NCLEX: The Roles and Responsibilities of the Nursing Assistant

The Roles and Responsibilities of the Nursing Assistant: Your Role and Responsibilities

Focus topic: The Roles and Responsibilities of the Nursing Assistant

Congratulations, you have taken the first step in helping others by choosing a career in health care as a nursing assistant. Your role is to provide personal care and assistance to the elder client who might receive health-care services in a variety of settings. Although you can work in various settings such as hospitals, clinics, physicians’ offices or clients’ homes, the practice focus of this text is on the long-term care setting. If you practice in a hospital or clinical setting, you can substitute the term patient for all references of resident in this chapter. You can also substitute the title patient care assistant or technician for the title of nursing assistant/aide. Regardless of your practice setting or your title, your job or position description outlines your responsibilities and duties in detail. The most important tasks you perform are direct personal care of the client referred to as the resident.

The Roles and Responsibilities of the Nursing Assistant: Job Responsibilities

Focus topic: The Roles and Responsibilities of the Nursing Assistant

Tasks listed on your job description can vary from one facility to another but often include personal care including, but not limited to

  • Activities of daily living (ADLs): Personal care activities performed by residents every day, which include bathing, grooming, dressing, eating and hydrating, toileting, ambulating, and exercising.
  • Measurement and client observation: Measuring, recording, and reporting resident vital signs (temperature, pulse, respiration, and blood pressure), height and weight, intake and output, meal consumption, changes in resident’s condition, collecting laboratory specimens, and applying resident restraints.
  • Procedures outlined in facility procedure manual and performed under the supervision of a licensed nurse: Performing skills including instilling enemas; applying non-sterile dressings; applying ice packs; attending to skin and oral needs; and admitting, transferring, and discharging patients.
  • Infection control: Adhering to facility care standards; that is, preventing and isolating client infection through hand washing, care and handling of contaminated objects, isolation procedures, and observing and reporting environmental situations that might spread infection.
  • Assisting with client ambulation, movement, and exercise: Lifting, moving, and transporting residents from one position to another, from one room to another, or from one facility to another. Assisting the resident to maintain or regain normal range of motion and body strength, and assisting physical exercise to maintain musculoskeletal function and general well-being.
  • Environmental care and safety: Making residents’ living conditions as comfortable and safe as possible by keeping the residents’ rooms clean and tidy, making beds and arranging residents’ furniture, adjusting room temperature and lighting, removing potential safety hazards or sources of personal injury such as spills or objects left on the floor, removing refuse and caring for plants, and performing CPR and resident evacuation in case of fire or other environmental threats.
  • Communication: Verbal or written communication with clients, visitors, and healthcare team members; observing and recording resident care or information; and answering the telephone and taking messages.

The Roles and Responsibilities of the Nursing Assistant

The Roles and Responsibilities of the Nursing Assistant: Other Tasks and Duties

Focus topic: The Roles and Responsibilities of the Nursing Assistant

Other tasks and duties that fall under the responsibility of the nursing assistant include the following:

  • Protecting residents’ rights, privacy, confidentiality, and dignity
  • Following safety rules, adhering to legal and ethical standards of care
  • Complying with all agency policies
  • Promoting client safety and well-being
  • Participating in facility efforts to provide quality care and performance improvement
  • Continuing staff education
  • Performing post-mortem procedures

The Roles and Responsibilities of the Nursing Assistant: Job Limitations

Focus topic: The Roles and Responsibilities of the Nursing Assistant

You must work under the direction of a licensed nurse or doctor. Your job responsibilities are limited to those specified in your job description. Limitations often include giving medications (includes applying prescription skin creams, lotions, or ointments), taking orders from a doctor, and performing any procedures prohibited by law or by the employing facility. When in doubt about performing any function or task for which you are unfamiliar or unsure, consult your immediate supervisor. In medicine, the adage “Do no harm” applies to your practice as well.

The Roles and Responsibilities of the Nursing Assistant: Personal Qualities

Focus topic: The Roles and Responsibilities of the Nursing Assistant

Honesty is one of the most important qualities you can bring to your job. Second only to knowing your job well and being accountable for what you do is being truthful in your interactions with others. Accepting your own limitations is another example of being truthful. These qualities are essential to effective, lawful practice.

Caring means having a sincere regard for the safety and well-being of all the residents in your care and being willing to care for them and about them. You can be the most skillful nursing assistant in the facility but, if you do not care about what happens to the residents, you are in the wrong job. The time you spend with residents other than the time required is a good way to evaluate your caring characteristics. Spending time with residents is only one way to evaluate caring behaviors but an effective job performance measure. The following caring characteristics are the hallmark of the exemplary employee:

  • Being considerate of others, both residents and coworkers, is very important if you are to an effective nursing assistant.
  • Being empathetic; that is, seeing yourself in others’ situations without pitying them is also a very important attribute you must possess. Consideration for other peoples’ feelings is also an important personal quality for effective practice. This means being aware of the effect of what you say and how you say it; cooperating with coworkers to help support them and the facility when short-staffed, is another example of being considerate.
  • Having respect for other people is important, especially when their values, culture, language, or beliefs differ from your own. Honesty, empathy, sincerity, and caring behaviors are all part of legal and ethical practice—basic but crucial expectations of your employer. Values, culture, and language considerations are included in subsequent chapters.
  • Dependability is a basic expectation of your employer. Coming to work when scheduled and on time demonstrates your commitment to your job and to the residents. Doing what you commit to do and doing it consistently also help to demonstrate your dependability.
  • Flexibility and dependability go hand in hand. Despite the best assignment plan, “stuff happens,” meaning you might be re-assigned to another unit or group of residents or staff you do not know. You must be able to accept this normal disruption in your work schedule and make the best of the situation.
  • Accountability is a key quality you bring to your work. You must care for all residents in a variety of conditions and situations for which you have been prepared to handle and are expected to perform your duties in the way you have been trained to perform them. Should you have any questions or concerns about your assignment, you should discuss them privately with your supervisor.
  • Self-responsibility is required for your own health and safety. Wearing personal protective equipment (PPE), using effective body mechanics when moving and lifting clients, maintaining a safe work space, organizing your work to conserve energy, and maintaining a healthy life style are examples of those actions you must take to protect yourself and promote your own well-being.

The Roles and Responsibilities of the Nursing Assistant: The Nursing Assistant as a Member of the Health-Care Team

Focus topic: The Roles and Responsibilities of the Nursing Assistant

You are one of the most important members of the health-care team, working with other nursing staff as well as technicians, therapists, health-care providers (physicians or nurse practitioners), dieticians, social workers, the clergy, support staff, and administration to help meet the mission of the facility whose goal is to provide the very best care possible to all residents.

Each of the following nursing staff members contributes to the well-being of the residents:

  • Registered Nurse (RN): The RN is responsible for carrying out both the medical plan of care prescribed by the physician as well as the nursing care plan developed by the nursing staff. The RN assesses each resident and modifies the nursing care as needed to help meet the patient’s needs. The RN also works with other therapists and staff to ensure the well-being of each resident. He or she assigns unlicensed assistive staff members to each day’s personal care activities and supervises the work. The RN works under the supervision of the Director of Nursing and is accountable for his or her practice according to the state’s nurse practice act, which outlines the practice competencies as well as limitations of the practice. The RN might supervise other RNs, LPNs, or unlicensed assistive personnel (UAPs).
  • Licensed Practical Nurse (LPN): Like the RN, the LPN carries out the medical and nursing plans of care for assigned residents but works under the supervision of the RN. The LPN performs treatments, administers medications, and documents care given according to a prescribed scope of practice set by the board of nursing or other licensing agency of the state in which the LPN practices. The LPN might supervise UAPs as well. His or her duties can be expanded with additional training and credentialing.
  • Nursing Assistant/Nurse Aide (CNA) or Patient Care Assistant/Technician (PCA/PCT): The CNA (or PCA/PCT) performs care and carries out duties under the supervision of the RN or LPN. The CNA (or PCA/PCT) is in a unique position as a first responder at the bedside. He or she become the eyes, ears, and hands of the licensed nurse, often being the first team member to identify resident needs and problems that can become life-threatening.

As a CNA, you spend more time with residents than any other team member. Because of your close interactions with residents, you befriend them and become their advocates, meaning you communicate their needs when they might not be able to.

You can also serve as the first line of defense for residents in situations that might threaten their health or well-being. For example, you will often be the first team member to notice a change in the resident’s vital signs that can signal an infection. You might also be the first to notice a skin irritation, a warning sign of a developing bedsore. Because you spend so much time with a resident, you might be the first team member to notice subtle changes in behavior that could point to a serious infection. These are only a few examples of the unique role you play on the health-care team.

The Roles and Responsibilities of the Nursing Assistant: Being a Team Player

Focus topic: The Roles and Responsibilities of the Nursing Assistant

As a team member, you carry out duties assigned to you by the RN or LPN. While you are responsible for completing assignments for specific residents in a timely manner, you also assist other team members with their assignments when you have completed your own or when urgent help is needed. Cooperating willingly to assist coworkers is an expectation of any employer but is particularly important in the long-term care facility. An isolated approach to your work is not only unmanageable but also potentially harmful to you and the residents. An example of working alone is lifting, moving, or assisting the resident to ambulate by yourself. The resident will feel safer if two or more staff members assist with this task. You also protect yourself, other workers, and the resident from injury by asking for help when you need it.

Working well with others is a hallmark of an efficient and effective nursing assistant. Your coworkers will more likely offer to help you if you assist them with enthusiasm and a can-do approach. Your supervisor will welcome your cooperation with assignments when carried out cheerfully and to the best of your ability. If you have a concern about an assignment or with a situation involving your coworker’s approach to cooperation and teamwork, discuss it privately with your immediate supervisor.

Being a team player also means being able to accept constructive criticism, especially from your supervisor. Listening to your superior’s feedback without being defensive helps you to improve your performance and contribute to your job satisfaction. Always follow the facility’s chain of command when resolving work-related issues, especially for work conflicts or other disagreements that are bound to occur. It is important for you to consult with your supervisor about any situations that will potentially interfere with resident welfare or that will compromise your own values and well-being.

The Roles and Responsibilities of the Nursing Assistant: Communication and Interpersonal Skills Needed for Effective CNA Practice

Focus topic: The Roles and Responsibilities of the Nursing Assistant

Being able to express yourself verbally and in writing is a skill you learn and apply throughout your health-care career. Likewise, forming positive working relationships with your coworkers as well as building an effective interpersonal relationship with residents are essential elements in effective CNA practice. Communication skills involve listening, responding, and documenting what residents tell you about themselves and their unique needs. Active listening, that is, listening to residents without being distracted by your own thoughts, is key to acknowledging them as worthy human beings who deserve your attention. This skill is called listening with a “third” ear. Your skill in observing what is omitted in conversation with residents will cue you to their unexpressed needs.

Verbal communication skills include speaking clearly at a level residents can understand, that is, avoiding medical jargon; asking open-ended questions that discourages a yes/no response; using phrases to encourage further exploration of thoughts and feelings: “Oh?,” “Tell me more,” and so on; and clarifying the message you receive: “Let me see if I understand what you mean…,” “Is this what I hear you say…?,” and so on.

Communication barriers can occur in practice. Try to avoid the following pitfalls when communicating with the resident: asking close-ended questions that prompt a yes/no answer; speaking “over the resident’s head,” using medical terms or other language that he or she cannot understand; and responding to him or her with advice, criticism, or sarcasm. Responses to the resident that begins with “You should/shouldn’t…” or “”Why?” are not only demeaning but encourage defensiveness and limit further communication. This reluctance to communicate can be hazardous for the resident and a detriment to an effective relationship with you.

It is important to recognize communication barriers that interfere with effective interpersonal relationships with residents and seek guidance and help from your supervisor to solve any communication problem you might encounter. Use an interpreter or family member to assist you in talking with the resident whose primary language is not English and be patient with the resident who struggles to understand your language. Cultural barriers can also interfere with effective communication, especially if the resident’s culture is very different from your own. Nonverbal gestures like avoiding eye contact might be viewed by the resident as offensive or disrespectful. Other cues to barriers include personal space (for example, standing too close to the resident), smiling or other facial expressions that do not match the verbal message, and your conversational tone or body posture. For example, smiling when talking to a resident might imply your agreement. At the same time, standing with your arms crossed over your chest and leaning away from the resident is a message that you, indeed, do not agree with him or her. At best, this message is confusing if not disrespectful. Admitting your own limitations and working to improve your communication skills are positive steps to building meaningful relationships.

Equally important to effective interpersonal relationships with residents is the need to maintain resident safety through clear communication. Countless stories abound regarding accidental resident injury or neglect that resulted from failure to communicate. Examples include failure to explain the dangers of walking without assistance for residents with mobility problems, misunderstanding or lack of sufficient information for family members regarding restrictions to their resident’s diabetic diet that led to hyperglycemia, or residents becoming upset with a change in their care plan due to faulty interpretation of the nursing staff’s instructions. Barriers to communication also include those linked to the senses (vision, hearing, and other sensory deficits). Speaking clearly, slowly, and directly to the hearing-impaired resident is important to ensure his or her understanding of your verbal communication. Offering large print reading materials or other assistance to the resident who is visually impaired is equally important. Some residents have a decreased sensation to pain and temperature changes. Specific details regarding working with impaired residents is covered in subsequent chapters.

Reporting conversations between you and the resident is also important to maintain his or her safety and well-being. This includes changes in resident condition, his or her specific requests, concerns or evaluations regarding care, safety considerations, and other pertinent observations.

Recording observations, measurements, and personal care of the resident is an important nursing assistant function. Charting and other resident documentation requires knowledge of medical terminology and abbreviations, proper spelling and grammar, and basic computation skills.

For example, measuring intake and output requires mathematics/addition with results expressed in milliliters, not household measures. Recording “I & O” is acceptable terminology for charting. Factual recording is required because your personal opinion has no purpose in communication. Although observation is the first step to assuring resident safety, you must record and report any resident responses to care or change in condition promptly to your supervisor. Consult your supervisor for help with documentation to ensure completeness, objectivity, and accuracy. Remember, you can never over communicate!

The Roles and Responsibilities of the Nursing Assistant: Legal and Ethical Considerations in Practice

Focus topic: The Roles and Responsibilities of the Nursing Assistant

Your job description is based on laws and rules for nursing assistant practice set by government agencies. As long as you follow those rules when carrying out your duties and observe the law, you are not liable for your performance. Liability means being responsible for providing care according to an accepted standard. If you perform duties outside your job description or perform appropriate duties incorrectly that results in harm to a resident, you can be found liable. Examples of liable acts include the following:

  • Abuse: A threat or actual physical or mental harm to a resident.
  • Aiding and abetting: Participating in an unlawful act or observing it and not reporting it. For example, observing sexual harassment of a resident and not reporting it.
  • Assault: Threat or actual touching of a resident without permission.
  • Battery: Unlawful personal violence toward a resident; for example, bathing a resident without his or her permission.
  • False imprisonment: Preventing a resident from moving freely about, with or without force, against the resident’s wishes.
  • Invasion of privacy: Failing to keep the resident’s affairs confidential or exposing the resident’s body when performing care.
  • Involuntary seclusion: Keeping a resident isolated from others as a form of punishment.
  • Neglect: Accidently or deliberately ignoring the needs of a resident that results in harm or injury.
  • Negligence: Either neglecting to act in the manner in which you were taught, or omitting care or performing care incorrectly that results in harm to a resident.
  • Theft: Taking something that does not belong to you.

The Roles and Responsibilities of the Nursing Assistant: Resident Rights

Focus topic: The Roles and Responsibilities of the Nursing Assistant

In 1973 the American Hospital Association (AHA) issued a policy for all patients called “A Patient’s Bill of Rights.” Soon after that publication, a guide for long-term residents was developed, called “Resident’s Bill of Rights.” Although both bills are similar, the Resident’s Bill of Rights contains additional considerations for residents in long-term care settings. By law, all nursing homes must have written policies describing residents’ rights and must make them available to any resident. The following outlines the issues addressed in the bill of rights, namely, that every resident has the right to:

  • Be informed about the facility’s services and charges: The services of the nursing home and all charges involved with the services should be made available and fully explained to every resident. Likewise, charges that are not covered by Medicare or Medicaid should also be included in the notice of services; this includes those services not covered by the basic charges for facility rates.
  • Be informed about one’s medical condition: Unless the physician notes in the medical record that to be informed of his or her medical condition is not in his or her best interest, every resident deserves to be apprised of his or her medical condition. Be truthful with your answers to residents’ questions about their condition, being careful to inform them of what you observe only; an example of this is answering the resident’s questions about vital signs or output. The RN or doctor should answer the resident’s medical condition because you cannot answer medical questions for which you have not been prepared to answer. It is your responsibility to report the resident’s request for information to your supervisor.
  • Participate in the plan of care: Every resident must have the opportunity to participate in his or her plan of care or to refuse care or treatment. Despite your belief that a procedure or care activity will be helpful to residents, be very careful that you do not force them to participate against their wishes. This includes assisting other staff to do the same. Failure to observe this resident right is an example of assault, battery, and invasion of privacy.
  • Choose one’s own physician: Every resident has the right to determine his or her own physician and pharmacy. Remember, your personal opinion is unimportant in this situation. Refer the resident to the RN or social worker for assistance.
  • Manage one’s own personal finances: Residents can manage their own finances or appoint someone else (power for attorney) to manage them. If authorized by the resident to manage funds, the manager must report the resident’s financial status as directed and provide all receipts for business transactions. Avoid handling the resident’s money or valuables (for example, inventory of personal items when admitted to the facility) without a witness.
  • Privacy, dignity, and respect: Privacy, dignity, and respect for each resident are of the utmost importance. Privacy includes visitation for married couples. Close the door to assure couples are alone and are not interrupted; knock before entering the room.
  • Use one’s own clothing and possessions: Unless hazardous, or potentially infringing on other residents’ rights, each resident has the right to wear his or her own clothing and use his or her own possessions.
  • Be free from abuse and restraints: Residents must be protected from mental and physical abuse, which can include unauthorized use of restraints. Except as authorized in writing by a physician for a specified and limited time or when necessary to protect the individual from hurting himself/herself or others, residents must be free from chemical or physical restraints that cause them to be unable to freely move about. Mental abuse refers to any threat to the psychological well-being of the resident that results in psychological or emotional distress. This can include financial exploitation or verbal assault; depriving residents of any of their rights listed here is considered mental abuse.
    Physical abuse includes hitting or rough handling of a resident. Withholding food or fluids, or failure to change a wet bed are forms of physical abuse. Sexual abuse is a form of physical abuse and involves threats or physical contact for sexual favor or control. Fondling or inappropriately touching a resident, rape, sexual assault, or sexual molestation are examples of sexual abuse. Sexual harassment, or making unwelcomed sexually explicit or implied statements to residents, is abusive and could become grounds for resident grievance.

Watch for signs or other clues of resident abuse that might include

  • Skin tears or bruises, especially in the genital area
  • Frequent crying or periods of sadness or withdrawal
  • Personality changes
  • Refusal to carry out ADLs
  • Fear of touch
  • Anxiety or nervousness
  • Refusal of certain visitors, including spouse or family members

You have a moral, ethical, and legal duty to report suspicion of abuse. Be as factual as possible, avoiding assumptions and expressing personal opinions about what you observe. Do not worry if your suspicions are unfounded. Your sincere attempt to protect the resident outweighs any fears you might have. In all cases, follow the facility policy for reporting abuse concerns. Abuse hotlines might also be available for reporting suspicions of abuse. An Ombudsmen Committee might also be available as a source for investigating abuse complaints. An Ombudsmen Committee is a group of concerned citizens, usually appointed by the state governor, to investigate all complaints of abuse. The committee members are not affiliated with a health-care facility. The originator of the abuse complaint, whether a fellow citizen or a health-care provider, is kept confidential.

  • Grievance without retaliation: Residents should be able to express concerns, make recommendations about facility services or care, and consult with outside sources to resolve conflicts involved in their care without fear of criticism, discrimination, or other acts of vengeance by the facility or its staff.
  • Be discharged or transferred only for specific reasons: Residents might be transferred or discharged from a facility only for medical reasons, for their welfare or the welfare of other residents, or for non-payment, which excludes becoming Medicaid-eligible. If transfer or discharge is planned, the resident or representative must be notified in writing within 30 days of the change.
  • Access to
    . Receive or refuse any visitor (includes family members)
    . Visiting hours, posted in public places
    . Confidential communication with visitors, including help with personal, social, or legal services
    . Claim own rights and benefits through consultation with others for the purpose of legal action, organizational activity, or other forms of representation

The Roles and Responsibilities of the Nursing Assistant: Ethics

Focus topic: The Roles and Responsibilities of the Nursing Assistant

Ethics is often linked with legalities when determining right and lawful behavior in health care. Ethics is a branch of philosophy dealing with the good, bad, right, and wrong thing to do in human interactions and the principles that help guide professionals in terms of what ought to be done in certain situations. Ethical principles, or standards, help guide you in your work. Examples cited include beneficence, or doing good for others. Confidentiality is another principle that you follow to keep resident’s matters private. Nonmaleficence, or “do no harm,” underscores the need to not cause undo harm to a resident, or to provide safe and effective care. Veracity, or truthfulness, means speaking the truth consistently and dependably.

Health-care professionals like nurses adhere to a published code of ethics, which admonishes them to practice in an ethical manner at all times. Such guiding principles help form a practice framework on which nurses can build upon. A description of ethical behavior is to “do the right thing when nobody else is looking.” This could be evidenced by refusing to accept money, gifts, or favors from residents or their families; avoiding shortcuts in job performance; maintaining a positive attitude about the facility; and treating residents’ belongings with care.

Ethical problems occur when your “inner ethical voice” conflicts with a situation that causes you to struggle with the right course of action to maintain your values, often reflected in ethical principles. Ethical dilemmas abound in today’s world, especially in health care. Specific examples of ethical dilemmas regarding residents in long-term care mirror those of clients in other health-care settings such as quality of life issues, death and dying, access to health care, and euthanasia. Solutions can become quite weighty but need not be solved alone. As a health team member, you can seek guidance from your supervisor and other professionals, including the clergy, to sort out all available alternatives in an ethical situation. Use your resources wisely in this regard and remember that you are not experiencing the situation alone.








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