In the United States of America, a Certified Nursing Assistant (CNA) is a skilled person who assists individuals with healthcare needs with activities of daily living (ADLs) and provide bedside care including basic nursing procedures under the supervision of a Registered Nurse (RN) or Licensed Practical Nurse (LPN). The Certified Nursing Assistant also known as  Patient Care Assistant (PCA), State Tested Nurse Aid (STNA) or Nursing Assistant-Registered (NA/R).

In the UK, as in other countries, a CNA might also be called a Nursing Assistant (NA), Auxiliary Nurse (Aux-N), Patient Care Associate (PCA), Nursing Tech (NT), Healthcare Assistant (HCA), Healthcare Support Worker (HSW) or Clinical Support Worker (CSW).

The Nursing Assistant is an important part of the health care team who holds a higher level of experience and ability. Attempts to regulate, control and verify education have been made in some places, and the result is the North American CNA (Certified Nursing Assistant), a credential gained by registering completion of the statuary level of workplace experience and academic achievement with a central Nursing Assistance Certification body. The CNA certification allows an employer to verify the Healthcare Assistant’s  experience and knowledge as well as to assist in preventing individuals who have been “struck off” (had registration/certification invalidated) from continuing to work in healthcare roles. In the UK, the credibility of the and other social care workers is intended to be strengthened by their compulsory registration from 2009 with the General Social Care Council in England or its Scottish or Welsh equivalents.

In today’s health care centers and extended care facilities, a nurse assistant is an important part of a health care team that includes many personnel other than of nurses. Certified Nursing Assistants are needed to provide routine care so that nurses can provide care that only they can perform, as outlined by each state’s Nurse Practice Acts, such as formulating care plans, nursing assessments, administering medication, and assisting in surgery room preparation. The nurse assistant must not only be very skilled in the actual procedures being performed but must also be able to observe a patient’s condition and report that information back to the nurse. Due to other responsibilities, the nurse cannot spend large amounts of time in the room with the patient so the nurse assistant is often referred to as the nurse’s “eyes and ears”.

Common basic tasks for CNA may include any of the following:

Answer patients’ call signals.
Turn and reposition bedridden patients, alone or with assistance, to prevent bedsores.
Observe patients’ conditions, measuring and recording food and liquid intake and output and vital signs, and report changes to professional staff.
Feed patients who are unable to feed themselves.
Provide patients with help walking, exercising, and moving in and out of bed.
Provide patient care by applying dressings and supervising exercise routines.
Prepare patients for surgery, treatment, or examination.
Transport patients to treatment units, using a wheelchair or stretcher.
Clean rooms and change linens.

A CNA must also have a strong grasp of emergency health care procedures and be able to stay calm in stressful medial situations
Unites States Federal nurse aide training regulations are mandated in the Omnibus Budget Reconciliation Act of 1987 (OBRA 1987). State approved training programs must include a minimum of 50 hours of theory and 100 hours of supervised clinical training. Aides who complete the program are known as certified nurse assistants (CNAs) or State Tested Nurse Aid (STNA) and are placed on the State registry of nursing aides. To maintain certification, all nurse aides must complete 48 hours of continuing education every 24 months.

Among the requirements for becoming a state-certified nurse assistant is the mastery of a set of basic skills. These skills are needed to care for patients in both long-term-care facilities and in home settings. The nursing assistant skills descriptions refer mostly to the care of elderly patients, but most of them would apply to any nursing assistant situation.

Nursing Assistants(NA) are normally used in hospital units, but there are some units that do not have NAs. Sometimes in high stress units (CCU, ICU) may not have NAs because of the critical condition of the patients.

Certified Nursing Assistant skills are the set of learned tasks used by nursing assistants in helping residents or patients with activities of daily living (ADLs) and providing bedside care, including basic nursing procedures, under the supervision of a Registered Nurse (RN) or Licensed Practical Nurse (LPN).

• Overview
• Patient Rights
• Universal Precaution
• Ambulation
• Applying antiembolic stockings
• Bedpan use and output measurement
• Oral/Dental care
• Dressing
• Feeding
• Hair care
• Bedmaking
• Nail care
• Bedbath
• Serving water
• Positioning
• Range-of-motion exercises
• Vital signs

Overview
The nurse assistant must not only be very skilled in the actual procedures being performed but must also be able to make quick observations of a patient’s condition and report that information back to the Registered nurse. Due to time constraints, Registered nurses often do not spend large amounts of time in the room with individual patients, the nursing assistant is known as the nurse’s “eyes and ears”.

A nurse assistant must also have a strong grasp of emergency procedures and be able to stay calm in stressful situations. They must be able to initiate a Code Blue and be certified in CPR.

Patient Rights
It is the job of the entire health care team to make sure that a patient’s rights are always adhered to, these include, but are not limited to the right to privacy and dignity while care is being given, the right to be informed of their care plan, the right to be included when making their care plan, the right to accept or refuse treatment, and the right to confidentiality of their patient information.

Universal Precaution
Proper hand washing is an important part of nurse assisting. It is the first step in preventing the spread of germs. Hand washing must be performed both before and after contact with a patient. Hands that do not appear soiled can still spread disease. It is important to wash hands even when using gloves as they do not provide an absolute barrier to the transmission of disease.

Gloves should be worn as needed, such as when exposure to bodily fluids is likely, when perineal or fingernail care is given, or when the patient is infected with a pathogen that is spread by direct contact (such as MRSA).

Ambulation
Ambulation assistance is a set of techniques for helping patients to walk. One example is the use of a gait belt or transfer belt for patients who cannot stand on their own. The gait belt is put around the patient’s waist and enables the assistant to lift the patient safely without straining his or her back. It can be used to help patients get in and out of bed, get up from a chair, or enter a walker.

Walkers help the elderly get exercise. Many elderly patients cannot walk on their own due to osteoporosis or other conditions. Exercise promotes movement, helps with circulation, helps the patient heal faster, be in better health, and ultimately have a longer, happier life.
Applying antiembolic stockings
An antiembolic stocking is a device that is used on patients under observation for (or at risk for) circulation problems. It is a high sock which applies pressure on the legs to prevent blood clots. It may also have a hole on the top or bottom of the foot for comfort, and easy access to the feet, so that the nurse assistant doesn’t need to remove the sock every two hours to check circulation.

Bedpan use and output measurement
A bedpan is a device that is placed under patients who are unable to get up and use a bedside toilet or go to the restroom. It is used to catch all of the urine and feces. The patient must be properly wiped and cleansed after elimination to prevent infection. The color, odor, consistency, and amount of urine is often measured and recorded. If a bowel movement has taken place, that is noted along with any significant characteristics of the stool.

Oral/Dental care
Denture and mouth care is very important in providing proper hygiene for patients. Teeth must be cleaned in the morning and after each meal. This will help prevent tooth decay or gum conditions that could lead to tooth loss. When providing oral care, it is important to check the patient’s teeth, lips, mouth, and tongue for bleeding and discoloration, sores, odor, cracking, or coating, and to report unexpected observations to the nurse immediately.

Dressing
For the dependent patients dressing is not an easy task. In fact it is very difficult and needs to be done properly. The best way to ensure that it is done right is to dress the weak side first so that the patient can help with their strong side, and to undress the strong side first so they can help undress the weak side as much as possible.

Feeding
Patients must not be overassisted in feeding or they may stop helping themselves. Assistance should be confined to those parts of the task they cannot accomplish for themselves. For example, a patient who cannot load a spoon but is capable of conveying it to their mouth should be assisted only in loading the spoon. They should convey it to their mouth themself, even if it would be faster for the assistant to do this for them.

Hair care
Providing hair care will help patients feel good about themselves. Long-term-care facilities may have a salon where residents can have their hair done once a week just as they would at home. Hair must be maintained every day as well. Hair should be brushed from roots to ends, and care should be taken to avoid irritating the patient’s scalp.

Bedmaking
Bedmaking as practiced by a nurse assistant is a skilled task that must be performed precisely. The bed must be wrinkle-free to prevent bedsores, which not only cause discomfort to the patient but can cause serious health problems, and the open end of the pillow case must be facing away from the door to prevent an infection control issue. There are specific bedmaking techniques for use when a bed is occupied by a patient.

Nail care
Nail care is important to ensure that Bacteria do not enter the nail bed and cause serious infections in elderly patients. It is helpful to soak nails for at least five minutes to help loosen dirt and germs that are lodged in nail beds.

Bedbath
Due to lack of staff, patients may only get a full bath once or twice a week; on other days, patients get bedbaths. This involves cleaning the underarms, torso, and perineal areas.

Serving water
Fresh ice water should be offered frequently (at least once every 8 hours) to promote hydration. It is important to encourage drinking, because it is not unusual for elderly patients to be unaware of thirst and thus be easily subject to dehydration.

Positioning
Positioning refers to a set of techniques for changing the posture of a bedridden person in order to avoid health problems such as bedsores. Many states require that bedridden persons be checked and repositioned at intervals of two hours or less.

Range-of-motion exercises
If not exercised, joints gradually lose their ability to move. Nurse assistants must be able to assist patients in performing a series of range-of-motion exercises that flex the joints of their arms, wrists, legs, fingers, hips, and feet. This aids circulation, prevents arthritis and stiffness, and speeds recovery from such conditions as strokes, seizures, and falls.

Vital signs
Vital signs (such as the patient’s temperature, respiration, blood pressure, pulse, and level of pain) are often taken and recorded at least once a day depending on the physician’s order. Increasing temperature can indicate infection or other disorder, decreasing temperature can indicate shock or decreased cardiac output; increasing blood pressure may require medical treatment and special diets while decreasing blood pressure may indicate shock or hemorrhage; and irregular, weak, fast, or slow pulse can indicate heart problems. If a patient’s vital signs have changed significantly within a short period of time, a double check for accuracy may be warranted. Any unusual findings should be brought to the attention of a supervising nurse or doctor.