1.2 Scope of Practice, Nursing Delegation & the Healthcare Team
Key Takeaways
Certified nursing assistants function as unlicensed assistive personnel under the direct or indirect supervision of an RN or LPN and cannot practice independently.
The Five Rights of Nursing Delegation (Right Task, Right Circumstances, Right Person, Right Direction/Communication, and Right Supervision/Evaluation) guide all assistive task assignments.
Permitted CNA tasks include measuring vital signs, assisting with ADLs, observing resident condition, safe transfers, and intake/output recording.
Basic CNA training does not authorize medication administration or advanced procedures; specific South Dakota exceptions require additional qualifications, delegation, and supervision.
CNAs serve as vital observational liaisons within an interdisciplinary team comprising nurses, physicians, physical therapists, occupational therapists, speech-language pathologists, dietitians, and social workers.
1.2 Scope of Practice, Nursing Delegation & the Healthcare Team
Operating safely as a certified nursing assistant requires a precise understanding of professional boundaries, the supervisory hierarchy, and the legal principles governing nursing delegation. In South Dakota, nursing assistants perform vital hands-on care, yet function strictly as unlicensed assistive personnel under the supervisory direction of licensed nurses. Recognizing authorized clinical interventions, mastering the Five Rights of Nursing Delegation, knowing when to refuse an assignment, and collaborating within an interdisciplinary team are foundational competencies for safe practice.
Legal Boundaries and Supervision Hierarchy
Under the Administrative Rules of South Dakota (ARSD 20:48), certified nursing assistants function in an assistive role to licensed nurses. The CNA does not hold an independent license, does not practice autonomously, and cannot exercise independent nursing judgment or make clinical diagnoses. Every task performed by a CNA must be assigned, delegated, and supervised by a licensed nurse—either a Registered Nurse (RN) or a Licensed Practical Nurse (LPN).
The delegating nurse retains legal accountability for the overall nursing process, including assessment, care planning, and evaluation of care outcomes. However, the CNA is personally and legally accountable for executing the delegated task. Once a CNA accepts a delegation, they are responsible for performing the task safely, following facility policy, and reporting resident responses or complications back to the supervising nurse immediately.
The Five Rights of Nursing Delegation
The Five Rights are a widely used nursing delegation framework. South Dakota's enforceable requirements are in ARSD 20:48:04.01; the framework helps organize those decisions without replacing the rules. The Five Rights of Nursing Delegation provide a structured decision-making model ensuring resident safety:
- Right Task: The task must recur routinely in daily care, follow an established sequence of steps, require minimal modification between residents, involve no clinical assessment during execution, and carry a predictable outcome.
- Right Circumstances: Delegation must occur in an appropriate setting with adequate resources, equipment, and staffing. The nurse considers the resident's condition and the task's risks. If a condition changes, stop unsafe activity and seek immediate nurse direction; the CNA does not independently decide that the previous delegation remains suitable.
- Right Person: The delegating nurse must verify that the specific nursing assistant has documented competency to perform the task. Concurrently, the CNA must ensure they have received proper training and feel competent to perform the procedure.
- Right Direction and Communication: The nurse must provide clear, concise instructions defining the task objective, resident limitations, completion timeframe, and specific parameters requiring immediate reporting (such as systolic blood pressure below 90 mm Hg).
- Right Supervision and Evaluation: The delegating nurse must monitor performance, remain accessible for guidance, intervene when necessary, evaluate resident outcomes, and verify documentation upon completion.
Refusing a Delegated Task
A CNA has the legal right and ethical duty to decline a delegated task if:
- The task lies outside the legal scope of a CNA under South Dakota law.
- The CNA has not received adequate training or validated competency for that procedure.
- The task requires nursing assessment or independent clinical judgment, or a procedure for which the aide lacks specific legal authorization and verified competency.
- The resident's condition is unstable or deteriorating rapidly.
- Appropriate equipment or protective supplies are unavailable.
When refusing an assignment, the CNA must never abandon the resident. The CNA must communicate with the nurse in private, state the specific reason for refusal respectfully, and offer to perform alternative authorized tasks within their validated scope.
Authorized Assistive Tasks vs. Prohibited Interventions
South Dakota distinguishes basic delegated care from nursing functions and specially authorized tasks. ARSD 20:48:04.01:07 reserves professional assessments, care planning/evaluation, accepting medical orders, and health teaching. Other provisions permit specific exceptions, including qualified medication administration and narrowly defined procedures. CNA registration alone does not establish qualification for an exception.
| Clinical Domain | Permitted CNA Assistive Tasks | Tasks Not Authorized by Basic CNA Training Alone |
|---|---|---|
| Vital Signs & Data | Measuring temperature, pulse, respirations, blood pressure, pulse oximetry, height, and weight | Performing clinical triage, diagnosing arrhythmias, interpreting lung sounds, or writing care plans |
| Personal Care & ADLs | Assisting with bed baths, showers, oral care, denture care, shaving, shampooing, nail care, and dressing | Performing sterile wound care, debridement, sharp diabetic nail trimming, or applying prescription medicated ointments |
| Elimination & Fluids | Assisting with bedpans, urinals, commodes, measuring urinary output, emptying drainage bags, recording fluid intake | Inserting or irrigating catheters without separate authorization/training, breaking closed catheter systems, or administering rectal medication without required medication qualifications |
| Nutrition & Feeding | Assisting stable residents with dining, setting up meal trays, opening containers, cueing swallowing, recording meal intake | Nasogastric feeding, independent decisions about tube placement, or feeding/flush procedures outside the aide's verified authorization and care plan |
| Medications & IVs | Reporting requests for medication assistance to the nurse; following a specifically authorized self-administration plan | Administering oral, topical, injectable, or ophthalmic medications; adjusting IV drip rates; managing IV infusion pumps |
| Clinical Orders | Observing resident behavior, noting complaints, and reporting observations promptly to the nurse | Receiving, taking, or transcribing verbal, telephone, or written physician orders; giving medical advice |
Collaborating with the Interdisciplinary Healthcare Team
Providing holistic, person-centered care requires close coordination among members of the interdisciplinary healthcare team (IDT). The CNA spends more direct time at the resident's bedside than any other professional, serving as the team's vital observational anchor:
- Registered Nurse (RN): Manages the nursing process, performs comprehensive assessments, formulates care plans, coordinates interventions, and administers complex intravenous therapies.
- Licensed Practical Nurse (LPN): Gathers focused assessment data, administers routine medications, delivers standard wound treatments, and directs CNA assignments.
- Attending Physician / Nurse Practitioner (APRN): Diagnoses medical pathology, prescribes medications and diagnostic tests, and directs the overall medical regimen.
- Physical Therapist (PT): Restores gross motor mobility, lower extremity strength, balance, transfer mechanics, and gait training with assistive devices.
- Occupational Therapist (OT): Restores fine motor skills, upper body function, ADL performance (eating, dressing, grooming), and recommends adaptive equipment.
- Speech-Language Pathologist (SLP): Evaluates speech, cognitive communication, and swallowing disorders (dysphagia), recommending individualized food textures and liquid consistencies for the clinical team's orders to reduce aspiration risk.
- Registered Dietitian (RD): Evaluates nutritional status, calculates caloric and fluid requirements, designs therapeutic diets, and oversees meal planning.
- Medical Social Worker (MSW): Coordinates community resources, emotional counseling, advance directives, and discharge planning.
By reporting subtle physical, cognitive, or behavioral changes promptly, the CNA ensures the team addresses potential complications before they escalate into acute emergencies.
South Dakota Exceptions Do Not Expand Every CNA Assignment
The current rules permit selected advanced tasks under specific conditions. Urinary catheterization is an exception to the general sterile-procedure prohibition, but this does not make catheter insertion part of every aide's basic assignment. Tracheostomy care/suctioning and gastrostomy insertion/removal have narrowly defined rules for specific clients in shared living homes. The gastrostomy rule became effective August 3, 2026. These provisions do not authorize an untrained nursing-facility CNA to improvise those procedures. Ask the nurse to verify the applicable rule, setting, resident, training, demonstrated competency, written protocol where required, and supervision before accepting an unfamiliar task. A facility policy cannot override a legal prohibition. An aide also cannot redelegate a nursing task to a coworker.
Sources checked October 16, 2026
South Dakota CNA registry rules; Knowledge handbook (September 2026); Delegation rules.
A CNA with only basic nurse aide training and no additional medication authorization is asked to give scheduled blood pressure medication and eye drops. How should the aide respond?
Administer the oral tablet if the resident is alert, but ask another nurse to administer the eye drops
Perform the task as long as the supervising nurse directly observes the CNA handing the medication to the resident
Check the resident's blood pressure first, and administer the medication only if the reading is within normal limits
Decline and promptly contact the nurse because this aide lacks the required medication qualifications and authorization
Which task is reserved to licensed nursing judgment and cannot be delegated to a CNA?
Formulating the nursing plan of care and evaluating the resident's response
Measuring and recording a resident's radial pulse and blood pressure
Assisting a resident with a bed bath and perineal care
Completing a transfer according to the care plan using required equipment and trained help
During breakfast, a CNA observes that a resident with a history of stroke coughs repeatedly after sipping thin liquids and exhibits a wet, gurgling voice. Which interdisciplinary team member should the nurse consult to evaluate the resident's swallowing safety?
Physical Therapist
Speech-Language Pathologist
Medical Social Worker
Activities Director
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