Key Takeaways
- Scope of practice is defined by state laws, employer policies, and your training
- CNAs cannot give medications, perform sterile procedures, or make nursing assessments
- You have the right to refuse tasks outside your scope or training—do so professionally
- The Five Rights of Delegation guide safe task assignment
- Working outside your scope can result in patient harm, certification loss, and legal consequences
CNA Scope of Practice
Scope of practice defines what a CNA is legally allowed to do. Working outside your scope is dangerous for patients and can result in loss of certification, legal action, and harm to others.
What Is Scope of Practice?
Scope of practice is determined by:
- State laws and regulations
- State Nurse Practice Act
- Employer policies
- CNA training and competency
The scope defines:
- Tasks you CAN perform
- Tasks you CANNOT perform
- Level of supervision required
- Documentation requirements
General CNA Scope of Practice
CNAs Typically CAN:
| Category | Tasks |
|---|---|
| Personal Care | Bathing, grooming, dressing, toileting, oral care |
| Nutrition | Feeding assistance, measuring intake |
| Mobility | Transfers, ambulation, positioning, ROM exercises |
| Vital Signs | Temperature, pulse, respirations, blood pressure |
| Observations | Report changes in condition |
| Communication | Answer call lights, report to nurse |
| Documentation | Record care provided, observations |
| Safety | Fall prevention, infection control |
CNAs Typically CANNOT:
| Category | Prohibited Tasks |
|---|---|
| Medications | Give any medications (oral, injectable, IV, topical) |
| Nursing Assessment | Diagnose, create care plans, make clinical judgments |
| Invasive Procedures | Insert catheters, start IVs, sterile procedures |
| Treatments | Change sterile dressings, suction, tube feedings |
| Medical Advice | Give medical advice to patients or families |
Note: Some states allow CNAs with additional training to perform certain tasks (e.g., finger stick blood glucose). Always know your state's specific rules.
The Five Rights of Delegation
Nurses delegate tasks to CNAs. Both the nurse and CNA have responsibilities:
| Right | Question |
|---|---|
| Right Task | Is this task appropriate for a CNA to perform? |
| Right Circumstance | Is it safe given the patient's condition? |
| Right Person | Is this CNA trained and competent for this task? |
| Right Direction | Are the instructions clear and complete? |
| Right Supervision | Is appropriate supervision available? |
CNA Responsibilities in Delegation
When a Task Is Delegated:
- Make sure you understand the task
- Ask questions if unclear
- Know the expected outcomes
- Know when to report back
- Know what to observe and report
You Have the Right to Refuse if:
- Task is outside your scope of practice
- You have not been trained
- Patient's condition makes it unsafe
- You have concerns about the order
How to Refuse Appropriately:
- Be professional and respectful
- Explain your concern
- Offer alternatives
- Document if needed
- Follow chain of command if unresolved
Chain of Command
When you have concerns, follow the chain of command:
- Charge Nurse / Supervisor - First report to
- Director of Nursing (DON) - If charge nurse doesn't respond
- Administrator - If DON doesn't respond
- State agencies - As a last resort for serious concerns
Working Within Your Scope
To Stay Within Scope:
- Know your state's CNA regulations
- Complete all required training
- Only perform tasks you're trained for
- Ask if unsure
- Refuse tasks outside your scope (professionally)
- Document accurately
Consequences of Working Outside Scope:
- Patient harm
- Loss of certification
- Criminal charges
- Civil lawsuits
- Job termination
- Unable to work as CNA
Common Scope Questions
| Situation | Answer |
|---|---|
| "Can I give a PRN Tylenol?" | NO - Medication administration is outside CNA scope |
| "Can I take a patient off oxygen?" | NO - Only if ordered; usually requires nurse |
| "Can I apply over-the-counter lotion?" | Maybe - Depends on facility policy and if it's in care plan |
| "Can I change a sterile dressing?" | NO - Sterile procedures are nursing tasks |
| "Can I help patient take their own medication?" | Maybe - Depends on state and if patient self-administers |
| "Can I tell family about diagnosis?" | NO - Medical information is nurse/physician responsibility |
Which task is typically OUTSIDE a CNA's scope of practice?
A nurse asks a CNA to perform a task the CNA has not been trained to do. What should the CNA do?
What determines a CNA's scope of practice?