Assigning Care to HCAs the Right Way To assign care to a health care aide (HCA), what do I need to know? • Your primary resource should be “Decision-Making Standards for Nurses in the Supervision of Health Care Aides” (2010). This joint document from the CLPNA, the College and Association of Registered Nurses of Alberta, and the College of Registered Psychiatric Nurses of Alberta ensures all potential risk factors are considered. It was developed to ensure consistent interpretation and application of the Health Professions Act and nursing regulations, and to increase clarity between health care workers and the public.
Describe the kind of care a HCA can provide? • ‘Restricted activities’ where the nurse consents to and supervises the health care aide in performing the restricted activity as authorized in the nursing profession’s regulation under the Health Professions Act. • Those tasks which would normally be considered restricted activities, but which, for a specific client, falls under the definition of ‘activities of daily living’, because they are part of the normal routines of healthy living for that individual. • The provision of care as identified in the competencies outlined in the Health Care Aides Competency Profile (Alberta Health and Wellness, 2001). (Decision- Making Standards, p4)
What are “activities of daily living”? • Routine and invasive self-care activities (ex. removal of slivers and wound cleansing). • Specifically taught procedures, which generally result in predictable and stable responses (ex. catheterization, maintenance of drainage tubes, administration of drugs by injection).
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Who determines whether it’s a ‘restricted activity’ or an ‘activity of daily living’? • “When nursing is being provided, regulated nurses have the authority and responsibility to determine when an invasive procedure is considered a restricted activity and when it is an activity of daily living. That decision determines what can and cannot be done by the health care aide.” (Decision- Making Standards, p3) • The Decision Tree: Restricted Activity or Activity of Daily Living (shown) describes all the considerations to be made when assigning care.
What restricted activities are permitted to be assigned to a HCA? • To insert or remove instruments, devices, fingers or hands. - Beyond the labia majora. - Beyond the anal verge.
What about when HCAs are assisting with medications? • HCAs may be responsible to assist the client with taking non-injectable medications. • It is not appropriate for the HCA to assess clients and then administer PRN medications. Assessment is a nurse’s responsibility. • A formalized medication administration system needs to be in place where HCAs assist with medication administration.
Is there anything else I need to know? • Decision-Making Standards provides further information about employer responsibility, health care aide accountability, managing unsafe situations, and guidance for other care provided by HCAs. • The CLPNA strongly recommends every LPN becomes familiar with and uses Decision-Making Standards in their workplace.