The Role of the CNA
You will perform simple and basic nursing functions under the supervision of a nurse. Your work will be supervised by an RN or an LPN. You will be concerned mainly with assisting nurses in giving care to the residents/patients. You will often perform simple functions without a nurse being physically present. At other times you will actually help the nurse give bedside nursing care.

The following rules should help you understand your role:

• You are to assist the nurse with her duties
• A nurse assigns and supervises your work
• You report any changes in a resident/patient's physical or mental status to the nurse
• You do not make any decisions about what should or should not be done for the resident/patient
• If you do not understand directions or instructions, ask the nurse for clarification before going to the resident/patient
• Perform no function or task that you have not been prepared to do or that you do not feel comfortable performing without the supervision of a nurse (a nurse should NEVER ask you to do this, in word, or by refusing to supervise. If that happens, report it to your DON or nurse manager.)

Functions and Responsibilities
You will perform functions and procedures relating to the personal hygiene, safety, comfort, nutrition, exercise, and elimination needs of residents/patients. You also will perform related functions such as lifting and moving the residents/patients, making observations, and collecting specimens as well as play an important role in the resident/patient's psychological comfort.

There are certain functions you should never perform! It is extremely important that you understand what you cannot do as a nursing assistant:

• Never give medication - This includes medication given orally, rectally, by injection directly into the bloodstream through an intravenous line, or applied to the skin
• Never insert tubes or objects into a resident/patient's body openings or remove them from the body - You must not insert tubes into the resident/patient's bladder, esophagus, trachea, nose, ears, bloodstream, or body openings that have been surgically created
• Never take verbal or telephone orders from doctors - promptly find a nurse to speak with the doctor
• Never perform procedures that require sterile technique - you can assist a nurse during a sterile procedures. However, you must never perform the procedure yourself
• Never tell the resident/patient or their family members the diagnosis or medical or surgical treatment plans - The doctor is responsible for informing the resident/patient and family about the diagnosis and treatment
• Never diagnose or prescribe treatment or medications for the resident/patients - Only the doctor can diagnose and prescribe
• Never supervise other nursing assistants - you will not be trained to supervise the work of others. Supervising other nursing assistants can have serious legal consequences!
• Never just ignore an order or request to do something that you cannot do or that is beyond your scope of practice as a nursing assistant - promptly explain to the nurse why you cannot carry out the order or request. Resident/patient care cannot just be neglected.

Always request a written job description from an employer!! No one can force you to perform a function, task, or procedure that is beyond your scope of a nursing assistant.

Terminology - As a CNA, you will need to know certain medical terminology in order to perform your duties to the best of your ability. (a new window will open containing the terminology chart)


Abbreviations - As a CNA you will need to know some medical abbreviations in order to perform your duties to the best of your ability. (a new window will open containing the common abbreviations)

Qualities and Characteristics
Caring about elderly and disabled residents/patients is an important trait for health care team members in long-term care. It is essential that you want to help the elderly and disabled residents/patients be as happy and independent as possible. It is equally important that you believe that each person has value as a human being no matter how old, ill, or disabled that person may be.

There are certain traits, attitudes, and manners that help one perform a job well.

• Dependability - Residents/patients and the nursing team rely on you to report to work when scheduled and to perform the duties and tasks as they are assigned to you.
• Consideration - You must be considerate of our resident/patient's physical and personal feelings. They rely on you for care. They deserve respect and kindness
• Cheerfulness - You need to greet and talk with your residents/patients and others in a pleasant manner. You must not be moody, bad tempered, or sarcastic when caring for residents/patients.
• Empathy - This is the ability to see things from the resident/patient's point of view - to put yourself in the their position. How would you feel?
• Patience - Elderly, ill or disabled people often move slowly, talk slowly, or have difficulty understanding or remembering directions. You must be patient. Let them do tasks at their own pace.
• Trustworthiness - Residents/patients and co-workers place their confidence in you. They believe that you will keep resident/patient information confidential.
• Respectfulness - A resident/patient has certain rights, values, beliefs, and feelings. You must not criticize or condemn the resident. Treat the resident/patient with respect and dignity at all times.
• Courtesy - You must be polite and courteous to residents/patients, families, visitors, and co-workers. Address people by title and name, such as "Mr. Johnson" or "Dr. Wilson", unless they request otherwise. Always remember your manners.
• Conscientiousness - You must be careful, alert, and exact in following orders and instructions. Always perform to the best of your ability.
• Honesty - You must be truthful, sincere, and genuine and show a true interest in residents/patients. The amount and kind of care you give, your observations, and your errors must be reported truthfully and accurately.
• Cooperation - You must be willing to help and work with others.
• Self-awareness - This means that you know your own feelings, strengths, and weaknesses. You need to understand yourself before you can help others.

Health, Hygiene and Appearance
The health care team serves as an example to others. Therefore your personal health, appearance, and hygiene deserve careful attention. Feeling and looking healthy are important to you as a person, to your residents/patients, and to your employer. Your residents/patients and employer trust you to provide conscientious and effective care. To fulfill this trust you must be physically and mentally healthy. Otherwise you cannot function at your best.

• Diet - Good nutrition means eating a balanced diet from the four main food groups
• Sleep and Rest - Sufficient sleep and rest are needed to do your job well and to stay healthy (7 to 8 hours of sleep daily)
• Body Mechanics - You will bend, carry heavy objects, and lift, move, and reposition residents/patients. You need to have good posture and learn to use your muscles effectively
• Exercise - This is important for muscle tone, circulation, and weight control

You must pay careful attention to personal cleanliness. Preventing offensive body and breath odors is important. Good health and personal hygiene practices will help you to look and feel well.

• Uniforms should fit well and be modest in length and style. Be sure your uniforms are clean, pressed, and mended. Wear a clean uniform daily.
• Underclothes should be worn clean, fit properly, and be changed daily.
• Jewelry, other than a watch, should not be worn while you are on duty.
• Stockings and socks should be clean, well-fitting, and changed daily. Do not roll stockings down or wear round garters. These practices interfere with the circulation in your legs.
• Shoes should be comfortable, give support, and fit properly. Clean and polish shoes often to keep them white and neat in appearance. Wash and replace shoelaces as necessary.
• Nail polish should not be worn.
• Hair should be worn simply and attractively. Keep hair off your collar and out of your face.
• Makeup should be modest in amount and moderate in color.
• Do not wear perfumes, colognes, or after shave lotion. They may offend and nauseate residents/patients.

Training and Competency
In 1987 the Congress of the United States passed the Omnibus Budget Reconciliation Act (OBRA). A major purpose of OBRA is to improve the quality of care given to residents of nursing facilities. OBRA requires education and competency evaluation for all nursing assistants employed in nursing facilities. The purpose is to ensure that nursing assistants have the necessary knowledge and skills to give care.

Many nursing facilities, now, have their own nursing assistant training and competency evaluation program. Training must be at least 75 hours long and include supervised practical experience. The students perform nursing care and procedures on other persons. This practical training (also called clinical practicum or clinical experience) is supervised by a nurse. Areas of study include communication, infection control, safety and emergency procedures, resident's rights, basic nursing skills, personal care skills, feeding techniques, and skin care. Students also learn how to transfer, position, dress, and ambulate residents, and how to perform range-of-motion exercises. They also learn the signs and symptoms of common diseases and conditions and how to care for cognitively impaired residents (those who have problems with thinking and memory).

The competency evaluation program includes a written test and a skills test. The written test involves about 75 multiple choice questions. The skills evaluation involves the demonstration of nursing skills. You will have to perform certain skills learned in your training program. OBRA requires that individuals be allowed three attempts to complete the evaluation successfully.

Registry
The registry is an official record or listing of persons who have successfully completed a nursing assistant training and competency evaluation program. The registry contains the following information about each nursing assistant:

• Full name, including maiden name and any married names
• Last known home address
• Social Security number
• Date of birth
• Last known employer, date hired, and date employment was terminated
• Date the competency evaluation was passed
• Information about findings of abuse, neglect, or dishonest use of property.

The information must remain in the registry for at least 5 years. Registry information can be requested by any nursing facility or agency needing the information.

OBRA also requires retraining and a new competency evaluation program for nursing assistants who have not worked for 2 consecutive years. Regular in-service education and performance reviews are other OBRA requirements. Nursing facilities must provide 12 hours of in-service training per year to nursing assistants. A nursing assistant's work also will be evaluated regularly.

Planning and Organizing Work
Working well with others includes working in an organized and efficient way. The following guidelines will help you to plan and organize your work:

• Discuss priorities with the RN or LPN when you receive your assignment
• Know the routine of your shift and your assigned work area
• List care or procedures that must be performed on a schedule. Some residents/patients must be positioned or toileted every 2 hours
• Estimate how much time is needed for each resident/patient, procedure, and task
• Identify the tasks and procedures that can be done while residents/patients are eating, visiting, or involved in activities or therapy
• Plan care around meal times, visiting hours, therapies, and daily recreation and social activities
• Identify situations in which you will need help from another co-worker. Ask a co-worker to help you when needed. Tell the person the approximate time when you will need help
• Schedule any equipment or rooms if necessary. Some facilities have only one shower and bathtub. You will need to schedule the tub or shower for your resident's/patient's use
• Review the procedures to be performed and gather the necessary supplies beforehand

Ethical and Legal Issues
You will often face situations in which you must decide what you should or should not do or what you can or cannot do. These circumstances may involve ethical or legal questions.

Ethics is the discipline concerned with right and wrong conduct. It involves morals and making choices or judgments about what should or should not be done. An ethical person behaves and acts the right way. Consider the following rules of conduct for nursing assistants:

• Respect each resident/patient as an individual
• Perform no act that is not within the legal scope of a nursing assistant
• Perform no act for which you have not been adequately prepared
• Take no drug without the prescription and supervision of a doctor
• Carry out the nurse's directions and instructions to the best possible ability
• Be loyal to your employer and to those with whom you work
• Act as a responsible citizen at all times
• Know the limits of your role and knowledge
• Keep resident/patient information confidential
• Consider the resident's/patient's needs to be more important than your own

Legal Considerations: negligence is an unintentional wrong. The person fails to act in a reasonable and careful manner and thereby causes harm to the person or property of another. Common negligent acts committed by nursing assistants include the following:

• Side rails have been ordered for a confused resident / patient. The nursing assistant leaves the side rails down. The resident / patient falls out of bed and breaks a hip.
• A resident / patient is burned because a nursing assistant applied a warm water bottle that was too hot.
• A resident's / patient's dentures break after being dropped by the nursing assistant.
• A resident / patient complains to the nursing assistant of difficulty breathing and chest pain. The nursing assistant does not report the complaints to the nurse. The resident / patient dies of a heart attack.
• A resident / patient puts on the signal light, and the nursing assistant does not answer the light for several minutes. The resident / patient goes into shock because of sudden, severe bleeding.

As a nursing assistant you are legally responsible (liable) for your own actions. What you do or do not do can lead to a lawsuit if harm results to the person or property of another.

Working With Others
You are a member of both the nursing and health care team. You will work closely with RN's, LPN's, and other nursing assistants. Your ability to work well with others will affect how well you function as a nursing assistant and the quality of care received by your residents / patients. The following guidelines will help you work well with others

• Understand the roles, functions, and responsibilities in your job description
• Develop the desired qualities and characteristics of a nursing assistant
• Report to work on time
• Call the faculty if you cannot report to work. Call as soon as possible and give reason for your absence
• Practice good personal health and hygiene measures
• Take pride in your appearance, and follow the facility dress code
• Act in an ethical and legal manner at all times
• Follow the directions and instructions of your supervisor
• Question unclear instructions and things you do not understand
• Report resident / patient or family complaints and your observations to the nurse promptly
• Help others willingly when asked
• Do not waste supplies and equipment
• Do not use the telephone, supplies, or equipment for our personal use
• Do not use the resident's / patient's telephone or personal belongings for your personal use
• Follow the rules and regulations of the facility in which you are employed
• Measure, report, and record accurately
• Tell the nurse when you are leaving and when you have returned to your work area
• Do not discuss your personal problems with residents / patients
• Protect the resident's / patient's rights at all times

Continue to: Career Choices: Certified Nursing Assistant, Part 2: The Hands-on world of the CNA