by

reducing stressreducing stress– Sufficient restSufficient rest– Good nutritionGood nutrition– Leisure activitiesLeisure activities– Stress reductionStress reduction– Group discussionGroup discussion– Stress managementStress management– Exercise programsExercise programs

• Personal Stress Personal Stress ReductionReduction– Go for a walkGo for a walk– Devote time to Devote time to

hobbieshobbies– Herbal teaHerbal tea– Relaxation exercisesRelaxation exercises– Quiet musicQuiet music– Warm, relaxing bathWarm, relaxing bath

There are many ways to reduce stress other than relying on drugs or alcohol to change your mood. Don’t get into a

situation you can’t get out of because of stress