Legal and Ethical Behavior

Scope of Practice — Your Legal Boundaries

Scope of practice is the set of tasks a CNA is legally trained and permitted to perform. Staying inside it protects residents and protects your certification. Working outside it — even with good intentions — is illegal and can be grounds for a finding against you on the Connecticut Nurse Aide Registry.

A CNA may: provide personal care (bathing, dressing, grooming, toileting), assist with eating and mobility, measure and record vital signs, observe and report changes, and support residents emotionally.

A CNA may not: diagnose conditions, give or adjust medications independently, insert or remove catheters/tubes, perform sterile procedures, give nursing judgments, accept verbal physician orders, or perform any task not covered by training.

Delegation — Working Under the Nurse

CNAs do not act alone; they work under delegation from a licensed nurse (an RN or LPN). The nurse remains accountable for the outcome, but the CNA is accountable for performing the task correctly and only when it is appropriate.

The five rights of delegation the nurse weighs are: the right task, right circumstance, right person, right direction/communication, and right supervision. As a CNA, your duty is simple: if a delegated task is unsafe, unfamiliar, or outside your training, decline and tell the nurse — do not attempt it. Refusing an inappropriate task is the lawful, protective choice, not insubordination.

Worked example: A nurse asks a CNA to remove a resident's urinary catheter "to save time." The CNA must decline — catheter removal is outside CNA scope — and explain that a nurse must perform it. Saying yes would be practicing beyond scope.

Advance Directives, DNR, and Connecticut's MOLST

Residents have the right to decide in advance what medical care they want at the end of life. These decisions are recorded in advance directives.

• A DNR (Do Not Resuscitate) order means no CPR is started if the heart or breathing stops.
• A DNH (Do Not Hospitalize) order keeps the resident in the facility for comfort care.
• Connecticut uses the MOLST (Medical Orders for Life-Sustaining Treatment) form — the state's version of POLST. A MOLST is a physician- (or APRN-) signed medical order that translates a resident's wishes about CPR, hospitalization, and artificial nutrition into orders any provider, including EMS, must follow.

These documents are legally binding medical orders. If a resident with a valid DNR or MOLST stops breathing, the CNA does not start CPR — the CNA calls for the nurse immediately and follows the order. Honoring the directive is correct care, not neglect. The CNA should always know which residents have a DNR/MOLST and report the directive's existence to the charge nurse.

Ethics, Conflicts of Interest, and Honest Documentation

Professional ethics protect both residents and the CNA. Several lines must never be crossed:

• No tips or gifts. Politely decline a $50 thank-you from a family — accepting personal gifts is a conflict of interest barred by most facility policies.
• Do not witness legal documents for a resident who may lack capacity. If a cognitively impaired resident is asked to sign a consent, refuse to witness and tell the nurse so capacity can be assessed.
• Never falsify records. Charting vital signs you did not take, or care you did not give, is fraud and a form of abuse-enabling neglect.
• Use only your own EHR login. Each CNA documents under unique credentials so that records are accurate and accountable.
• Report, don't fix, a charting error. If you spot a wrong medication time in the record, tell the charge nurse — do not alter the record yourself.

Restraints — A Legal Last Resort

A restraint is any device or drug that restricts a resident's free movement. OBRA and Connecticut DPH allow restraints only under strict conditions: a physician's order, a documented medical safety reason, resident or representative consent, and only after least-restrictive alternatives (sensor alarms, closer supervision, padding, repositioning) have been tried and failed.

Using a restraint for staff convenience or punishment is abuse, full stop. The guiding principle is the least restrictive alternative: always try non-restraint interventions first, and monitor, release, and reassess any ordered restraint frequently. On the exam, the only "appropriate" restraint answer involves a physician order plus documented safety — every "to keep the resident still" or "because we're short-staffed" option is wrong.

Standard Precautions Apply Equally — No Discrimination

Ethical care also means treating every resident the same regardless of diagnosis. A resident known to have HIV/AIDS receives the same Standard Precautions as everyone else — not extra isolation, not avoidance. Singling out a resident because of their condition, or refusing to provide ordinary care, is both unethical and a form of mistreatment.

This principle pairs with cultural and language access. A resident with limited English proficiency who must give informed consent needs a trained medical interpreter provided by the facility — not a family member improvising, and not the CNA guessing. Equal, respectful access to information is part of lawful, ethical care.

Confidentiality Is Both Legal and Ethical

HIPAA makes confidentiality a legal duty, but it is also an ethical one. Only staff with a legitimate, job-related need to know may access a resident's record, and each CNA documents under their own unique login. Sharing a password, charting under someone else's credentials, or browsing a record out of curiosity are violations that can cost a CNA their certification.

Why These Rules Matter for the Exam

The Legal & Ethical domain is only about 3% of scored questions, but its logic — stay in scope, honor directives, document honestly, never exploit a resident — runs through communication, safety, and client-rights items too. When a question offers a tempting shortcut (skip the nurse, accept the gift, alter the record, restrain for convenience), the safe, lawful, resident-centered choice is almost always correct.