2.2 The Healthcare Team
Key Takeaways
- CNAs are part of an interdisciplinary team; each discipline has a distinct, testable role
- The CNA's direct supervisor is the licensed nurse (RN or LPN/LVN), not the physician
- Chain of command runs CNA → nurse → charge nurse → DON → administrator
- CNAs are the team's 'eyes and ears' because they have the most direct resident contact
- Good reports are objective, specific, and timed; gifts and personal involvement cross professional boundaries
The Interdisciplinary Team
No single professional can meet every resident need, so care is delivered by an interdisciplinary team (also called the interprofessional or multidisciplinary team). Exam questions test which discipline owns which job and how the CNA interacts with each.
| Team Member | Primary Role | How the CNA Interacts |
|---|---|---|
| Registered Nurse (RN) | Assessment, care planning, medications, delegation | Direct supervisor; receives CNA reports |
| Licensed Practical/Vocational Nurse (LPN/LVN) | Medications, treatments, wound care | May supervise CNAs in long-term care |
| Physician (MD/DO) | Diagnosis, treatment orders, prescriptions | CNA reports through the nurse, not directly |
| Nurse Practitioner (NP) / PA | Advanced assessment, orders | Similar to physician |
| Physical Therapist (PT) | Strength, gait, mobility | CNA reinforces ordered exercises/transfers |
| Occupational Therapist (OT) | ADL retraining, fine motor, adaptive devices | CNA encourages learned techniques |
| Speech-Language Pathologist (SLP) | Swallowing, communication | CNA follows feeding/thickened-liquid precautions |
| Registered Dietitian (RD) | Nutrition assessment, therapeutic diets | CNA reports food intake and refusals |
| Social Worker (MSW) | Discharge planning, resources, counseling | CNA relays resident/family concerns |
Key trap: residents and families often ask the CNA medical questions. The CNA reports observations to the nurse, who communicates with the physician — a CNA does not call the doctor directly.
Chain of Command and the CNA's Place
The chain of command is the formal line of authority and communication. Knowing it tells you who to go to when a problem is not resolved.
- CNA — reports to and takes direction from
- LPN/LVN or RN (charge of resident care) — escalates to
- Charge Nurse / Unit Manager — escalates to
- Director of Nursing (DON) — reports to
- Administrator — answers to the
- Governing Board / Owner
Follow the chain in order. If your nurse does not respond to a safety concern, you go to the charge nurse next — not straight to the administrator, and not outside the facility first.
Why the CNA is the "eyes and ears"
CNAs spend more direct time with residents than anyone else on the team, so they:
- Notice subtle changes (less appetite, new confusion, a new bruise) first
- Know each resident's baseline — their normal behavior, skin, and intake
- Catch problems early enough to prevent emergencies
Because of this, a vague report wastes the team's most valuable early-warning system. Reporting is a clinical skill, not just a courtesy.
Reporting Effectively and Holding Professional Boundaries
A strong verbal report to the nurse is objective, specific, and timed. Include:
- Resident name and room number
- What you observed in measurable terms (not opinions)
- When it happened and during what activity
- Change from baseline, with vital signs if relevant
Good report: "Mrs. Smith in 203 has a change. During 8 AM care her left lower leg is swollen and warm, she rates pain 6 of 10, and she is more confused than her baseline. BP 150/92."
Compare that to a weak report: "Mrs. Smith seems off today" — it gives the nurse nothing to act on.
Professional boundaries
| Do | Don't |
|---|---|
| Be warm, caring, and respectful | Become personally/romantically involved |
| Accept a thank-you card or small treat for the unit | Accept cash, tips, or expensive gifts |
| Keep resident information confidential (HIPAA) | Discuss residents in hallways or on social media |
| Treat every resident equally | Play favorites or neglect "difficult" residents |
| Share your work role | Burden residents with your personal problems |
Teamwork scenario
A new CNA is overwhelmed and a resident's call light has been on for ten minutes. The right move is collaboration: answer the light if you are free, then tell the nurse so coverage can be balanced. Effective teams run on respect, open communication, collaboration, flexibility, and accountability.
Communicating Across Barriers and Resolving Conflict
A large share of CNA work is communication, and the exam tests therapeutic communication techniques alongside team roles. Good communication is mostly listening.
| Technique | What It Looks Like | Why It Helps |
|---|---|---|
| Open-ended questions | "Tell me how you're feeling" | Invites the resident to share more |
| Active listening | Face the resident, nod, don't interrupt | Shows respect, catches details |
| Reflecting/paraphrasing | "You're worried about the surgery?" | Confirms you understood |
| Silence | Pause and wait | Gives the resident time to gather thoughts |
| Reassuring presence | Sit, make eye contact | Reduces anxiety |
Avoid communication blockers: changing the subject, false reassurance ("Everything will be fine"), giving advice, or asking "why" questions that sound accusing.
Special communication needs
- Hearing-impaired resident: face them, speak clearly at normal volume (don't shout), reduce background noise, and make sure hearing aids are in and working.
- Vision-impaired resident: announce yourself when entering, explain what you're doing before touching, and keep belongings in the same place.
- Aphasia or post-stroke: use simple words, yes/no questions, gestures, and a communication board; allow extra time.
- Non-English-speaking resident: use the facility's interpreter service, not the resident's child, for medical information.
Conflict on the team
Conflict is normal in busy units. Handle it professionally: address the person directly and privately, focus on the issue rather than personalities, stay calm, and if it affects resident safety, escalate up the chain. Never argue in front of residents or families — it undermines trust in the whole team and is exactly the wrong behavior the exam will flag.
A resident's daughter offers you $50 in cash to 'take extra-good care of Mom.' What is the most appropriate response?
Which discipline's instructions would a CNA follow regarding a resident's thickened-liquid and swallowing precautions?
You report a urgent skin concern to your assigned nurse, who is busy and does not act. Following the chain of command, who do you go to next?