Role of the Nurse Aide and Resident Rights
Scope and chain of command
A nurse aide provides basic nursing care under the supervision and delegation of a licensed nurse (RN or LPN). Aides do not assess, write care plans, give medications, insert tubes, or perform sterile procedures. Delegation flows downward only; an aide may not hand off an assigned task to another aide. When a request falls outside your training or the care plan, stop and ask the nurse. Report changes in condition promptly and factually, and let the nurse decide what to do.
Resident rights
OBRA (the 1987 Nursing Home Reform Act) made resident rights federal law: dignity, privacy, self-determination, freedom from abuse and neglect, freedom from unnecessary restraints and drugs, choice of physician, visitors, mail, telephone, activities, confidentiality of records, and the right to voice grievances without retaliation. Residents may refuse care. If someone refuses a bath or a meal, respect the refusal, document it, and tell the nurse. Never force, threaten, or bribe. An ombudsman advocates for residents and may be contacted confidentially. Abuse, neglect, and misappropriation of property must be reported immediately to the nurse and administrator; aides are mandatory reporters, and substantiated abuse can place an aide on the state nurse aide registry.
Traps
Questions love small boundary violations: accepting a tip, discussing a resident's diagnosis in the hallway, posting about a resident online, or borrowing a resident's phone. Each is a violation regardless of kind intent. Another favorite: a resident asking to see the chart, which you redirect to the nurse.
Rule of thumb
If you are unsure whether something is your job, it isn't. Ask the nurse, then chart what happened.