CNA Scope of Practice: Overview and FAQ

All nursing professionals must deliver care that aligns with their training and skill level. Not only does this help keep patients safe, but it also preserves the professional integrity of the entire team. Certified nursing assistants (CNAs) in particular must stay within the CNA scope of practice to ensure that they’re meeting appropriate standards of care.

If you’re a facility leader looking to implement protocols that protect patient safety, you may be wondering, what is the scope of practice for a CNA? In this FAQ, we’ll provide an overview of what CNAs are qualified to do, how regulations differ by state, and what can happen if a CNA steps outside of their scope of practice.

What Is the CNA Scope of Practice?

The CNA scope of practice is a regulatory framework that defines what type of care tasks CNAs are authorized to perform based on their level of education and training. Each state has its own set of laws (referred to as Nurse Practice Acts) that includes scope of practice guidelines establishing what CNAs can and cannot do.

In general, a CNA is an entry-level nursing role that supports registered nurses (RNs) and licensed practical nurses (LPNs) on a care team. CNAs typically need to complete a one- to four-month training program and pass a competency exam for certification. Since these requirements are not as extensive as what’s needed to obtain an RN and LPN license, CNAs have a much more restricted scope of practice.

What Can a CNA Do?

The exact scope of practice for a CNA differs by state. However, we can broadly go over which types of tasks CNAs may carry out in their day-to-day work. These tasks typically include:

• Assisting with activities of daily living. CNAs help patients with daily self-care tasks such as eating, bathing, dressing, and other grooming activities.
• Checking and documenting vital signs. CNAs monitor and record vital signs, such as blood pressure and temperature. They can also take blood sugar readings.
• Moving and transporting patients. CNAs help reposition and move patients, such as from a bed to a wheelchair. They also help transport patients to different locations within a care facility.
• Reporting changes in condition. If a CNA observes any drastic changes in a patient’s condition, they should typically report this to their supervising nurse.
• Providing companionship. CNAs spend a lot of time at the bedside, often taking on a caregiver-like role — especially in settings like skilled nursing facilities (SNFs).

What Are Tasks That a CNA Cannot Do?

You may also be wondering what tasks CNAs are specifically prohibited from carrying out. A CNA typically cannot:

• Perform open wound care. While CNAs should report changes in skin condition to a supervising nurse, they’re not trained to assess, treat, or clean an open wound.
• Insert catheters. CNAs can’t insert or remove catheters. They can, however, monitor urine output and empty catheter bags.
• Administer IV injections. CNAs typically aren’t trained to give IV injections or medications. However, in some states they may be able to receive additional training to administer certain types of medications.
• Give tube feedings. While CNAs can deliver and help patients eat meals, they’re not permitted to give tube feedings, as this task requires advanced nursing assessment.

How Does the Scope of Practice for CNAs Differ by State?

Each state’s Nurse Practice Act more specifically defines which tasks can be delegated to a CNA and whether CNAs can receive additional training to expand their scope of practice. For example, under the CNA scope of practice, Texas nursing aides can receive an additional certification to administer medications with supervision. However, Mississippi CNAs don’t have this option, and RNs can only delegate medication administration to other licensed nurses.

What Happens if a CNA Steps Outside of Their Scope of Practice?

If a CNA steps outside of their scope of practice, then they’ve completed a task or duty that they’re not trained or competent to perform. This ultimately compromises care quality and exposes patients to potential harm. Both the CNA and their supervising nurse may be held liable for any damages that occur as a result, and the board of nursing imposes penalties on a case-by-case basis.

To help prevent this, facility leaders should stay informed of their state’s Nurse Practice Act and enforce appropriate care protocols. These protocols should outline basic competency requirements, delegation guidelines, and incident reporting processes that help promote a better culture of safety.

Take Smart Measures to Maintain Compliance

Keeping up with the RN, LPN, and CNA scope of practice is not easy, especially while running a facility. Need reliable and easy-to-access resources? Get dozens of free, expert-written insights on nursing laws, management, and more, delivered straight to your inbox from IntelyCare.

Legal Disclaimer: This article contains general legal information, but it is not intended to constitute professional legal advice for any particular situation and should not be relied on as professional legal advice. Any references to the law may not be current, as laws regularly change through updates in legislation, regulation, and case law at the federal and state level. Nothing in this article should be interpreted as creating an attorney-client relationship. If you have legal questions, you should seek the advice of an attorney licensed to practice in your jurisdiction.