Legal and Ethical Responsibilities and Role of the Nurse Aide
What you must know
Your scope of practice is defined by state law and your training. You provide personal care, ambulation, positioning, feeding, vital signs, and observation, and you report to the licensed nurse. You do not assess, diagnose, give medications, perform sterile procedures, or teach. You cannot delegate your duties to another aide. If you are unsure whether a task is within your role, ask the nurse - refusing to do something outside your training is appropriate.
Abuse and neglect reporting is mandatory. Abuse can be physical, sexual, verbal, psychological, or financial, and includes involuntary seclusion and misappropriation of property. Neglect is failure to provide needed care. If you suspect abuse, protect the resident, report immediately through your chain of command and the state hotline, and document objectively. You do not investigate or confront the suspected person.
Confidentiality is a legal duty under HIPAA and facility policy: share information only with the care team, never on the phone to a caller, never on social media.
Consent and directives: informed consent belongs to the nurse or physician. Advance directives, living wills, DNR orders, and durable power of attorney for health care tell you what the resident wants. Honor a DNR - do not start CPR on a resident with a valid DNR order; call the nurse.
Incident reports document facts for the facility's records; they are not placed in the resident's chart, and you never blame or speculate in them.
Traps
Giving a medication because the nurse is busy; signing as a witness to a will or a consent; discussing a resident in the elevator; charting "resident was fine" instead of facts; investigating an abuse allegation yourself.
Rule of thumb: when in doubt, report to the nurse and document what you saw, not what you concluded.