What Not to Do as A CNA: A Comprehensive Guide

Certified nursing assistants (healthcare workers) are regarded as the backbone of nursing. CNAs are more limited within their scope of practice, i.e., duties they’re allowed to perform legally under the laws. Wondering what tasks/duties a CNA can’t perform?

Many tasks/duties are out of CNA’s scope, including diagnosis & medicine prescription, medicine administration, blood draws, dealing with oxygen tanks, changing the sterile dressing, tube feeding, catheter insertion, injections/shots preparation & administration, irrigating body cavities, bowel evacuation, invasive procedures, and complex or open wound care.

Besides federal laws, two other factors determine the scope of a CNA:

• State laws
• Rules & regulations of the workplace

The CNAs working in some states may be authorized to venipuncture or medicine administration in assisted living environments. While CNAs in other states may not perform such duties, i.e., they may only supervise or monitor patients. This article will discuss all the tasks/responsibilities a CNA is not authorized to do. Let’s discover duties/tasks out of the scope of a CNA.

Out-of-Scope Tasks

A certified nursing assistant works under the direction of a vocational nurse, a registered nurse, or an LPN. Depending upon healthcare or facility practice. CNAs provide primary patient care & assist in many activities of daily life (ADLs). These duties include bathing, dressing, grooming, turning, transferring patients, helping with walking, toileting, taking vital signs, etc.

The following duties aren’t within the scope of a CNA:

Medication Administration

It’s not the CNA’s scope of practice to administer medication. Only RN (registered nurse) or LPN (licensed practical nurse) is authorized to handle medication. Only CNAs with additional medication training are allowed to give some medicines, including otic (ear), optic (eye), topical (dermal-skin), or nasal (nose) types of medications under LPN or RN supervision. But CNAs aren’t allowed to give

• Urethral medication
• Vaginal medication
• Rectal medication
• Nebulizer treatment

High-Alert Medication

Only nurses(healthcare professionals) are also allowed to administer high-alert medications. CNAs are prohibited to avoid any complications. High-alert medication includes:

• Insulin
• Anticoagulants (blood thinner)
• Narcotics
• Sedatives

Diagnosis & Medicine Prescription

CNAs aren’t allowed to diagnose or prescribe patients medicines. For instance, if a patient says they have a headache, you shouldn’t specify them to take paracetamol. You’d inform the RN/LPN & they would determine if the patient is allowed it or not by checking the drug chart.

As a CNA, to comfort the patients, you can only ask them to lie down, bring them water, or open a window.

Oxygen Tanks

Whether in aged care, hospital, or home-based, handling oxygen tanks is out of your scope of practice. Oxygen is regarded as medication. CNAs aren’t allowed to regulate the flow of oxygen.

But they can swap tanks or turn on a preset concentrator (where a preset regulator is attached) only if facility procedures & practice and state CNA SOP allow. You can only position a Hudson mask or nasal prongs on your patient, but only when the oxygen is off. You can do this if the delegating nurse is comfortable with it.

Injections/shots preparation and administration

Legally, CNAs aren’t authorized to prepare or give IV or intramuscular injections or shots. Assisting patients to fill/organize insulin needles even on the patient’s demand is also prohibited. LPN or RN can give heparin or insulin; it sometimes requires two nurses as a safety check.

Venipuncture

Venipuncture is drawing blood from a vein using a needle for a laboratory test. Venipuncture is not the core function of CNAs. At the start of their career, CNAs can’t draw blood. But if they pass & complete further phlebotomy training classes, they’re allowed to venipuncture legally. However, only some states allow it.

Complex Wound Care

CNAs do not do complex or open wound care. Only RNs have skills/knowledge type, wound depth & treatment, and negative or positive changes. However, RNs depend on the CNA to promptly report patient skin changes if seen during toileting, dressing, or showering.

CNAs with proper wound care training can handle uncomplicated wounds like 1-degree burns, stage 1 pressure sores, etc.

Catheter Insertion

Catheter insertion means inserting a small tube in the patient’s body to remove the urine from the bladder into a plastic bag outside the body. Mostly, the tube is inserted through a small hole in the patient’s body or urethra.

CNAs aren’t allowed to insert or remove catheters. RNs are responsible for ensuring the patient’s safety during removals or insertions of catheters. CNAs can monitor fluid output and intake from urinary catheter bags & empty them when full.

In Florida, not all but only properly trained CNAs are allowed to insert intermittent or Foley catheters.

Tube Feeding

Those residents who cannot get essential nutrition through eating are subjected to tube feeding therapy. In this treatment, a flexible tube is inserted into the patient through the belly or nose. This tube provides liquid nutrition directly into the small intestine or stomach.

CNAs aren’t allowed to do this delicate job. Only RNs are allowed to do tube feeding. Accurate nursing assessment skills are necessary for this job that nurses are taught. 

Bowel Evacuation

This treatment is for non-reflex bowel patients. The stool is extracted by softly inserting a finger into the patient’s rectum.

CNAs can’t do this task as it is hazardous; only RNs can attempt bowel evacuation measures. There is a chance of a vaso-vagal response during this process that can trigger a stroke or may cause the resident to pass out.

Changing Sterile Dressing

Only RNs or LPNs can change the sterile dressing. CNAs are only allowed to change a non-sterile bandage. It is regarded as skilled nursing care if a patient requests help and the doctor’s order needs a sterile dressing. It requires both a script from an LPN or higher and a physician.

Irrigating Body Cavities

As a nursing assistant, you’re prohibited from irrigating body cavities like:

• Enema
• Irrigating a wound
• Irrigating a colostomy
• Gastric irrigation or gastric lavage

Can A CNA Suction a Patient?

Suctioning is a technique of removing /clearing mucous from the lungs. Patients with brain or spinal cord injury may have breathing problems due to congestion. Suctioning will alleviate the patient’s airway.

Oral or any other kind of suctioning is a nurse’s duty (a nursing function) and can only be performed by a nurse because nurses are trained to do so in nursing school. It is out of CAN’s scope of practice.

Can A CNA Perform Any Invasive Procedures?

In invasive procedures, access to the patient’s body is gained through the percutaneous puncture, incision, or natural orifice, where instrumentation is used. Only nurses are allowed to do; a CNA can’t perform any invasive procedures like:

• Taking rectal temperatures
• Removing or checking for fecal impactions
• Administering rectal or vaginal installations
• Installation of any fluids
• Enema

What Are CNAs Prohibited to Do?

CNAs must stick to their state’s guidelines for CNA care. Generally, CNAs shouldn’t do any task or thing considered dangerous, invasive, or neglectful. Going out of practice can put your job at stake, or the nursing board may cancel your license.

Your “State CNA registry” can better guide you on what you can’t or can do as a certified nursing assistant in your area.