The Certified Nursing Assistant is a vital part of any healthcare staff. While the position is that of an assistant, the work is extremely important in assisting other health care professionals and, of course, the patients. CNAs are often the main point of contact with residents, and beyond that the roles are many and the responsibilities cover a lot of ground. Below you will find a comprehensive list of a CNA’s roles and responsibilities.
- Qualities of a CNA
- How Do CNAs Compare To Other Nurses?
- Communication
- Liabilities
- Patient’s Rights
- Ethics
- Continuing Education
- Data Collection & Reporting
QUALITIES OF A CNA
To become a CNA, one has to meet their state’s required hours of classroom learning and clinical experience. In addition to the knowledge that the CNA obtains, it is also important to have certain personal characteristics that help CNAs perform their duties to the best of their abilities. Let’s look at each of these characteristics:
- Good communication skills:A CNA should be able to provide clear instructions and relevant information to the patient, and the patient’s families. Having good communication skills also helps to build rapport with the patients and co-workers.
- Observation:The CNA is responsible for observing the patient’s condition so that any changes in the patient’s health can be reported immediately to the supervisor. Some examples include changes in routine activities, changes in temperature or blood pressure, or a change in the patient’s appearance.
- Physical/Mental strength:The CNA should have adequate physical and mental strength to handle the different job challenges such as attending to multiple patients, working on a weekend or helping co-workers.
- Dependability: A CNA should demonstrate dependability. Patients, as well as co-workers, depend on a CNA for different tasks. The CNA should show a positive attitude and approach each task with a resolve to do it successfully. The CNA should use the time management skills to prioritize tasks so that each patient receives proper care.
- Patience and co-operation:The CNA should also understand that helping patients and co-workers demand a great deal of patience and co-operation. The CNA should be calm and show encouragement in case of some patients who require additional time to perform simple tasks. Examples include helping patients walk after a surgery, or teaching them to dress up. Helping co-workers when they request help can also enhance work relationships.
- Empathy:Empathy is the ability to understand someone else’s feelings. Empathy is an important personal characteristic, as it helps CNA to understand the patient better and accordingly provide proper care.
- Respect:The CNA should demonstrate professional behavior by showing respect towards the patients, attending to their needs and provide appropriate care as required. The CNA should also respect the workplace rules and regulations, which helps maintain a safe environment.
CNA VS. OTHER NURSING POSITIONS
Licensed practical nurses (LPNs), Registered nurses (RNs), and Certified nursing assistants (CNAs) are different types of healthcare providers in the nursing profession. Both CNAs and LPNs work under the supervision of the registered nurse. Let’s understand how CNA compares to the two other nursing positions.
Roles: A RN decides the plan of care for a patient, and evaluates patient data. An LPN assists the registered nurse and provides basic nursing care to all patients. A CNA provides basic care to the patients while working under the supervision of the LPN and the RN.
Education: The RN completes a four years degree or a graduate program from a state-approved nursing program. The LPN completes a one year accredited program at a vocational or community college, and has to pass the NCLEX-PN exam. To work as an LPN in a particular state in the US, one also applies for a license from the respective state board of nursing. CNAs on the other hand, complete a post-secondary program in which they learn about the nursing profession and the clinical practice.
Responsibilities of an RN, LPN and a CNA
RNs:
- Provides treatments prescribed by the physician
- Operates medical equipment
- Observes and records patient data
- Guides and plans tasks for LPNs and CNAs
LPNs:
- Assists the RN
- Provides basic care for patients
- Administers medications
- Collects vital signs and other basic patient data
- Reports any emergencies or change in patient status to the RN
CNAs:
- Answers calls when patients need help
- Assists patients with activities of daily living such as bathing, dressing up, feeding meals, making beds
- Transports patients
- Takes vital signs
- Reports any emergencies or change in patient status to the RN
COMMUNICATION SKILLS
Good communication is an important characteristic for CNAs to perform their daily duties. CNAs should be able to express themselves clearly when communicating with the patient, co-workers, supervisors and other people in the healthcare field. This not only ensures patient safety but also builds a good working relationship with the team members.
Good communication skills include active listening and accurately documenting/reporting the patient’s status.
Active listening: CNAs should listen to the patients’ queries and needs without any judgment or personal bias. They should pay attention to the patient’s requests and make them feel worthy of attention and respect. Being sarcastic or judgmental or asking Yes/No questions will limit the conversation and will not help the CNA understand the patient properly. If a patient is not able to articulate his needs, the CNA should use open-ended questions and try to find more about what the patient is feeling. This will help the CNA provide the best care for the patient. The CNA should avoid the use of medical jargon, and keep the communication simple so that the patient is not confused. Observing the nonverbal cues such as eye contact, and facial expressions are also one of the ways to pay attention to the patients’ needs. Sometimes, CNAs have to interact with patients who do not speak English or belong to a different culture. On such occasions, it is important to use an interpreter or speak to the patient’s relatives to understand what the patient needs. At other times, a CNA may encounter a patient with disabilities such as hearing impairment, visual impairment, or speech disabilities. The CNA should ensure in such cases that proper aids are used to communicate with the patient. For instance, speaking slowly and directly to a patient with hearing impairment may help the patient to understand the message clearly. Providing large and readable printed instructions to a patient with visual impairment will ensure that the patient understands the instruction correctly. The CNA can use gestures and written materials to communicate with a patient with speech problems.
Accurate documenting and reporting: The CNA requires good communication skills to document relevant information. The CNA documents and reports important patient health information such as changes in the patient’s condition and other safety information. The patient health report should have correct grammar and spelling and correct use of medical terms. For patient safety, it is important that the information is documented clearly and appropriately. This will enable the healthcare team take appropriate action. The CNA can also take the help of the supervisor in documenting health-related information to ensure accuracy and record factual information.
A lack of proper communication skills can cause misunderstandings and even endanger the patient’s safety. Therefore, it is important for all CNAs to enhance their communication abilities to enable proper care for the patient.
LIABILITIES OF CNAS
CNAs should perform their duties in a legal and ethical manner, failing which, they may face a legal consequence and may even lose their CNA license.
Common allegations against CNAs can include:
Negligence: A CNA can face legal liability if he demonstrates negligence when performing his duties. For instance, a patient burns his/her skin because the CNA did not check the water temperature before a bath. Another example could be, the CNA does not handle the patient correctly due to which the patient falls and is injured. Such conduct violates the law and so a liability occurs. The CNA should ensure that all precautions are taken and care is provided as prescribed.
Assault and Battery: Assault includes slapping, pinching, shaking, hitting the patient, or restraining the patient with force. Battery involves offensively touching the patient without consent. Such conduct can have legal consequences for the CNA.
Abuse: Any verbal, emotional, physical and sexual abuse on the part of the CNA can result in a legal liability. Examples include making fun of the patient, shouting, violently threatening the patient or rape.
Neglect: Neglect includes neglecting the patient’s personal hygiene, diet, not providing care as prescribed, not paying attention to the patient’s needs or concerns that can deteriorate the patient’s condition.
Legal liabilities can be avoided if CNAs perform their duties carefully and exercise their judgment when providing care. CNAs should employ the following principles for providing proper care to the patient:
- Follow the facility rules and regulations
- Ensure that the duties performed are within the scope of practice
- Seek guidance from LPN and RN if in doubt
- Be kind to all patients and perform all your duties in a professional manner
- Inform the patient what care you will be providing before starting the care procedure
- Do not touch the patient if he refuses care; report the incident to the supervisor
- Report immediately if any other CNA is not performing his/her duty in an ethical manner
PATIENT’S RIGHTS
In accordance with the Patient’s Bill of Rights, a medical care facility should have a written policy that states the patients’ rights. Each patient should have access to this policy whenever required. The patients should be aware of their rights so that they know how concerns can be addressed and what to expect from nursing assistants. CNAs should also be aware of the patient’s rights so that they can follow it when providing care.
According to the Bill of Rights, the patient has the right to know about their health condition, diseases, and the prescribed treatment. The patient also has the right to choose the primary care provider at a facility he prefers. Therefore, the CNAs should answer any health-related queries that are within their scope to answer. Examples include a change in vital signs or temperature changes. As a precaution, the CNA should first inform the supervisor before providing any health-related information to the patient.
The patient has a right to know about any fees and charges that he/she may incur during her stay in the hospital. In some cases, the charges may not be covered by Medicare or Medicaid. Therefore, the patients should be provided any information they may need to know about financial transactions, records, bills.
The patient also has a right to privacy and confidentiality. The CNA should ensure that the patient is provided privacy as needed. Examples include, not interrupting the patients’ private conversation with family members, not sharing information with the patient’s family without the patient’s consent, knocking the door before entering the patient room, or putting curtains when dressing the patient, so that the patient’s private parts are not exposed.
The patient has a right to voice their opinions about the quality of care provided by the nursing assistants or other healthcare staff. Residents should not be criticized or threatened for any negative opinions. The CNAs should also ensure that the resident does not experience any physical, mental or sexual abuse in the facility. Any signs of abuse should be immediately reported. The resident has a right to safety and security in the medical facility. Any neglect or harm to the patient from the healthcare team such as threats or beating can result in a legal liability.
The Patient’s bill of rights provides protection to patients and the CNAs should know what is and is not in it. For instance, a patient cannot demand a transfer to another facility only because they do not want to be in the hospital. Similarly, in an emergency situation, the patient cannot take his/her own decisions and has to be treated by the doctor. Therefore, knowing the bill of rights will help CNA take proper healthcare decisions for the patient and also protect their rights.
Click the following link to learn more about the Patients’ Bill of Rights:
https://www.healthsourceglobal.com/docs/Patient%20Bill%20of%20Rights_merged.pdf
ETHICS
A CNA should demonstrate ethical behavior while caring for the patients. Ethical behavior protects life and promotes the health of the patients. The CNA should employ the following ethical principles at work:
- Arrive on time for work, so that the patient is not left unattended. Take a leave only when necessary and inform the supervisor before being absent.
- Follow all rules and regulations of the hospital and ensure that the work is performed within the scope of practice.
- Demonstrate loyalty, flexibility, and co-operation at work.
- Keep the patient’s personal information confidential. Discuss health-related information with the relevant healthcare team and not with colleagues or other patients. Do not share any patient information with others without the patient’s consent.
- Respect each patient and provide care based on need and above all perform your job to the best of your ability.
The CNA should also guard himself/herself against unethical behaviors. The following behaviors can damage the professional image of a CNA, and also affect relationships with co-workers and patients:
- Being absent from work without any reason.
- Avoiding work by spending time in cafeterias or break rooms
- Ignoring patients, not performing tasks as assigned, not answering call lights
- Practicing discrimination towards patients from another race or culture
- Using hospital stationery and other materials for personal use
CONTINUING EDUCATION
CNA education does not end just because one completes the clinical experience and passes the CNA test. A CNA is required to continue education to work actively in the nursing field. By continuing their medical education CNAs can update themselves with the current patient care practices, and thereby offer better care to the patients.
In the US, the federal law requires CNAs to take a minimum of 12 hours of continued education (CE) every year. In some states, the minimum CE requirement is 24 hours.
Remember that a change in the medical procedure may make it necessary to change the certification and licensure requirements. Continuing education is one way in which the CNAs can ensure that their certification is updated too.
There are multiple options for CNAs to continue their education, such as:
- Local community colleges
- State nursing board
- Current employer
CNAs can choose from a variety of subjects to continue education, such as:
- Current clinical practices
- Elderly care
- Patient care for HIV/AIDS
- Patient Rights
- Care for cognitive impairment
There are many such medical courses available, which CNAs can avail, as per their interests.
By continuing their education, CNAs update themselves on different areas in the healthcare field and use that knowledge in their day to day work. For instance, transferring and lifting patients needs specialized skills and techniques, to maintain patient safety. By continuing their education on such medical subjects, CNAs can update themselves and employ this knowledge while handling patients at their workplace.
Sometimes, a CNA may be assigned to a geriatric ward or may have to provide stress/end-of-life care. If the CNA does not have prior experience in dealing with such kinds of patients, it would create many challenges, and may also affect patient care. Continuing education in such areas would ensure safe patient care.
CNAs should also be aware of the advancements in medicine/technologies, and the discovery of new diseases, or illnesses. Continuing education is one way in which the CNAs can learn about such current advancements in the healthcare field.
If a CNA cannot attend a full-time college, he can avail the online CE courses and can update his certification. For instance, free HIV education courses are available on the U.S. Centers for Disease Control and Prevention (CDC) website.
CE is an integral part of the healthcare field as it helps CNAs perform their duties efficiently. It also ensures that patients are not harmed due to lack of knowledge. Continuing education also boosts professional confidence and helps CNAs grow in their career.
DATA COLLECTION AND REPORTING
Observation of patients and reporting relevant patient data to the supervisor are important duties of the CNA. Observation helps identify different needs of the patients, and changes in their health, and accordingly helps the healthcare team to provide care to the patient.
The CNA should use the following methods of observation:
Objective observation: This involves what the CNAs observe in a patient. The CNAs should use their senses and active listening skills to identify any changes in the patient. The CNA should look out for any visible change in the patient’s appearance, blood pressure levels, pulse rate, skin color, consciousness levels, and signs of pain. Objective observation also includes paying attention to bad breath, or foul odors from the wound or urine, and any kind of swelling on the body parts.
Subjective observation: This involves any complaints and information provided by the patient about their health. This includes statements from patients such as ‘I’m feeling too cold’ or ‘I’m feeling unusually tired today’. Such complaints can indicate a health concern and should be promptly reported for further assessment and care.
Once the CNA identifies the patient’s needs, they should promptly report their findings. They should ensure that the information that is reported is accurate and avoid assuming anything. Their reports should contain the patient’s name, room/bed number, and a detailed description of the observation. In case the observation includes dangerous situations such as broken equipment or an unusual observation such as suspicions of abuse, the incident should be immediately reported without delay. Acute changes in mental status, such as confusion or delirium should be immediately reported.
Other than reporting, the CNA should also document their findings in charts, worksheets or facility records or according to the procedure followed by the facility. While documenting the patient’s condition, the following precautions are taken:
- Ensure that the resident’s name is written on each page along with time, date and the CNA’s name and title.
- Handwriting should be neat and eligible.
- Ink is used to write a report and not a pencil or a felt tip.
- Ensure that the written report is not exaggerated but states only what was observed, or what the patient said.
- Medical terminologies and abbreviations should be used according to the medical standards.
- Ensure that the documentation is done according to current nursing practices.
