Role of the Nurse Aide and Legal/Ethical Issues
What this domain covers
Nursing assistants work under the supervision and delegation of a licensed nurse. Knowing where your role begins and ends protects residents, your license, and you.
Scope of practice. You may perform tasks you were trained for and that are delegated under your facility's policy: bathing, feeding, ambulation, vital signs, specimen collection, and observation. You may not perform sterile procedures, give medications (including ear or eye drops), start IVs, do wound care requiring sterile technique, or take verbal orders. If asked to do something outside your scope, do not do it - report to the nurse and follow the chain of command.
Delegation and rights. The nurse assesses; the aide reports and carries out delegated tasks. You may refuse a task that is outside your training or unsafe for the resident, and you may refuse to accept an assignment you are not competent to perform. Document what you did and what you observed, sign your own entries, and never chart for someone else.
Confidentiality and consent. Discuss resident information only with those involved in care. HIPAA applies to you. Informed consent belongs to the resident or their legal representative; aides do not obtain consent for procedures.
Ethics and legal risk. Negligence is failing to provide the standard of care; malpractice is professional negligence. Abuse, neglect, and misappropriation of property are reportable and may be criminal. Do not accept money, gifts, or tips from residents, do not accept a resident's bequest, and do not borrow items.
Traps. Questions test whether you would "help out" by giving a pill, signing a coworker's charting, or accepting a $20 gift. All are wrong.
Rule of thumb. When a request falls outside your training, the correct answer is always to stop, say no politely, and report it to the nurse.