The role of Certified Nursing Assistant (CNA) brings with it certain legal and ethical responsibilities that are unique to the medical field. It is important that you know the standards of care set by the government and your facility to ensure that you are both meeting job standards and working within your scope of practice. If you do not perform your job as expected or perform duties you have not been trained to do, you may be liable (legally answerable) for your actions.
In the healthcare setting, there are many types of liabilities. Abuse is willfully physically or mentally harming a patient. Aiding and abetting can be thought of as being an “accomplice” to a crime by either participating in it or knowing about it and failing to report it. For instance, not reporting a CNA who hit a confused patient might make you liable for the crime, even though you did not hit the resident yourself. Assault and battery are legal terms that are often used together. Assault is the threat of violence and battery is the actual offensive touching or use of force on someone. False imprisonment is not allowing the patient to move freely about. An example would be applying wrist restraints to a patient who does not have a doctor’s order for such restraints. Invasion of privacy deals with the failure to keep a patient’s information confidential. The Health Insurance Portability and Accountability Act (HIPAA) is an important law to know for anyone that works in the healthcare field. Sharing “individually identifiable health information” with someone who is not directly responsible for caring for the patient may lead to job termination or legal action. Being cognizant of patient privacy laws at all times is important because, unlike willfully harmful actions such as assault or battery, HIPAA violations are not always obviously “bad.” For example, sharing with your grandmother that you took care of her friend Mary after her knee surgery and that she’s doing well may not be a maleficent act on the surface, but it would likely be considered a violation of Mary’s HIPAA rights in the court of law. Neglect and negligence can be used almost interchangeably. Being found negligent or neglectful in a healthcare context means that you either omitted care or failed to perform it correctly, and patient harm or injury was the result. Finally, theft, or stealing, is taking something that does not belong to you.
The American Hospital Association created “A Patient’s Bill of Rights” in 1973. A “Resident’s Bill of Rights” was created soon after to include additional rights for those living in a long-term care setting. Because many CNA’s practice in such settings, it is important to know the rights found in each bill and what they mean for your job. The bill states that every resident has the right to know what they are being charged, to know about their medical condition, to participate in their own plan of care, to control their own finances and wear their own clothes, to be free of abuse and restraints, and to expect privacy and respect, among other things. While it is important to follow these rules, it is also important to remember to do so within your scope of practice. For example, the patient has the right to know about his medical condition, but as a CNA you should not be the one to answer questions about a cancer diagnosis; that is the doctor’s job. In this instance, your responsibility would be to go through the appropriate channels to ensure the patient is able to talk with his doctor about his questions.
Ethics are a trickier subject as we all have our own ideas of good and bad and right and wrong. In the healthcare field, many facilities and professional groups have a published code of ethics that can help guide one in ethical decision-making. Generally speaking, you should always operate with the principles of beneficence and nonmaleficence in mind. Beneficence is doing good for others, and nonmaleficence is doing no harm. When issues that are ethically complex or have more than one solution arise, it is best to consult with a supervisor or other health professionals to come to a good resolution.