Role, Responsibilities, and Scope of Practice

What a CNA Is — and Is Not

A Certified Nurse Aide (CNA) is an unlicensed assistive personnel (UAP): a worker without an independent license who carries out tasks delegated by a licensed nurse. The CNA is the eyes, ears, and hands at the bedside, but the registered nurse (RN) or licensed practical nurse (LPN) holds accountability for the care plan.

For the exam, this single idea explains most "What should the CNA do?" questions: when a task requires assessment, judgment, teaching, or a licensed skill, the correct answer is almost always to report to or ask the nurse, not to act alone.

Within the CNA Scope of Practice

A Connecticut CNA may, when delegated and trained, perform tasks that are routine, with predictable outcomes, and that do not require nursing judgment:

• Assist with Activities of Daily Living (ADLs): bathing, dressing, grooming, toileting, feeding, and mobility.
• Measure and record vital signs: temperature, pulse, respirations, blood pressure, height, weight, and pain rating.
• Provide restorative care: range-of-motion (ROM) exercises, ambulation with a gait/transfer belt, and use of assistive devices.
• Observe and report changes in a resident's condition (skin breakdown, intake/output, behavior, appetite).
• Maintain safety and infection control: hand hygiene, PPE, fall prevention, and a clean environment.

Outside the CNA Scope of Practice

These tasks are reserved for licensed staff and are classic wrong-answer traps:

• Administering medications (oral, topical, injectable, or IV) — even a single Tylenol.
• Performing sterile procedures, inserting/removing catheters, or starting IVs.
• Assessing, diagnosing, or interpreting (deciding a wound is infected, that a resident has a UTI, or that vitals are "normal").
• Creating or changing the care plan, or delegating tasks to others.
• Teaching a resident or family a new skill independently.

Reporting vs. Interpreting

A core distinction: CNAs report objective data; nurses interpret it. Say what you observe — "the resident's urine is cloudy and has a strong odor" — not a conclusion like "the resident has a urinary tract infection." Objective reporting keeps the CNA inside scope and gives the nurse accurate information.

Worked example: A resident's skin over the tailbone is red and does not blanch (turn white) when pressed. The correct CNA action is to report it to the nurse promptly and continue repositioning, not to apply a treatment cream or label it a "Stage 2 ulcer."

The Five Rights of Delegation

When a nurse delegates a task, both the nurse and the CNA rely on the five rights of delegation. The nurse keeps overall accountability; the CNA is responsible for performing the delegated task correctly and for speaking up if it is unsafe.

1. Right Task — a task that is appropriate to delegate (routine, low-judgment).
2. Right Circumstance — the resident's situation is stable enough.
3. Right Person — the CNA is trained and competent for it.
4. Right Direction/Communication — clear, specific instructions are given.
5. Right Supervision — the nurse monitors, evaluates, and follows up.

Exam tip: if any "right" is missing — for example, you were never trained on a device — the correct response is to decline and tell the nurse, not to attempt it. A CNA may always refuse a task that is unsafe or outside their training without it being insubordination.

Legal and Ethical Duties

Connecticut CNAs are mandated reporters. You must report suspected abuse, neglect, or misappropriation — not just confirmed cases — to your charge nurse immediately, and the facility must escalate to DPH. Other duties include protecting confidentiality (HIPAA), honoring residents' rights, documenting accurately and only what you did, and never falsifying records. Acting outside your scope, even with good intentions, can lead to a registry finding and loss of certification.

Accurate Documentation

Documentation is part of the CNA role and is tested under Communication (about 8% of the exam). Three rules to memorize:

• Chart only what you actually did and observed — never pre-chart or chart a coworker's care.
• Record objective, measurable information (e.g., "ate 75% of breakfast," "output 300 mL") rather than vague opinions.
• Correct an error by drawing a single line through it, writing the correction, and initialing — never erase, white-out, or scribble. Late entries are labeled as such.

Falsifying a record — for example, charting that a resident was repositioned when they were not — is a serious offense that can lead to termination and a registry finding.

How Scope Connects to Residents' Rights

Staying inside scope is also how a CNA protects residents' rights under federal OBRA 1987. Residents have the right to refuse care, to privacy and dignity, to be free from abuse and unnecessary restraints, and to self-determination. Forcing care on a resident who refuses is abuse — the correct CNA action is to respect the refusal, offer alternatives, document it, and tell the nurse.

Worked example: a resident refuses a shower. The CNA does not insist or skip bathing silently; instead the CNA offers a partial bath, documents the refusal, and reports it so the care plan can be adjusted. This single scenario ties together scope, rights, communication, and documentation — exactly the kind of integrated question the exam favors.