Role of the Nurse Aide and the Health Care Team
Scope of practice
The nurse aide is the member of the team who spends the most time with the resident and provides hands-on care under the direction of a licensed nurse. Iowa requires completion of an approved nurse aide training program and a competency evaluation before a person is listed on the Iowa Direct Care Worker Registry, which also records substantiated findings of abuse, neglect, or misappropriation. Delegation belongs to the nurse: the RN or LPN decides what the aide may do and remains accountable for it. If a task is not in your training or assignment, do not perform it; say so and ask the nurse.
Things a nurse aide does not do: assess, interpret findings, teach, perform sterile procedures, or give medications (unless a state-approved medication aide program applies). Things a nurse aide does do: observe and report, provide ADLs, measure vital signs, and document the care given.
The health care team
Understand the chain of command: aide, then charge nurse, then nursing supervisor, then administrator. The interdisciplinary team includes the nurse, physician, therapists, dietitian, social worker, and activities staff. The care plan is built from the resident's needs, and your observations at care conferences matter.
Traps
Questions like 'which task should the aide perform' usually have a correct answer that involves reporting to the nurse; the wrong answers involve deciding, diagnosing, or evaluating. Also watch for the difference between being assigned a task and being delegated one, and the fact that you may refuse an unsafe or out-of-scope task but must report it.
Rule of thumb
If a task requires the aide to decide, assess, evaluate, teach, or judge, it belongs to the nurse. If it requires the aide to provide, assist, observe, report, or document, it can belong to the aide.