6.3 Legal, Ethical Scope & the Care Team

The SRNA Scope of Practice

Every Kentucky SRNA works under the supervision of a licensed nurse (LPN or RN) within a legal scope of practice defined by 907 KAR 1:450 and enforced by the Kentucky Board of Nursing (KBN). Staying inside that scope is both a safety issue and a legal one, and it is one of the most heavily tested ideas in the Role domain.

What the SRNA MAY and MAY NOT Do

The SRNA observes and reports; the nurse assesses, diagnoses, and treats. Noticing white patches in a resident's mouth is your role; deciding it is thrush and starting an antifungal is not. Even an SRNA enrolled in nursing school does not gain an expanded work scope — performing an out-of-scope task on the job, even with a supervisor's verbal 'okay,' is practicing nursing without a license.

Delegation & Working Under the Nurse

Delegation is the nurse transferring the authority to perform a specific task to an SRNA who is competent to do it. The five rights of delegation (right task, right circumstance, right person, right direction, right supervision) guide the nurse. Your responsibilities:

• Accept only tasks you have been trained and are competent to perform.
• If a task is unfamiliar or unsafe, politely decline and ask for training, supervision, or reassignment — do not attempt it and hope for the best.
• Accountability is shared: you are responsible for performing a delegated task correctly, and the nurse is responsible for delegating it appropriately. If care goes wrong, both can be disciplined.

Ethical & Professional Behavior and Boundaries

Professional conduct protects residents and your certification. Core expectations:

• Honesty and integrity — never falsify records or time sheets. Clocking out for a coworker or documenting care not given is fraud and can trigger a KBN investigation and registry removal.
• Professional boundaries — the relationship is therapeutic, not personal. Do not accept cash gifts, lend or borrow money, or become the beneficiary of a resident's will.
• Conscientious objection — if a care situation conflicts with sincere personal or religious beliefs, tell your supervisor in advance so another aide can be assigned; never abandon a resident who needs emergency care.
• Cooperation with surveyors — when a CHFS surveyor asks about care, answer honestly and accurately about your own work; false statements to a surveyor carry personal sanctions.

The Interdisciplinary Care Team

SRNAs are indispensable members of a larger team and spend more direct time with residents than anyone else, which makes their observations vital. The team includes the RN/LPN (assessment, medications, care planning), the physician or advanced practice provider (orders and diagnosis), the registered dietitian (nutrition), physical, occupational, and speech therapists (restorative care and swallowing), the social worker (rights, finances, discharge planning), and the Long-Term Care Ombudsman as an outside advocate. When a family member or resident asks a question beyond your scope, refer them to the appropriate team member rather than guessing.

The Kentucky Nurse Aide Registry & Maintaining Certification

Three agencies with distinct roles are commonly confused on the exam:

• KBN (Kentucky Board of Nursing) — maintains the Kentucky Nurse Aide Registry and processes renewals and findings.
• KCTCS (Kentucky Community and Technical College System) — the sole provider that administers the written and skills competency exam.
• CHFS (Cabinet for Health and Family Services) — licenses, regulates, and inspects nursing facilities and runs Adult Protective Services.

After you pass both exam parts, KCTCS notifies the KBN, and your name is added to the registry within about 30 days; physical SRNA cards are no longer issued, so employers verify status through the KBN Nurse Portal. Renewal every 24 months requires proof of at least 8 paid hours of nursing or nursing-related work — a pay stub, a W-2, or a notarized employer letter — with no continuing-education hours required. Candidates get 3 attempts to pass within one year of completing training (or within a 4-month initial employment period if an employer hired them before certification); failing all attempts or letting the year lapse means repeating the full 75-hour program. A registry finding of abuse, neglect, or misappropriation bars employment in any Medicare/Medicaid facility nationwide.

Negligence & Liability Basics

Negligence is failing to provide the care a reasonably careful SRNA would provide, causing harm — for example, leaving the side rail down when the care plan requires it and the resident falls. Malpractice is professional negligence. Battery is unlawful touching without consent, such as forcing care on a refusing resident; assault is the threat of it. False imprisonment includes improper restraint. Working within scope, following the care plan, and reporting promptly are your best protection against liability.

Remember the practical chain of command for a safety or quality concern: raise it with the charge nurse first, then the Director of Nursing and Administrator if it is unresolved, and finally CHFS or the Ombudsman for a serious unaddressed problem. Kentucky whistleblower protections shield an SRNA who reports a legitimate concern in good faith from employer retaliation, so escalating an unsafe situation the right way is part of professional practice, not a risk to your job.