As a member of the health care team, your responsibility includes informing patients and their families of your role on the team. If they need more assistance than you are able to provide, help them to understand who can provide that and get the help they need. Of course, if their need is urgent, all you have to say is, “Let me get the nurse for you.” Later you may have an opportunity to explain the organization to them.

Sometimes patients refer to the aide as their nurse and the R.N. as the treatment or medication nurse. Everyone can help alleviate this situation with a simple correction and by referring to each other by the appropriate title. The intention is to inform the patient and not to mislead them. If the patient doesn't understand your role, she may be frustrated with the care she is receiving. A patient may also make demands that can jeopardize her care as well as cause you professional issues as an employee. This can escalate if there are language and cultural barriers for the patient or the staff. Setting a tone and precedence for using appropriate titles can make an important difference in the quality of patient care.

Misunderstandings about a role or scope of practice can also affect the credibility of the health care worker in the eyes of the patient. This can happen frequently in a setting such as home care where different disciplines visit at different times and even different days. As an example, the patient may have a home health aide (HHA) three times a week and the R.N. visits only monthly for catheter care. The patient is a diabetic and often has questions about something she read or heard on television. The HHA is also a diabetic and feels free to discuss what her physician told her about this. The patient sees her aide as “the nurse” and gives more credence to the information she has shared with the aide. When the R.N. visits, the patient doesn't voice her diabetic concerns because she feels that her needs have been met by “the nurse.” The patient also doesn't understand exactly why someone else comes to change her Foley. No one suspects anything until a supervisory visit is made and the R.N. observes the discussion of the diabetic care during the bath. No harm was done, but the aide was overstepping her scope of practice.

It is not uncommon for a patient to confide more in his aide. The aide often spends more time with the patient and is involved in care that may be more intimate such as bathing and toileting. If you have seen a patient's back side or cleaned up his mess, while helping to protect his dignity, then the patient often feels more comfortable in sharing his concerns and fears. This can be very beneficial as long as the whole team understands the situation and averts potential problems.