CNA Scope of Practice: In-Depth Guide

What does the scope of practice mean? Why is it essential for CNAs to understand the scope of practice? Or How is it helpful for CNAs?

Officially, “scope of practice” refers to the workplace duties and tasks that competent, fully trained healthcare workers are deemed to perform & allowed to engage in. Health workers perform their duties under the terms of their professional certificate or license.

Certified nursing assistants must completely apprehend their scope of practice, ensuring the safest care. Simply put, the scope of practice means sticking to the tasks CNAs are permitted to do or staying in one’s lane (without deviation). Scope of practice covers “What procedures CNAs are authorized to do.”

Each state’s board of nursing or CNA certification registry has documentation with activities falling into the CNA scope of practice. In this article, we’ll discuss tasks permissible for CNAs to perform and why it is crucial to stay on track.

Importance of CNA Scope of Practice

CNAs help the nursing team but within the allowed scope of care responsibilities & duties (under a licensed nurse’s supervision). Most CNAs secure employment in a position involving direct care tasks for the patients.

But if a nursing assistant completes a task outside the documented range of permissible activities, he’ll be held accountable for the patient’s poor outcome. Most CNAs lose their state-issued certification or other severe consequences if found guilty. So staying within the scope of the line is very important.

Competencies & Standard of Practice for CNAs

Competencies & standards of practice for CNAs are statements of knowledge and skills written as descriptions of measurable and observable behavior. A licensed practical nurse/registered nurse supervises and directs all the competencies.

For both nursing assistant-registered & CNA, the following competencies are the standards of practice.

Personal Care Skills

Nursing assistants perform personal care skills while looking after patients. While performing, CNAs can:

• Help the patient with dressing and grooming.
• Help the patients with toileting.
• Assist residents with oral hygiene, dental care, bathing, shaving, and skin care.
• Assist patients with hydration and eating.
• Provide care for hands and feet.
• They can use proper oral feeding techniques.

Basic Technical Skills

A CNA conducts basic technical skills to relieve an optimal level of the patient’s functioning. A CNA can perform the following tasks under this skill.

• Measure & record weight and height.
• Measure & record the input and output of food and fluids.
• Can perform CPR (cardiopulmonary resuscitation) independently and demonstrates proficiency in it.
• Takes & records vital signs.
• They must recognize normal body functions to promptly report any deviation from normal body function to the supervising nurse.
• Recognize and report any problem or change in the patient’s environment to ensure the comfort and safety of the client.
• They can participate in the care planning & nursing reporting process.

Care of Cognitively Impaired Patients

CNAs demonstrate care for cognitively impaired patients or residents. CNAs can:

• Use techniques for addressing the behaviour and unique needs of patients with cognitive impairment, including mental illness, Alzheimer’s, dementia, delirium, developmental disabilities, and other conditions.
• They can communicate with cognitively impaired patients in a manner suitable to their needs.
• Show sensitivity and respond appropriately to the cognitively impaired patient’s behavior.

Social Service Needs & Mental Health

Certified nursing assistants demonstrate the ability to recognize the patient’s psychological needs based upon awareness of age-specific and developmental processes. A certified nursing assistant can:

• Addresses the patient’s individual behavioral needs.
• Provide & reinforce behaviors consistent with patient’s dignity but also allows patients to make personal choices.
• CNA is supportive and sensitive, responds to patients’ emotional needs, and can provide them with emotional support.
• Aware of and can perform the developmental tasks linked with the age-specific and developmental process.

Patient’s Rights & Promotion of Independence

All CNAs must deal with patients separately, keeping their rights in view. They should also consider the opinion of the patient before performing any task. They should promote independence & care for the patients, regardless of religion, race, lifestyle, disease process, or gender. A CNA:

• Recognizes that patient has the right to give their opinion in decisions about their care.
• Respect and promotes the patient’s right to personal choices to accomplish their needs.
• Recognizes & respects the patient’s privacy and confidentiality.
• Help patients participate in activities.
• Respect the employer and patient’s belongings, and don’t take the property, material, supplies, medication, or other things for personal use or benefit.
• Promote the patient’s right to be free from mistreatment, abuse, and neglect.
• Interferes suitably when mistreatment, abuse, or negligence is observed on the patient’s behalf.
• Note and report incidents of neglect, abuse, abandonment, exploitation, etc., to the health department or health and social services department.
• Report patient’s concerns.
• Participates in care plan concerning the use of restraints according to the current professional standards.

Basic Restorative Services

The CNAs incorporate skills and principles in providing restorative care. A CNA can:

• Demonstrate skill and knowledge in using assistive devices in transferring, ambulation, dressing, and eating.
• Demonstrate proper techniques for positioning & turning the patient into a chair and bed.
• Demonstrate skill and knowledge for the care and use of prosthetic devices by patients.
• Show proper techniques for ambulating and transferring patients.
• Demonstrate skill and knowledge in the maintenance of ROM (range of motion).
• Demonstrate methods for meeting the patient’s elimination needs.
• Use essential restorative services by teaching the patient self-care according to the patient’s capabilities.

Infection Control

CNAs use standard & transmission-based precautious measures to avoid the spread of microorganisms. CNAs can:

• Demonstrate knowledge of cleaning agents & methods which destroy germs on surfaces.
• Explain how pathogenic microorganisms spread and transmission of bloodborne pathogens.
• Demonstrate infection control techniques, and use medical asepsis principles and standard transmission-based precautions.

Communication & Interpersonal Skills

CNAs use interpersonal & communication skills to operate effectively as medical team members. A nursing assistant:

• Can explain procedures and policies before & during the care of the patient.
• They should be able to speak, write, read & understand English effectively to perform their duties as CNAs smoothly.
• Listens & responds to nonverbal and verbal communication in a suitable manner.
• Identifies how their conduct impacts the patient’s behavior & uses resources to help comprehend the patient’s behavior.
• Can use health care terminologies to record & report observations & patient information. 
• Can adjust their behavior to accommodate the patient’s mental and physical limitations.
• Appropriately record & report actions, information, and observations accurately & promptly. 

Safety & Emergency Procedures

CNAs display the ability to recognize and implement emergency & safety procedures. A CNA:

• Gives an environment with proper warmth, ventilation, and quiet.
• Recognizes and uses measures for accident prevention.
• Illustrate the correct use of protective devices in the patient’s care.
• Recognizes and exhibits principles of sanitation and health in food service.
• Exhibit the proper use of cleaning agents & other potentially hazardous materials.
• Demonstrate knowledge & follows disaster and fire procedures.
• Promotes a safe, clean and orderly environment, including equipment for patients.
• Demonstrate the fundamentals of good body mechanics for the patient, using the most efficient and safest methods to move and lift clients or heavy items.

Can A CNA Check Blood Sugar?

All nursing assistants are trained to recognize symptoms of diabetic emergencies & also prevent hypoglycemia. CNAs have to make sure that the residents eat every day at the same time & have snacks between meals. CNAs can check the blood sugar of patients & report changes in appetite.

Can CNAs Administer Medication?

CNAs are not allowed to administer medicine in Florida except CNAs can:

• Put ointments, lotions, and creams on the patient’s skin but not on the open area without consulting the doctor or nurse.
• Assist patients with eardrops and nose sprays.
• Assist in oral medication but only in opening the medication container.
• Assist the patients with inhalers (metered dose).
• Help with transdermal medications, i.e., medicine is given to the patient via the skin by a patch.

Certified nursing assistants must remain within their domain and should only do what they are authorized to perform. Doing something out of the scope can adversely affect a patient’s health. If anything happens to a patient, a CNA will be held accountable for their act of exceeding their rights. Knowing the scope of your job is essential to avoid any incident.