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Standards of practice and competencies for nursing assistants.

Competencies and standards of practice are statements of skills and knowledge, and are written as descriptions of observable, measurable behaviors. All competencies are performed under the direction and supervision of a licensed registered nurse or licensed practical nurse as required by RCW 18.88A.030. The following competencies are considered standards of practice for both nursing assistant-certified and nursing assistant-registered:
(1) Basic technical skills. A nursing assistant demonstrates basic technical skills which facilitate an optimal level of functioning for client or resident, recognizing individual, cultural, and religious diversity. A nursing assistant:
(a) Demonstrates proficiency in cardiopulmonary resuscitation (CPR) and can perform CPR independently.
(b) Takes and records vital signs.
(c) Measures and records height and weight.
(d) Measures and records fluid and food intake and output.
(e) Recognizes normal body functions, deviations from normal body functions and the importance of reporting deviations in a timely manner to a supervising nurse.
(f) Recognizes, responds to and reports client's or resident's emotional, social, cultural and mental health needs.
(g) Recognizes, responds to and reports problems in client's or resident's environment to ensure safety and comfort of client.
(h) Participates in care planning and nursing reporting process.
(2) Personal care skills. A nursing assistant demonstrates basic personal care skills. A nursing assistant:
(a) Assists client or resident with bathing, oral care, and skin care.
(b) Assists client or resident with grooming and dressing.
(c) Provides toileting assistance to client or resident.
(d) Assists client or resident with eating and hydration.
(e) Uses proper oral feeding techniques.
(3) Mental health and social service needs. A nursing assistant demonstrates the ability to identify psychosocial needs of all clients or residents based upon awareness of the developmental and age specific processes. A nursing assistant:
(a) Addresses individual behavioral needs of the client or resident.
(b) Knows the developmental tasks associated with the developmental and age specific processes.
(c) Allows the client or resident to make personal choices, but provides and reinforces behaviors consistent with the client's or resident's dignity.
(d) Is sensitive and supportive and responds to the emotional needs of the clients or residents and their sources of emotional support.
(4) Care of cognitively impaired residents. A nursing assistant demonstrates basic care of cognitively impaired clients or residents. A nursing assistant:
(a) Uses techniques for addressing the unique needs and behaviors of individuals with cognitive impairment including Alzheimer's, dementia, delirium, developmental disabilities, mental illnesses and other conditions.
(b) Communicates with cognitively impaired clients or residents in a manner appropriate to their needs.
(c) Demonstrates sensitivity to the behavior of cognitively impaired clients or residents.
(d) Appropriately responds to the behavior of cognitively impaired clients or residents.
(5) Basic restorative services. The nursing assistant incorporates principles and skills in providing restorative care. A nursing assistant:
(a) Demonstrates knowledge and skill in using assistive devices in ambulation, transferring, eating, and dressing.
(b) Demonstrates knowledge and skill in the maintenance of range of motion.
(c) Demonstrates proper techniques for turning and positioning a client or resident in a bed and chair.
(d) Demonstrates proper techniques for transferring and ambulating client or resident.
(e) Demonstrates knowledge about methods for meeting the elimination needs of clients or residents.
(f) Demonstrates knowledge and skill for the use and care of prosthetic devices by client or resident.
(g) Uses basic restorative services by training the client or resident in self care according to the client's or resident's capabilities.
(6) Client or resident rights and promotion of independence. A nursing assistant demonstrates behavior which maintains and respects client or resident rights and promotes independence, regardless of race, religion, life-style, sexual preference, disease process, or ability to pay. A nursing assistant:
(a) Recognizes that client or resident has the right to participate in decisions about his or her care.
(b) Recognizes and respects clients' or residents' need for privacy and confidentiality.
(c) Promotes and respects the client or resident right to make personal choices to accommodate their needs.
(d) Reports client or resident concerns.
(e) Provides assistance to client or resident in getting to and participating in activities.
(f) Respects the property of client or resident and employer and does not take equipment, material, property or medications for his, her or other's use or benefit. A nursing assistant may not solicit, accept or borrow money, material or property from client or resident for his, her or other's use or benefit.
(g) Promotes client or resident right to be free from abuse, mistreatment, and neglect.
(h) Intervenes appropriately on the client's or resident's behalf when abuse, mistreatment or neglect is observed.
(i) Complies with mandatory reporting requirements by reporting to the department of health and the department of social and health services instances of neglect, abuse, exploitation or abandonment.
(j) Participates in the plan of care with regard to the use of restraints in accordance with current professional standards.
(7) Communication and interpersonal skills. A nursing assistant uses communication and interpersonal skills effectively to function as a member of the nursing team. A nursing assistant:
(a) Reads, writes, speaks, and understands English at the level necessary for performing duties of the nursing assistant.
(b) Listens and responds to verbal and nonverbal communication in an appropriate manner.
(c) Recognizes how his or her own behavior influences client's or resident's behavior and uses resources for obtaining assistance in understanding the client's or resident's behavior.
(d) Adjusts his or her own behavior to accommodate client's or resident's physical or mental limitations.
(e) Uses terminology accepted in the health care setting to record and report observations and pertinent information.
(f) Appropriately records and reports observations, actions, and information accurately and in a timely manner.
(g) Is able to explain policies and procedures before and during care of the client or resident.
(8) Infection control. A nursing assistant uses standard and transmission based precautions to prevent the spread of microorganisms. A nursing assistant:
(a) Uses principles of medical asepsis and demonstrates infection control techniques and standard and transmission based precautions.
(b) Explains how disease causing microorganisms are spread.
(c) Is knowledgeable regarding transmission of bloodborne pathogens.
(d) Demonstrates knowledge of cleaning agents and methods which destroy microorganisms on surfaces.
(9) Safety and emergency procedures. A nursing assistant demonstrates the ability to identify and implement safety and emergency procedures. A nursing assistant:
(a) Provides an environment with adequate ventilation, warmth, light, and quiet.
(b) Promotes a clean, orderly, and safe environment including equipment for a client or resident.
(c) Identifies and utilizes measures for accident prevention.
(d) Demonstrates principles of good body mechanics for self and client or resident, using the safest and most efficient methods to lift and move clients, residents, or heavy items.
(e) Demonstrates proper use of protective devices in care of clients or residents.
(f) Demonstrates knowledge and follows fire and disaster procedures.
(g) Identifies and demonstrates principles of health and sanitation in food service.
(h) Demonstrates the proper use and storage of cleaning agents and other potentially hazardous materials.
(10) Rules and regulations knowledge. A nursing assistant demonstrates knowledge of and can explain the practical implications of the laws and regulations which affect nursing assistant practice including but not limited to:
(a) Mandatory reporting procedures related to client or resident abuse, neglect, abandonment, and exploitation.
(b) Scope of practice.
(c) Workers right to know.
(d) The Uniform Disciplinary Act.
[Statutory Authority: RCW 18.88A.060(1) and 18.88A.030(5). WSR 08-06-100, § 246-841-400, filed 3/5/08, effective 4/5/08. Statutory Authority: RCW 18.88A.060. WSR 91-23-077 (Order 214B), § 246-841-400, filed 11/19/91, effective 12/20/91; WSR 91-07-049 (Order 116B), recodified as § 246-841-400, filed 3/18/91, effective 4/18/91. Statutory Authority: RCW 18.88.080. WSR 90-20-018 (Order 091), § 308-173-210, filed 9/21/90, effective 10/22/90.]
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