Role of the Nursing Role of the Nursing AssistantAssistant

Interdisciplinary Health Care Interdisciplinary Health Care TeamTeam

Includes:Includes: Patient, family members, Patient, family members,

physician, nursing team, & physician, nursing team, & specialistsspecialists

Nursing team provides:Nursing team provides: Skilled nursing careSkilled nursing care Plans & directs physicians ordersPlans & directs physicians orders

Training periodTraining period

Trained to assist with patient Trained to assist with patient carecare

Short time frame because the Short time frame because the NA responsibilities and skills are NA responsibilities and skills are not as greatnot as great

Growth and learning will Growth and learning will continue throughout the careercontinue throughout the career

Registered NurseRegistered Nurse

Passes national licensure examPasses national licensure exam Associate or bachelor degreeAssociate or bachelor degree Duties are to assess, plan, Duties are to assess, plan,

evaluate and coordinate patient evaluate and coordinate patient carecare

Licensed Practical NurseLicensed Practical Nurse

1 yr – 18 month program1 yr – 18 month program Pass national licensure examPass national licensure exam Works under supervision of RN, Works under supervision of RN,

physician or dentistphysician or dentist

Nursing AssistantNursing Assistant

Trained to assist with patient Trained to assist with patient carecare

90 hours training90 hours training

OrganizationOrganization

Primary nursingPrimary nursing Functional Functional

NursingNursing Team NursingTeam Nursing Patient Focused Patient Focused

carecare

Primary NursingPrimary Nursing

Care is given by the registered nurseCare is given by the registered nurse Assigned to that patient for the entire Assigned to that patient for the entire

hospitalizationhospitalization LPN/LVN & CNA’s help w/ care and LPN/LVN & CNA’s help w/ care and

follow directions of the RNfollow directions of the RN Enables patient to relate directly to Enables patient to relate directly to

one specific nurseone specific nurse May be responsible for 6-8 patientsMay be responsible for 6-8 patients

Functional NursingFunctional Nursing

Task-oriented careTask-oriented care Nurse in charge is the person Nurse in charge is the person

responsible for all patientsresponsible for all patients Staff is assigned specific tasks:Staff is assigned specific tasks:

Giving meds; providing tx’s; Giving meds; providing tx’s; providing hygiene careproviding hygiene care

Patient’s may find it confusing Patient’s may find it confusing because many people are because many people are involved in the careinvolved in the care

Team NursingTeam Nursing

Most common methodMost common method RN team leader determines the RN team leader determines the

nursing needs of all the patients nursing needs of all the patients assigned to the teamassigned to the team

Team members receive their Team members receive their instructions and report back to instructions and report back to the team leaderthe team leader

Includes family in the planned Includes family in the planned care for the patientcare for the patient

Patient Focused CarePatient Focused Care

Goals are:Goals are: Limits the number of people involved in Limits the number of people involved in

patient carepatient care Contains costContains cost Meets patient’s needs efficientlyMeets patient’s needs efficiently

Staff members are prepared as Staff members are prepared as multi-skilled workers by cross-multi-skilled workers by cross-training them to perform special training them to perform special duties that are normally carried out duties that are normally carried out by someone elseby someone else Ie: drawing blood, obtaining statistics, Ie: drawing blood, obtaining statistics,

etc.etc.

RegulationRegulation

NA’s must understand the scope NA’s must understand the scope of practiceof practice

All states required to specificially All states required to specificially address duties & responsibilities address duties & responsibilities of NA as well as educationof NA as well as education

OBRA – Federal law that OBRA – Federal law that regulates the education & regulates the education & certification of NA’s (falls under certification of NA’s (falls under DHHS)DHHS)

continued . . .continued . . .

Effective 1990, anyone working Effective 1990, anyone working as NA must complete a as NA must complete a competency evaluation program competency evaluation program (state approved course)(state approved course)

Actual training/education of NA Actual training/education of NA is under individual state is under individual state jurisdiction guided by federal jurisdiction guided by federal regulationsregulations

NACEPNACEP

Nurse Aide Competency Nurse Aide Competency Evaluation ProgramEvaluation Program

Guide for individual programs Guide for individual programs that register and awards that register and awards credentials to NAcredentials to NA

Specifies minimum skills to be Specifies minimum skills to be achievedachieved

Meets the requirements of Meets the requirements of OBRAOBRA

continued . . .continued . . .

Georgia requirements:Georgia requirements: Minimum 90 hours classroom timeMinimum 90 hours classroom time Minimum 24 hours clinical practiceMinimum 24 hours clinical practice Passing written exam score of 75 Passing written exam score of 75

or betteror better Skills practicumSkills practicum

Randomly chosen by evaluatorRandomly chosen by evaluator One must be vital signsOne must be vital signs

Guidelines for NAGuidelines for NA

Only perform tasks you have Only perform tasks you have been trained to perform and are been trained to perform and are legally within your scope of legally within your scope of practicepractice

Better to ask for clarification or Better to ask for clarification or help than to make an error and help than to make an error and cause an injurycause an injury

Personal AdjustmentsPersonal Adjustments

Certain amount of adjustments Certain amount of adjustments may be needed due to work may be needed due to work situationssituations Following orders promptlyFollowing orders promptly Ensuring rules are followed Ensuring rules are followed Accepting criticismAccepting criticism Willing to learn and growWilling to learn and grow DependabilityDependability Respect for co-workersRespect for co-workers Learning to be tactfulLearning to be tactful

Interpersonal relationshipsInterpersonal relationships

Interactions between peopleInteractions between people Warm; acceptingWarm; accepting Positive attitudePositive attitude Smiling at others when you don’t Smiling at others when you don’t

feel like itfeel like it Cooperative Cooperative

AttitudeAttitude

Most important characteristicMost important characteristic Shown through behaviorShown through behavior Attitude should reflect:Attitude should reflect:

CourtesyCourtesy CooperationCooperation Emotional controlEmotional control Empathy (understanding)Empathy (understanding) TactTact SympathySympathy

Patient relationshipsPatient relationships

All ages become illAll ages become ill Good NA shows empathy for Good NA shows empathy for

patient by being gentle and kind patient by being gentle and kind even when they may be nasty even when they may be nasty and meanand mean

When person is ill, they are When person is ill, they are frightened – personalities frightened – personalities changechange

Meeting patient’s needsMeeting patient’s needs

Patient may have difficulty Patient may have difficulty meeting social, spiritual and meeting social, spiritual and physical needs due to limits of physical needs due to limits of illnessillness

Offer emotional support, Offer emotional support, listening skills and meeting listening skills and meeting patient’s needs as best you canpatient’s needs as best you can

Family’s needsFamily’s needs

Concern for family members Concern for family members adds stress to their livesadds stress to their lives

Need reassurance that person is Need reassurance that person is being cared forbeing cared for

Co-workers who are ill add Co-workers who are ill add stressstress

Need patience and tactNeed patience and tact Be aware of body language, not Be aware of body language, not

just wordsjust words

Staff relationshipsStaff relationships

All staff members share same All staff members share same goal – to help patientgoal – to help patient

Good interpersonal skillsGood interpersonal skills Do not criticize othersDo not criticize others Cheerful, positive attitudeCheerful, positive attitude Watch body languageWatch body language

Personal grooming Personal grooming

Essential because of close Essential because of close contact w/ patientscontact w/ patients

Includes:Includes: Daily showersDaily showers Mouth careMouth care No strong perfumes/lotions (can No strong perfumes/lotions (can

make patient sick)make patient sick) Keep hair/nails cleanKeep hair/nails clean No dangling jewelryNo dangling jewelry

Stress !!!!Stress !!!!

Work is physically and mentally Work is physically and mentally demanding. To stay healthy:demanding. To stay healthy: Sufficient restSufficient rest Good nutritionGood nutrition Satisfying leisure activitiesSatisfying leisure activities Burnout is total mental, emotional, Burnout is total mental, emotional,

and sometimes physical and sometimes physical exhaustionexhaustion