7.3 Legal and Ethical Behavior and Scope of Practice

7.3 Legal and Ethical Behavior and Scope of Practice

Confidentiality

Every resident's health information is protected, and the Health Insurance Portability and Accountability Act (HIPAA) sets the baseline federal privacy standard every nursing facility must follow. In practice, confidentiality means a nurse aide shares resident information only with care team members who need it to provide care, never in hallways, elevators, break rooms, or on social media, even if the resident is not named. A photo posted online that shows a resident's room, face, or other identifying details can violate confidentiality just as clearly as talking about a diagnosis out loud. When in doubt, the rule is simple: if the person asking does not need the information to provide care, do not share it.

Informed Consent and the Nurse Aide's Role

Informed consent — a resident's agreement to a treatment after understanding its risks, benefits, and alternatives — is a formal legal process obtained by a physician or nurse, not by the nurse aide. The aide does not explain the risks and benefits of medical procedures or ask a resident to sign a consent form. However, the aide has a related, everyday responsibility: before performing any task, the aide should tell the resident what is about to happen in simple language, such as "I'm going to help you get dressed now," and get the resident's simple agreement to proceed. This respects the resident's autonomy, reduces fear and confusion, and reinforces the resident's right to refuse discussed in Section 7.2 — if the resident says no to even a basic care task, the aide stops and reports the refusal rather than proceeding anyway.

Professional Boundaries

A nurse aide's relationship with residents and families must stay professional, even when the relationship becomes warm and familiar over time. This means:

• Never accepting gifts, tips, or money from a resident or family member
• Never lending or borrowing money, or doing personal favors outside the assigned caregiving role
• Keeping physical contact within the appropriate, therapeutic context of care
• Not forming personal or romantic relationships with residents or their families
• Referring clinical or care-plan questions from family members to the supervising nurse rather than answering informally

Boundary violations are a common exam trap because the scenario is often framed as kindness — for example, an aide accepting a small cash tip "because the family insisted." A well-meaning intention does not change the fact that accepting the tip crosses a professional boundary.

Honesty and Incident Reporting

Ethical practice requires honesty even when honesty is uncomfortable. If a nurse aide makes a mistake, such as bumping a wheelchair, delivering the wrong resident's tray, or forgetting to lock a wheelchair brake, the correct response is to report it immediately to the supervising nurse rather than hoping no one notices. Documentation must never be falsified, backdated, or written for care that was not actually provided; falsifying a record is both an ethical violation and a legal one.

Ethical Judgment in Gray-Area Situations

Not every situation on the exam has an obvious rule to point to, and part of legal and ethical behavior is knowing when to escalate a judgment call rather than deciding alone. If a nurse aide is unsure whether a task is within scope, whether a resident's request crosses a boundary, or whether something a coworker did should be reported, the safe default is to ask the supervising nurse rather than guess. Hesitating to ask a clarifying question out of fear of looking uncertain is actually a more common exam trap than asking the question, since raising a concern protects the resident and reflects sound professional judgment, while guessing incorrectly can cause real harm.

Nevada Scope of Practice for the Certified Nursing Assistant

In Nevada, nurse aides practice under NRS Chapter 632 ("Nursing"), and every certified nursing assistant works under the supervision of a registered nurse (RN) or licensed practical nurse (LPN). Within that supervised role, a CNA:

• Cannot diagnose a resident's condition
• Cannot prescribe treatment or medication
• Cannot administer medications, with one narrow exception: a nurse aide who completes additional training of approximately 40 hours to become a Medication Aide-Certified (MAC) may administer certain routine medications under specific conditions
• Cannot perform sterile or invasive procedures that require nursing judgment and specialized technique

Staffing pressure never expands a nurse aide's legal scope of practice. If a nurse asks an aide to perform a task outside this scope, even during a short-staffed shift, the correct response is to decline and clearly explain that the task is outside the aide's scope of practice.

Connecting to the Duty to Report

As introduced earlier in this guide, NRS 200.5093 creates a mandatory duty for nurse aides and other caregivers to report suspected abuse, neglect, exploitation, isolation, or abandonment of an older or vulnerable resident, while the separate NRS 632.472 requires reporting a fellow licensee's or certificate holder's professional misconduct to NSBN. Both are concrete examples of the broader legal and ethical behavior domain covered here: just as confidentiality, informed consent basics, and professional boundaries protect a resident's rights and safety, these mandatory reporting duties make protecting residents and the profession a personal, non-delegable legal obligation for every nurse aide. Staying silent or looking the other way is itself a violation, not a neutral choice.