1.2 Scope of Practice and the Health Care Team

Scope of Practice and the Health Care Team

Quick Answer: A CNA carries out delegated, routine care under a licensed nurse and is the team's eyes and ears: you observe and report changes, but the nurse assesses and decides. You never diagnose, give medications, perform sterile procedures, or take a physician's order.

The Role of the Nurse Aide content area is 26% of the Georgia exam, so scope-of-practice questions are common. The governing principle is delegation: under OBRA '87 and the Georgia Nurse Practice Act, every task a CNA performs is assigned by a licensed nurse — a Registered Nurse (RN) or a Licensed Practical Nurse (LPN) working under an RN's direction. The nurse who delegates stays accountable for the resident's overall care; the CNA is responsible for completing the assigned task correctly and reporting back.

What a CNA May and May Not Do

When a task falls outside your scope, the correct action is always the same: notify the nurse and do not perform it yourself.

Delegation and the Five Rights

Delegation is not random — the nurse must confirm each task is appropriate before handing it to you. The exam expects you to recognize the five rights of delegation, which the nurse applies and which justify your right to refuse an unsafe assignment:

1. Right task — a routine task with a predictable outcome that the law allows a CNA to do.
2. Right circumstance — the resident's condition is stable enough for an aide to handle.
3. Right person — the aide is trained and competent for this specific task.
4. Right direction/communication — clear instructions on what, how, and what to report.
5. Right supervision — the nurse remains available to guide, monitor, and step in.

If an assignment is outside your scope, beyond your training, or unsafe, you may and should decline and explain why to the nurse — refusing is not insubordination, it is patient safety.

The Chain of Command

The CNA fits into a clear reporting structure. Follow it in order, and never skip a level except in the abuse situation noted below:

1. Certified Nursing Assistant (CNA) — reports observations and concerns up the chain.
2. Charge Nurse (LPN/RN) — your first point of contact; delegates tasks and receives your reports.
3. Registered Nurse (RN) / Nurse Manager — assesses, plans, and evaluates care.
4. Physician / Provider — orders treatments and medications.

The one exception: if your supervisor is the suspected abuser, you bypass the chain and report directly to the Georgia DCH, because abuse reporting is mandatory and cannot be blocked by the person involved.

The Aide as a Member of the Interdisciplinary Team

Long-term care is delivered by an interdisciplinary team: nurses, the physician, a dietitian, physical and occupational therapists, a social worker, an activities director, and the nurse aide. Because the CNA spends the most time at the bedside, your observations feed the team's care plan — a written, individualized plan the RN creates and the whole team follows. You do not write the care plan, but you carry it out and report whether it is working.

Example: During morning care, an aide notices a resident is eating only half her meals and seems more tired than usual. The aide cannot diagnose depression or order a diet change — but by reporting these observations to the charge nurse, the aide triggers a team response: the nurse assesses, the dietitian adjusts the meal plan, and the social worker explores the resident's mood. The aide's timely report is what set the whole team in motion.

Professional Boundaries

Maintaining professional boundaries protects both you and the resident. Do not accept money, gifts, or tips; do not share personal contact information or pursue a social or romantic relationship; do not discuss your personal problems with residents; and always protect private health information under HIPAA (Health Insurance Portability and Accountability Act). Crossing these lines can lead to a substantiated finding on the Georgia Nurse Aide Registry.

Time Management and Organization

A CNA may care for many residents at once, so organization is a real skill. Plan your shift around scheduled tasks (meals, vital signs, repositioning every 2 hours), cluster care to limit trips, prioritize safety and urgent needs first, and answer call lights promptly. When you fall behind or a task is unsafe to rush, tell the nurse rather than cutting corners — skipping steps to save time is how errors and injuries happen.