9.4 CNA Scope of Practice

CNA Scope of Practice

Scope of practice is the legally defined boundary of what a CNA may do. Stepping outside it endangers residents and exposes you to loss of certification, civil suits, and criminal charges. Four sources define your scope:

1. State law and regulations for nurse aides.
2. The State Nurse Practice Act, which governs delegation from nurses.
3. Employer (facility) policy, which may be narrower than state law.
4. Your own training and demonstrated competency.

The rule to memorize: a CNA may only do a task that is allowed by all four sources. If any one says no, the answer is no.

What CNAs CAN Do

What CNAs CANNOT Do

State variation matters. Some states certify a CNA II or a medication aide who, with extra training, may do tasks like a finger-stick glucose or pass routine medications. On the exam, the default answer is that medication administration is out of scope unless the question specifies you hold that additional certification.

The Five Rights of Delegation

Because nurses delegate tasks to CNAs, both share responsibility. Before accepting a delegated task, the nurse and CNA verify:

Your Right and Duty to Refuse

You may, and sometimes must, refuse a delegated task when it is outside your scope, beyond your training, unsafe for the resident's condition, or unclear. Refusing is not insubordination when done correctly:

• Be professional and respectful, never combative.
• State the specific concern ("I have not been trained to suction").
• Offer an alternative ("I can get the nurse who is trained").
• Document the refusal if required, and follow the chain of command if unresolved.

Chain of Command

1. Charge nurse / immediate supervisor first.
2. Director of Nursing (DON) if unresolved.
3. Administrator next.
4. State survey agency or licensing board as a last resort for serious safety issues.

Worked Scope Questions

The pattern: assist, observe, measure, and report = yes; administer, assess, and perform invasive/sterile care = no.

Observe and Report vs. Assess

The line between an allowed observation and a prohibited assessment trips up many test-takers. A CNA may observe and report objective data: "the heel is red," "the resident ate 25%," "the blood pressure is 150/92." A CNA may not assess, meaning interpret that data, reach a clinical conclusion, or decide what it means: saying "the resident has a stage 2 pressure ulcer" or "this is a hypertensive crisis" is the nurse's judgment, not the CNA's. Report the finding; let the licensed nurse assess and act.

Negligence and Standard of Care

Working outside scope, or carelessly within it, can constitute negligence, which is the failure to provide the care a reasonably careful CNA would provide in the same situation, resulting in harm. Malpractice is the professional form of negligence. Examples a CNA must avoid include leaving a confused resident unattended on a toilet, ignoring a call light, transferring a resident alone when two-person assist is ordered, or failing to report a change in condition. The standard of care is what a competent CNA with similar training would do; meeting it is your legal shield.

Liability Is Shared but Personal

Under delegation, the nurse is responsible for delegating appropriately and the CNA is responsible for performing competently or refusing. "The nurse told me to" does not excuse a CNA who performs a clearly out-of-scope or unsafe task. Both can be held accountable. This is why the right to refuse is also a duty: accepting a task you are not trained for transfers real legal exposure onto you and endangers the resident. When unsure, the protective move is always to ask, clarify, or escalate before acting.