Introduction to Nurse AssistantModule 1 (Green Skills Book)

Chapter 1& 2 in Palliam

What is a Certified Nurse Assistant?

• Just exactly what the title states:• An assistant to the nurse (RN, LVN, N.P, M.D etc.)• You are the most INTIMATE/CLOSE healthcare worker the

resident/patient/client will have.• You are the EYES AND EARS of the nurse who is busy supervising and

passing medications• YOU DO SO MUCH AND WILL HAVE SO MUCH KNOWLEDGE TO

EFFECTIVELY AND EFFICIENTLY TAKE CARE OF YOUR PATIENTS.• There are some basics you need to know about how the healthcare

system works

Code of Regulations, Division 5, Title 22 Laws

• These laws are established for the following:• Licensing and certification standards of health care facilities• Minimum standards of care for the resident.• Regulations which govern Nursing Assistant Programs • Nurse Assistant Certificaion Requirments-initial and renewal.• Skilled Nursing facilities must be licensed.• Skilled Nursing Facilities must have policies and procedures to ensure

resident’s rights and safety.• Violation of Title 22 may lead to issuance of state citation with a fine.

OBRA OF 1987• OBRA goal is to improve quality of care in skilled nursing facilities.• requires that nurse aids receive training and pass a competency exam within four

months of employment in a skilled nursing facility.• Establishes standards of resident care for Medicare (people 65 & older) and

Medi-cal (for families with children and for the disabled) reimbursement.• Authorize the Federal Government to contract with the individual states to do

Federal onsite surveys (observing) to make sure facilities are following regulations.• Violating regulations will result in:• Loss of facility's ability to provide Nursing Assistant training Program.• $$$$$$$ penalties• Denial of payment• State monitoring• Termination of facility (no longer in service) • **refer to handout instructor gives out**

Title 22 and OBRA Requirements for the Nursing Assistant •

• Complete Nurse Assistant training course approved by the California Department of Public Health (CDPH).• Minimum of 50 hours theory, + 10 hours recommended Alzheimer’s Disease

and Elder Abuse.• Minimum 100 hours clinical training in a skilled nursing facility.• What the course is teaching must be approved by Title 22 and OBRA.• Students who are employees of skilled nursing facilities must be paid an hourly

wage while in training.• Criminal background check done upon enrollment in nurse assistant course and

work.• History & Physical Exam (w.Dr.) Tuberculosis clearance (TB test must be done

before working with any patients)• Reguires you pass the state competency exam• **Refer to teacher handout for this**

How does the State Competency Exam work?• Includes a written exam and skills exam

• 3 opportunities to pass• A competency test fee• Facility must pay competency test fee if the student is an employee • If student is hired by a skilled nursing facility within a year of passing

the competency test, the facility must reimburse the competency test fee.• Criminal Background Check Required before certification.• California has a contract with 2 companies that can give the test :

• RED CROSS AND NNAAP;PEARSON VUE BY COMMUNITY COLLEGES

How do you Renew your License?

• Complete the CDPH RENEWAL APPLICATION-HS 283C form• Complete 48 hours of approved in-service/continuing education

hours every 2 years with at least 12 of the 48 hours completed in each of the two years. 24 hours can be done online now.• Must complete at least 1 day of work for pay, in nursing related

services in the past 2 years.• Criminal clearance----but no fingerprinting required for renewal just

for done once.

To be approved for Competency Exam you must ?

• If approved you will receive a CDPH FORM 932• FORM MUST CONTAIN THE STATE STAMP AND SEAL MUST BE

UNBROKEN.• Their will be date by which the candidate must successfully pass the

evaluation.• Form must be presented at time of testing.• Candidate’s Right thumb fingerprint will be applied to form each time

candidate tests.• If candidate does not pass, they will need to keep the form for retesting.

Qualities of Successful Nursing Assistant

• Dependable, considerate, pleasant, empathetic, flexible, honest, compassionate and caring, sensitive to others, respectful, cooperative, team player, observant, well groomed, organized, respectful of cultural differences!• Take notes here on what the instructor says these mean:

Who is part of the Healthcare Team?• Resident ( the person receiving treatment in a long-term skilled facility, the word patient

is used for a person in hospital setting, the word client is used for person in home health setting.)

• FAMILY • REGISTERED NURSE (RN) (MY SUPERVISOR)• NURSE PRACTITIONER (NP) (RN’S SUPERVISOR)• PHYSICIAN’S ASISSTANT (PA) • LICENSED VOCATIONAL NURSE (LVN; MRS. AISHA =), THE CNAS

SUPERVISOR AND OR CHARGE NURSE )• CERTIFIED NURSE ASSISTANT ( THAT WILL BE YOU =) )• RESTORATIVE NURSE ASSISTANT (RNA EXTRA CERTIFICATE YOU CAN GET)• PHYSICAN (DOCTOR)• PHYSICAL THERAPIST (PT)• OCCUPATIONAL THERAPIST (OT)• SPEECH THERAPIST • DIETICIAN (PLANS DIET FOR PATIENT)• ACTIVITIES DIERECTOR• SOCIAL WORKER• CLERGY (RELIGIOUS DIRECTOR)• OMBUDSMAN (PATIENT’S ADVOCATE THEY SPEAK FOR THEM HELP THEM

REPORT FOR THEM “HAVE THEIR BACK”)

INTERDISCIPLINARY TEAM (PROFESSIONAL AND

NON PROFESSIONAL)

Where can C.N.A’s be Employed?

• Skilled nursing (convalescent, long-term care facilities for chronic illnesses…chronic -means long term)• Acute hospital ( Acute is short term, acute illness- short term illness)• Immediate care facility• Disabled habilitative (icf/ddh)• Disabled nursing• Hospice care-patient has 6 months to 1 year to live has terminal

illness (dying) no more cure, now just trying to make their dying experience as comfortable and pain free as possible.

Where can C.N.A’s be employed? continued

• Assisted Living/Residential Care/Board & Care Facilities• Pyschiatric Facilities (mental health)

• Clinics ( where you can get physicals and immunization’s done etc.)• Prison System Facilities• Alzheimer’s Units

Who is the C.N.A’s Supervisor?• Direct Supervisor of the C.N.A is a licensed nurse RN, LVN, OR LPN

that is functioning/working as the CHARGE NURSE.• Depending on where you work you may also report to others such as :

• DSD (DIRECTOR OF STAFF DEVELOPMENT)• DIRECTOR OF NURSING• FACILITY/AGENGY ADMINISTRATOR• PHYSICIAN ( IN A CLINIC SETTING)

What is Scope of Practice?

• Scope of Practice- are the tasks that the nurse assistant is allowed to perform according to state and federal law and facility policies.• This is done in order to provide uniform ( equal) and sage care• Must provide care according to educational standards at ALL TIMES.• Following your scope of practice is a LEGAL CONCEPT. ( means if you

do not follow your scope of practice you are BREAKING THE LAW)

What is the C.N.A’S SCOPE OF PRACTICE:

(**very important slide**)• PROVIDE SAFE ENVIRONMENT FOR RESIDENT/PATIENT/CLIENT.• AWARENESS OF POTENTIAL HAZARDS ( such as LIQUID SPILLS)• PRACTICE PERSONAL HYGIENE AND CLEANLINESS• CARE FOR RESIDENT’S PERSONAL PROPERTY• ADHERE TO) STANDARD PRECAUTIONS (universal precautions)• MEET THE CLIENT’S PHYSICAL NEEDS:• ADL (activities of daily living)• Assist with medical and rehabilitative activities ( vital signs, turning,

collecting specimens, ambulation.

What is the C.N.A’S SCOPE OF PRACTICE continued: (**very important slide**)• MAINTAIN A CLEAN ENVIRONMENT• ASSIST WITH ADL’S IN A TIMELY MANNER• DOCUMENT CARE PROVIDED AS REQUIRED BY FACILITIES POLICY• OBSERVE CHANGES IN RESIDENT’S PHYSICAL STATUS AND REPORT AS NEEDED.• ASSIST THER RESIDENT TO MEET THEIR PSYCHOSOCIAL, EMOTIONAL, SPIRITUAL AND

CULTURAL NEEDS.• OBSERVE CHANGES AND RESIDENT’S PHYSICAL STATUS AND REPORT AS NEEDED• ASSIST WITH RESIDENT COMFORT AND ANXIETY RELIEF• PROTECTING RESIDENT’S RIGHTS• You are NOT ALLOWED TO GIVE ANY FORM OF MEDICATIONS TO PATIENT’S• NOT ALLOWED TO PERFORM ANY STERILE PROCEDURES, YOU ARE NOT ALLOWED TO

INSERT OR REMOVE ANY TYPE OF TUBING OR DRAINAGE FROM A PATIENT• YOU ARE NOT ALLOWED TO TAKE ORDERS OVER THE PHONE FROM THE DOCTOR.• *look in your book to fill out scope of practice worksheet**

What are the Resident’s Rights?(**very important slide**)

• The nurse assistant will ensure that the resident will :• Be treated with dignity and respect• Feel secure• Be recognized as an INDIVIDUAL.• Love and be loved• Feel a sense of accomplishment• Feel good about themselves • Follow personal beliefs• Receive nursing care that assures cultural awareness and

ACCEPTANCE.

You are the Resident’s/ Patients/Client’s MANDATED

REPORTER• Mandated Reporter is : LEGALLY required to report suspected or observed abuse or neglect (not meeting the patient’s needs, not performing a task properly, ignoring the patient, not following directions properly)Example of Neglect: ( write what your instructor say’s here)

You will fill out a Abuse Report Form SOC341

C.N.A’s RESPONSIBILITIES TO EMPLOYER (JOB)• Report to work on time (enough time to be fully prepared not just

minutes before)• Fulfill assigned schedule reliably• Notify supervisor when ill in a timely manner.• Work as a team member• Perform one’s job to the best of his or her ability as specified by a job

description (what the employer expects you to do)• Conserve supplies and equipment

Definition of Professionalism for the Nurse Assistant

• Professionalism:• Involves carrying out resident care in a manner that is:• Ethical• Competent• Knowledgeable• Carrying• Committed• Representative of high standards.

Examples of Professional Behaviors or Attitudes:• Skilled, caring, responsible, trustworthy, truthful

• Attending in-service educational activities to improve skills and knowledge• Showing compassion for others• Being a team player• Doing the best job possible• Asking for assistance when necessary• Being a mandated reporter• Adhering to scope of practice• Maintaining current nurse assistant certification• Maintaining professional appearance

• Daily bath/shower and use of deodorant, uniform clean and pressed• Shampoo hair on a regular basis, treat dandruff and other scalp conditions• Fingernails should be short and clean, no acrylics (home for bacteria and disease causing microbes-

germs)• Daily oral hygiene and mouthwash• Men keep facial hair shaved or groomed neatly.• Follow facility protocol for tattoos and piercings

Ethical Behavior for the C.N.A

Ethical Behavior- for resident care means the Nurse Assistant should:1. PROTECT LIFE2. PROMOTE HEALTH3. KEEP PERSONAL INFO CONFIDENTIAL4. RESPECT EACH PERSON AS AN INDIVIDUAL (REGLIGIOUS BELIEFS,

CULTURAL DIFFERENCES)5. GIVE CARE BASED ON NEED, NOT GRATUITIES

Ethical Behavior for Work Includes:

• Working assigned shifts• Arriving on time for work• Being absent only when necessary• Notifying employer prior to necessary absences in a timely manner.• Following instructions given by supervisor with scope of practice.• Being a loyal, flexible cooperative team member

Unacceptable Behaviors which may result in being fired/dismissal

• Any abuse of residents: Physical, Emotional, Psychological, Verbal Abuse• Stealing or willfully damaging a property (can be considered Battery)• Insubordination (disobedience)• Neglecting duties• Falsifying records or reports• Working under the influence of alcohol or drugs• Dishonesty in any form• Breeching confidentiality

The C.N.A and Confidentiality(**very important slide**)

The C.N.A must:Keep patient’s information confidential by ONLY DISCCUSSING with appropriate health team members at appropriate times and places.The worker you are discussing confidential information with must be involved in the health care plan (plan that the interdisciplinary teams makes to direct the way the patient will be taken care of) of the patient. Just because you are Co-workers does not make it okay to discuss patient information. Do NOT DISCUSS, at lunch, on breaks, in the hallway, in front of family, friends or visitors.As the YOU HAVE NO RIGHT TO GIVE ANY PRIVATE INFORMATION TO FAMILY MEMBERS INCLUDING THEIR DIAGNOSIS!!!YOU WILL BE BREAKING THE LAW.

HIPPA

• Health Insurance Portability and Accountability Act• Law passed for protection of patient’s information to be kept

confidential.• Privacy Rule!!!!! KEEP CONFIDENTIAL!!!!

• Refer to Instructor's Hand-Out for this and Book.

Examples of maintaining Confidentiality

• Following to HIPAA guidelines• Discussing observations with nurse or resident’s physician.• Discussing the resident’s care while participating in team

conference/planning.

Examples of Exposing Confidentiality

( gossiping or revealing private information)Telling another resident

Telling concerned friends or visitorsMembers of the news mediaMembers of the Nurse Assistant’s FamilyPeople in the communityHealth team not directly involved with resident care.

Please Complete Module 1 Sample Quiz

This is in your GREEN SKILLS BOOK.