5.2 Role of the Nurse Aide & the Care Team

The CNA's Scope of Practice and the Care Team

Role and Responsibility is 5 of the 70 knowledge questions and overlaps almost every scenario. The CNA provides direct, hands-on care under the direct supervision of a licensed nurse — a Registered Nurse (RN) or Licensed Practical Nurse (LPN) — and follows the care plan.

Quick Answer: A CNA gathers data and reports it; the nurse turns data into nursing judgment. The CNA does not assess, diagnose, prescribe, or change the plan of care. When in doubt, report to the nurse.

Delegation means the nurse assigns a task; the nurse stays accountable while the CNA is responsible for doing it correctly and within scope. You may — and should — decline an unsafe or out-of-scope task and tell the nurse why.

The broader care team includes the resident and family, the physician, therapists, the dietitian, and the social worker. Because the CNA spends the most hours at the bedside, the CNA's observations feed the team. The chain of command for concerns starts with the supervising nurse — report up rather than skipping the nurse. Never tell a resident a diagnosis, prognosis, or test result; refer those to the nurse.

The Minnesota Skills Test: Format and Scoring

Minnesota's nurse aide competency exam has two parts you must both pass: the Knowledge Test and the Manual Skill Test, administered by D&SDT-Headmaster (Headmaster LLP) through the TMU system. The skills test is scored in person by an RN Test Observer.

• You demonstrate 3 or 4 skill tasks in a maximum of 30 minutes (you are alerted when 15 minutes remain).
• Your test always begins with one mandatory task that has embedded hand washing, then 2-3 randomly selected tasks drawn by the TMU algorithm so every test is comparable in difficulty.
• You must score 80% on each task AND not miss any bolded key step (critical element step) to pass that task.
• Every step must be actually performed — steps that are only verbalized do not count.
• Steps are not order-dependent unless they say BEFORE or AFTER.

The four possible mandatory first tasks are: Perineal Care for a Female; Catheter Care for a Female; Assisting with a Bedpan, Measure and Record Urine Output; or Donning PPE, Emptying a Urinary Drainage Bag, Measure and Record Urine Output and Remove PPE — each with hand washing.

The other 2-3 tasks are drawn from about two dozen skills, such as ambulating with a gait belt, transfer bed-to-wheelchair, range of motion, counting radial pulse and respirations, feeding a dependent resident, modified bed bath, mouth care, foot care, and applying an anti-embolic stocking. Key grading facts: a step that is only verbalized does not count; you may repeat or restart a task within your 30 minutes; and missing a single bolded key (critical element) step fails that task. You cannot ask content questions once the timer starts.

Indirect-Care Critical Steps Scored on Almost Every Skill

A cluster of indirect-care steps appears on nearly every Minnesota skill and is easy to forget under pressure. Burn this begin/end routine into memory:

Beginning of almost every skill:

1. Perform hand hygiene (cover all hand surfaces with sanitizer; rub until fully dry) — or full hand washing where the task specifies it.
2. Explain the procedure to the resident, speaking clearly and maintaining face-to-face contact.
3. Provide for privacy (curtain/door; expose only the area being cared for).
4. Raise the bed height for tasks done at the bedside (body mechanics).

End of almost every skill:

1. Lower the bed if it was raised.
2. Place the call light / signaling device within easy reach of the resident — a near-universal final step.
3. Maintain respectful, courteous interpersonal interactions at all times.
4. Perform hand hygiene again.

Miss the call light, privacy, or hand hygiene and you can fail an otherwise perfect skill. These indirect steps protect dignity, safety, and infection control, which is exactly why graders score them on every task.

Hand Washing — The Always-Tested Skill

A task with embedded hand washing using soap and water is always part of your Minnesota skills test, so master the exact sequence (verified from the Headmaster candidate handbook):

1. Turn on water and wet hands with fingers pointing down.
2. Apply soap and scrub all surfaces for at least 20 seconds.
3. Scrub with fingers interlaced, pointing downward.
4. Clean fingernails by rubbing fingertips against the opposite palm.
5. Rinse fingers, hands, and wrists thoroughly with fingers pointed down.
6. Dry starting at the fingertips, working up to the wrists, with clean paper towels.
7. Discard paper towels as used.
8. Turn off the faucet with a clean, dry paper towel (or a knee/foot control).
9. Do not re-contaminate your hands at any time during the procedure.

Trap: Touching the dirty faucet handle with clean bare hands recontaminates them and breaks a critical infection-control step — using a paper towel (or knee/foot control) to shut off the faucet is scored. Hand washing keeps your hands below your elbows with fingers down so water runs from clean to dirty, off your fingertips into the sink.