Current through Register Vol. 24-24, December 15, 2024
Competencies and standards of practice are statements of
knowledge, skills, and behaviors. They are written as descriptions of
observable, measurable actions. All nursing assistant 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) The
nursing assistant role and knowledge of rules and regulations.
(a) A nursing assistant demonstrates
competency in providing holistic, person-centered care that supports the human
needs of diverse individuals. The nursing assistant:
(i) Identifies the holistic needs of clients
or residents.
(ii) Provides care to
support holistic needs in accordance with nursing assistant competencies and
clients' or residents' plans of care.
(iii) Provides person-centered care by
adjusting care approaches to accommodate the unique needs and preferences of
clients or residents.
(b)
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:
(i)
Mandatory reporting procedures related to client or resident abuse, neglect,
abandonment, and exploitation (chapters 74.34 RCW and 246-16 WAC, and WAC
246-841A-720);
(iii) Opportunities for expanding scope:
(A) Nurse delegation; and
(B) Medication assistant certification
endorsement;
(iv) Workers
right to know (chapter 49.70 RCW);
(v) The Uniform Disciplinary Act (chapter
18.130 RCW);
(vi) Omnibus Budget
Reconciliation Act (OBRA);
(vii)
Medicare and medicaid.
(2) Client or resident rights and promotion
of independence. A nursing assistant demonstrates behavior which maintains and
respects clients' or residents' rights and promotes independence, regardless of
race, religion, lifestyle, sexual orientation, gender identity, disease
process, or ability to pay. A nursing assistant:
(a) Recognizes that clients or residents have
the right to participate in decisions about their care.
(b) Recognizes and respects each client's or
resident's need for privacy and confidentiality.
(c) Promotes and respects clients' or
residents' rights to make personal choices to accommodate their
needs.
(d) Reports clients' or
residents' concerns and gives assistance with resolving grievances and
disputes.
(e) Provides assistance
to clients or residents in getting to and participating in
activities.
(f) Respects the
property of clients or residents and employer and does not take equipment,
material, property, or medications for the nursing assistant's or another's use
or benefit. A nursing assistant may not solicit, accept or borrow money,
material, or property from a client or resident for the nursing assistant's or
another's use or benefit.
(g)
Promotes clients' or residents' right to be free from abuse, mistreatment, and
neglect.
(h) Intervenes
appropriately on a 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 regarding the use of restraints in accordance
with current professional standards.
(3) 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 one's own behavior
influences a client's or resident's behavior and uses resources for obtaining
assistance in understanding the client's or resident's behavior.
(d) Adjusts one's own behavior to accommodate
clients' or residents' physical or mental limitations.
(e) Uses terminology accepted in the health
care setting to appropriately record and report observations, actions, and
pertinent information accurately and timely.
(f) Is able to explain policies and
procedures before and during care of clients or residents.
(4) 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 including, but not limited to:
(i) Demonstrates effective handwashing
methods.
(ii) Identifies different
types of personal protective equipment (PPE) and demonstrates how and when to
use each.
(b) Explains
how disease-causing microorganisms are spread.
(c) Explains transmission of bloodborne
pathogens.
(d) Demonstrates
knowledge of cleaning agents and methods which destroy microorganisms on
surfaces.
(5) Safety and
emergency procedures. A nursing assistant demonstrates the ability to identify
and implement safety and emergency procedures, including the Heimlich maneuver.
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 uses measures for accident
prevention.
(d) Demonstrates
principles of good body mechanics for self and clients or residents, using the
safest and most efficient methods to lift and move clients, residents, and
heavy items.
(e) Demonstrates
proper use of protective devices in the care of clients or residents.
(f) Demonstrates knowledge of 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.
(6) Basic
nursing skills. A nursing assistant demonstrates basic technical skills which
facilitate an optimal level of functioning for clients or residents,
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
clients' or residents' emotional, social, cultural, and mental health
needs.
(g) Recognizes, responds to,
and reports problems in clients' or residents' environment to ensure safety and
comfort of clients.
(h)
Participates in care planning and the nursing reporting process.
(7) 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, positioning, and repositioning
clients or residents in a bed and chair.
(d) Demonstrates proper techniques for
transferring and ambulating clients or residents.
(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 clients or residents.
(g) Uses basic restorative services by
training clients or residents in self-care according to their
capabilities.
(8)
Personal care. A nursing assistant demonstrates basic personal care skills. A
nursing assistant:
(a) Assists clients or
residents with bathing, oral care, and skin care.
(b) Assists clients or residents with
grooming and dressing.
(c) Provides
toileting assistance to clients or residents.
(d) Assists clients or residents with eating
and hydration.
(e) Uses proper oral
feeding techniques.
(9)
Life transitions. A nursing assistant demonstrates the ability to support the
care needs of clients or residents during life transitions with competency in
the following areas:
(a) Uses basic procedures
for admitting, transferring, and discharging clients or residents and maintains
professional boundaries.
(b)
Applies knowledge of psychosocial and mental health considerations during life
transitions. Examples include, but are not limited to:
(i) Human responses to stress and
stressors;
(ii) Stages of
psychosocial development across the lifespan; and
(iii) Human responses to grief and
loss.
(c) Demonstrates
ability to support clients' or residents' holistic needs at the end of
life.
(d) Demonstrates knowledge of
legal documents affecting care and the nursing assistant role in using the
documents:
(i) Advance directives (living
wills, durable power of attorney);
(ii) Portable orders for life sustaining
treatment (POLST);
(iii) Do not
resuscitate (DNR).
(e)
Demonstrates the ability to provide postmortem care with respect for clients'
or residents' rights and sensitivity to the grieving process of their loved
ones.
(f) Demonstrates awareness of
the need for self-care and support in response to grief and loss.
(10) Care of clients or residents
with developmental disabilities. A nursing assistant demonstrates basic care of
clients or residents with developmental disabilities. In accordance with
developmental disability specialty training (WAC
388-112A-0430), a nursing
assistant:
(a) Demonstrates a basic
understanding of developmental disabilities and awareness of the unique needs
of residents with developmental disabilities.
(b) Promotes and supports a resident's
self-determination.
(c) Provides
culturally compassionate and individualized care by utilizing a basic
understanding of each client or resident and each client's or resident's
history, experience, and cultural beliefs.
(d) Uses person-centered and interactive
planning when working with clients or residents with developmental
disabilities.
(e) Uses a
problem-solving approach and positive support principles when dealing with
challenging behaviors.
(f) Supports
clients or residents experiencing a crisis and gets assistance when
needed.
(g) Promotes and protects
the legal and resident rights of clients or residents with developmental
disabilities.
(11) Mental
health and social service needs. A nursing assistant demonstrates the ability
to identify psychosocial needs of 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.
(e) Applies the
knowledge, skills, and behaviors from mental health specialty training in the
care of residents and clients (WAC
388-112A-0450).
(12) Care of clients or residents with
cognitive impairment. A nursing assistant demonstrates basic care of clients or
residents with cognitive impairment. 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 clients or residents with cognitive impairment in a manner
appropriate to their needs.
(c)
Demonstrates sensitivity to the behavior of clients or residents with cognitive
impairment.
(d) Appropriately
responds to the behavior of clients or residents with cognitive
impairment.
