Unit A Nurse Aide Workplace Fundamentals Essential Standard 1.00 Understand the range of function, legal and ethical responsibilities of the nurse aide within the healthcare system. Indicator 1.01 Understand healthcare facilities and organizational structure with focus on LTC Nursing Fundamentals 7243 Understand healthcare facilities and organizational structure with focus on LTC.

2 NAs NAs can work in a variety of settings ClinicsHospitals Rehab Centers Homes for Aged HOME CARE LTC Psychiatric Facilities 1.01Nursing Fundamentals 7243

Provide care for individuals of all ages with a broad range of health problems 31.01Nursing Fundamentals 7243Hospitals

Hospitals Services varied and extensive Diagnostic Diagnostic Therapeutic Therapeutic Medical Medical Surgical Surgical Emergency Emergency 41.01Nursing Fundamentals 7243

So what does Diagnostic mean? 5 Remind me from HSII… 1.01Nursing Fundamentals 7243

Diagnostic mean? 1.01Nursing Fundamentals Pertaining to the Identification of a medical condition or disease as determined by a physician. A statement of what is wrong with a resident.

So what does Therapeutic mean? 7 and…. Pertains to treating, fixing, or correcting a medical or surgical problem 1.01Nursing Fundamentals 7243

So what does Medical mean? 8 Pertaining to the science of treatment that includes drugs, diet, exercise and other non-surgical means.Pertaining to the science of treatment that includes drugs, diet, exercise and other non-surgical means. aaaaaaaand …. 1.01Nursing Fundamentals 7243

What is Surgical … 91.01Nursing Fundamentals 7243

1.01Nursing Fundamentals Pertains to the treatment of injury, deformity, and disease by manual and instrumental operations. … Surgical…..

So what does Emergency mean? 11 and last but not least…. Sudden occurrence of a serious and urgent nature that demands immediate attention Nursing Fundamentals 7243

Hospitals 12 3 Types of Care AcuteChronic Terminal / Palliative 1.01Nursing Fundamentals 7243

So what does Acute mean? 13 OK so…..remind me An acute illness has a sudden onset from which the resident is expected to recover.An acute illness has a sudden onset from which the resident is expected to recover. Acute therapy is short-term medical treatment, usually in a hospital, for patients having an acute illness or injury or recovering from surgery.Acute therapy is short-term medical treatment, usually in a hospital, for patients having an acute illness or injury or recovering from surgery. Example: Outpatient care, rehab or hospiceExample: Outpatient care, rehab or hospice 1.01Nursing Fundamentals 7243

Chronic means…. 14 Then… A chronic illness has slow or gradual on set, for which there is no known cure, the illness can be controlled and complications prevented.A chronic illness has slow or gradual on set, for which there is no known cure, the illness can be controlled and complications prevented. Chronic care is medical and nursing services that focus on long term care of people with chronic diseases or conditions, either at home or in a medical facility. It includes measures specific to the problem, as well as others to encourage self-care, promote health, and prevent loss of function.Chronic care is medical and nursing services that focus on long term care of people with chronic diseases or conditions, either at home or in a medical facility. It includes measures specific to the problem, as well as others to encourage self-care, promote health, and prevent loss of function. 1.01Nursing Fundamentals 7243

What are some examples of Chronic conditions? Physical disabilities Heart disease Strokes 1.01Nursing Fundamentals

What does Terminal mean? 16 An illness from which the resident is not expected to recover and will die. Residents with terminal illnesses are given Palliative (comfort) care instead of curative care. 1.01Nursing Fundamentals 7243

LONG TERM CARE FACILITIES Referred to as: Extended care facilities Extended care facilities Skilled care facilities Skilled care facilities Nursing homes Nursing homes CCRC – continuing care retirement community (includes skilled nursing) CCRC – continuing care retirement community (includes skilled nursing) Nursing Fundamentals 7243

LONG TERM CARE FACILITIES Provide healthcare services to individuals unable to care for themselves: elderly persons elderly persons disabled or handicapped persons disabled or handicapped persons people with chronic illness people with chronic illness Nursing Fundamentals 7243

191.01Nursing Fundamentals 7243

HOMES FOR THE AGED (HA) HOMES FOR THE AGED LICENSE (HAL) Formerly called: Rest home Rest home Assisted living Assisted living Nursing Fundamentals 7243

HOMES FOR THE AGED Types: Family Care Home – serves 2-6 unrelated persons Family Care Home – serves 2-6 unrelated persons Adult Care Home – serves 7 or more unrelated persons Adult Care Home – serves 7 or more unrelated persons Group Home – for developmental disabled adults Group Home – for developmental disabled adults Multi unit housing with services Multi unit housing with services Nursing Fundamentals 7243

HOMES FOR THE AGED SUCH AS REST HOMES OR ASSISTED LIVING Assists resident with medication administration Assists resident with medication administration Assists with personal care, dressing, or grooming Assists with personal care, dressing, or grooming Provides three meals a day Provides three meals a day Provides housekeeping Provides housekeeping LIMITED MEDICAL SUPERVISION LIMITED MEDICAL SUPERVISION Nursing Fundamentals 7243

HOMES FOR THE AGED Monitored by: Adult Home Specialist within County Department of Social Services Monitored by: Adult Home Specialist within County Department of Social Services 23 Licensed by Licensed by 1.01Nursing Fundamentals 7243

HOME CARE AGENCIES Provide care in the home for people needing health services, but not hospitalization Nursing Fundamentals 7243

What are roles of home care CNAs: Bathing Cook meals or pre Assist with feedings Laundry Clean the house Shop for groceries Take to doctors appt 1.01Nursing Fundamentals

HOME CARE AGENCIES Services provided include: 26 Nursing / CNA / PCA Nursing / CNA / PCA Physical therapy Physical therapy Occupational therapy Occupational therapy Speech therapy Speech therapy Social services Social services Nutritional and food services Nutritional and food services Respiratory therapy Respiratory therapy Homemaker services Homemaker services 1.01Nursing Fundamentals 7243

HEALTHCARE FACILITY ORGANIZATIONAL STRUCTURE Displays chain of command Displays chain of command Shows lines of authority Shows lines of authority Identifies health care worker’s position Identifies health care worker’s position Identifies immediate supervisor Identifies immediate supervisor Nursing Fundamentals 7243

HEALTHCARE FACILITY ORGANIZATIONAL STRUCTURE Responsible for provision of safe and adequate care at a reasonable cost Responsible for provision of safe and adequate care at a reasonable cost Makes facility policies Makes facility policies Delegates management to an administrator Delegates management to an administrator Governing body Governing body = (Board of Directors) Nursing Fundamentals 7243

HEALTHCARE FACILITY ORGANIZATIONAL STRUCTURE Department heads – Have specific areas of responsibilities – Supervise department staff Finance Finance Ancillary services Ancillary services Nursing Nursing Nursing Fundamentals 7243

HEALTHCARE FACILITY ORGANIZATIONAL STRUCTURE Medical Director Supervises medical staff activities Physicians Physicians Residents Residents Interns Interns Nursing Fundamentals 7243

HEALTHCARE FACILITY ORGANIZATIONAL STRUCTURE Director of Nursing and Assistant DON Supervises nursing staff activities Supervises nursing staff activities Responsible for safe nursing care Responsible for safe nursing care Registered nurses Registered nurses Nursing Fundamentals 7243

HEALTHCARE FACILITY ORGANIZATIONAL STRUCTURE Nursing supervisor Assists director of nursing Assists director of nursing Licensed nurse Licensed nurse Assigned areas of responsibility Assigned areas of responsibility Assigned to specific shift Assigned to specific shift Nursing Fundamentals 7243

HEALTHCARE FACILITY ORGANIZATIONAL STRUCTURE Charge Nurse – Has specific areas of responsibility – Responsible for resident care in specific area Nursing Fundamentals 7243

HEALTHCARE FACILITY ORGANIZATIONAL STRUCTURE Charge Nurse Supervises staff in specific area Registered nurses (RNs) Registered nurses (RNs) Licensed practical nurses (LPNs) Licensed practical nurses (LPNs) Nurse aides (NAs) Nurse aides (NAs) Nursing Fundamentals 7243

LTC FACILITIES REGULATION 35 Federal Level State Level 1.01Nursing Fundamentals 7243

36 Federal Level Federal agency that works with state agenciesFederal agency that works with state agencies Runs two national care programsRuns two national care programs Medicare- Medicare- Medicaid Medicaid 1.01Nursing Fundamentals 7243

Medicare- Covers people over age of 65 or who are disable and cannot work Has 4 parts- A-Pays for hospitals/skilled nursing facilities B-doctor services, equipment, medical services C. Allows private insurances to provides Medicare benefits D. Medication and prescriptions plan Medicaid Insurance for people who fit within the income guidelines Pays for doctors office visits, dental, emergency rooms, surgery and prescriptions 1.01Nursing Fundamentals

38 Federal Level Helps pay for health care including nursing home careHelps pay for health care including nursing home care Sets quality standards for long term care facilitiesSets quality standards for long term care facilities Nursing homes must be certified to receive Medicare and Medicaid fundsNursing homes must be certified to receive Medicare and Medicaid funds 1.01Nursing Fundamentals 7243

39 Federal Level Nursing Home Compare for Consumers Five Star rating systemFive Star rating system Quality of care informationQuality of care information Characteristics of nursing homesCharacteristics of nursing homes 1.01Nursing Fundamentals 7243

LTC FACILITIES REGULATION 40 State Level Two Sections of DHSR: Nursing Home Licensure and Certification Section Health Care Personnel Registry Section 1.01Nursing Fundamentals 7243

LTC FACILITIES REGULATION 41 Nursing Home Licensure and Certification Section Determines location and number of nursing homes needed in NCDetermines location and number of nursing homes needed in NC Issues licenses to nursing homes giving permission to operate and provide careIssues licenses to nursing homes giving permission to operate and provide care "Surveyors" conduct inspections to find out whether the nursing home meets federal rules"Surveyors" conduct inspections to find out whether the nursing home meets federal rules Routine inspections take place in nursing homes that receive payment through Medicare and Medicaid every 9 to 15 months Routine inspections take place in nursing homes that receive payment through Medicare and Medicaid every 9 to 15 months Surveys take three days on average Surveys take three days on average 1.01Nursing Fundamentals 7243

LTC FACILITIES REGULATION 42 Responsibilities of the nurse aide during the survey process Provide quality careProvide quality care Protect residents rightsProtect residents rights Provide for resident and personal safetyProvide for resident and personal safety Keep center clean and safeKeep center clean and safe Conduct yourself in a professional mannerConduct yourself in a professional manner Demonstrate good work ethicsDemonstrate good work ethics Follow center policies and proceduresFollow center policies and procedures Answer surveyor questions honestly and completelyAnswer surveyor questions honestly and completely 1.01Nursing Fundamentals 7243

LTC FACILITIES REGULATION 43 LTCs can be put on “SANCTION” because of: Substandard careSubstandard care CMP – Civil Money PenaltyCMP – Civil Money Penalty 1.01 Nursing Fundamentals 7243

LTC FACILITIES REGULATION CMP-Civil Money Penalty 44 Fines collected as a result of nursing home violationsFines collected as a result of nursing home violations Fines are redirected back in the nursing home industry to improve the quality of careFines are redirected back in the nursing home industry to improve the quality of care In NC – Win A Step Up is funded by CMPIn NC – Win A Step Up is funded by CMP 1.01Nursing Fundamentals 7243

LTC FACILITIES REGULATION 45 Health Care Personnel Registry SECTION There are two branches: 1.Investigations Branch 2.Center for Aide Regulation and Education (CARE) Branch 1.01Nursing Fundamentals 7243

LTC FACILITIES REGULATION LTC FACILITIES REGULATION 46 Health Care Personnel Registry SECTION Investigations BRANCH responsible for: 1.Health Care Personnel Registry 2.Receiving reports from health care facilities 3.Unlicensed health care worker investigations 4.Listing "Pendings" and "Findings" on the Nurse Aide I and Health Care Personnel Registries 1.01Nursing Fundamentals 7243

LTC FACILITIES REGULATION 47 Health Care Personnel Registry SECTION Center for Aide Regulation and Education (CARE) BRANCH is responsible for 1.Nurse Aide I Registry, training and competency programs 2.Medication Aide Registry and competency programs 3.Geriatric Aide Registry and training 4.Feeding assistant training curriculum 5.Providing registry access and listing verification 1.01Nursing Fundamentals 7243

LTC FACILITIES REGULATION 48 NC New Organizational Vision Award ~NC NOVA~ NC Special State License that honors excellence in the workplace for people employed by home care agencies, adult care homes, and nursing homes. 1.01Nursing Fundamentals 7243

LTC FACILITIES REGULATION 49 NC New Organizational Vision Award NC NOVA facilities have the following: 1.Well trained staff, satisfied and loyal workers helping families by caring for their loved ones; 2.Stronger links among workers, residents, families, and management; 1.01Nursing Fundamentals 7243

LTC FACILITIES REGULATION 50 NC New Organizational Vision Award NC NOVA facilities have the following: 3.Chances for staff to better their skills and advance their careers; 4.Stable, quality worker available now and for the future. 1.01Nursing Fundamentals 7243

LONG TERM CARE REGULATIONS – SO WHAT? 51 Nurse Aides must provide good care and comply with state and federal and regulations. 1.01Nursing Fundamentals 7243

Consequences of inappropriate actions by the Nurse Aide Student or CNA Name of the Nurse Aide will be listed on the Health Care Personnel Registry for a "pending" allegation or substantiated allegation "finding(s)" Nursing Fundamentals 7243

Consequences of inappropriate actions by the Nurse Aide Student or CNA Nursing homes and other facilities must access the NC DHSR Health Care Personnel Registry before they hire unlicensed staff. Listings include: Name of the Nurse Aide Name of the Nurse Aide Nature of the finding or allegation Nature of the finding or allegation Status of the investigation Status of the investigation Listings on the NC Health Care Personnel Registry will also be listed on the National Practitioner Data Bank Listings on the NC Health Care Personnel Registry will also be listed on the National Practitioner Data Bank Nursing Fundamentals 7243

54 Healthcare Integrity and Protection Data Bank Nurse Aides are considered “practitioners”Nurse Aides are considered “practitioners” Substantiated negative “Findings” for nurse aides will appear in this national data bank!Substantiated negative “Findings” for nurse aides will appear in this national data bank! Nursing Fundamentals 7243

Consequences of inappropriate actions by the Nurse Aide Student or CNA Deficiencies may be cited against the LTC where the Nurse Aide is employed Nursing Fundamentals 7243

Prevent Problems Prevent Problems Good resident care Good resident care Given with a good heart Given with a good heart Using Good standards Using Good standards Each and every day Each and every day Equals a GREAT CNA who has nothing to fear and everything to gain. Equals a GREAT CNA who has nothing to fear and everything to gain Nursing Fundamentals 7243