Scope Of Practice For A Certified Nursing Assistant

As the name would imply, a Certified Nursing Assistant or CNA, helps patients and doctors in completing their daily tasks and routine in a hospital. They may do anything from helping a patient get dressed or eat to helping doctors with their administration. They are also responsible for checking vital signs and documenting the care that the patient is getting.

Becoming a CNA means completing a course, either at a college or community college, and then working under a doctor or registered nurse to see to the basic needs of every patient. As a CNA, you will have a lot of duties, some of which may include practical work while others may include administrative work. You need to be prepared though, for just about anything. Whether you attend a community college or a technical school to compete your qualification, there are some skills that you will learn at college and some skills that will need to be based on your common sense.

A really good CNA is able to look at the environment in which they work and determine, intuitively, what needs to be done. This is not easy, especially in a hospital where there is a lot of running around and seeming chaos, but it a good CNA is one that keeps their head in the game and gets the work done.CNA Scope Of Practice

The Working Environment

A CNA may have to work at any time of the day or night depending on the shifts required, but many of them do not work more than a standard 40 hour week. Depending on the environment, a CNA may be called upon to work with just one patient for a few days, such as in a hospital, or with a patient for a few years, such as in a nursing home. They will need to assist patients with walking and dressing, often having to physically exert themselves in instances where the patient cannot.

As a CNA, you may need to care for those who cannot care for themselves, and this means bathing patients, helping them eat, escorting them to the bathroom and helping them get dressed. In some cases, where the patient cannot move at all, the CNA will have to collect the patient’s bedpan and even give them sponge baths. You may have to empty catheter bags, collect specimens and samples and even clean wounds. Basically, any job that qualifies as caring for the patient needs to be done by the CNA and sometimes this is a little grisly, such as when infected wounds need to be bandaged and re-bandaged.

The working environment obviously differs depending on where you choose to work, and some of the workplaces can include: hospitals and short term care centers, long term care centers, prisons and schools and even community centers.

Why Choose To Become A CNA?

A CNA is a specialised worker who has a nursing qualification from a community college. This means that there is not much need for years of study in this field, but for many who cannot afford to go to college, it is a great stepping stone to becoming a Licensed Practicing Nurse or a Registered Nurse. Depending on the state you live in, you may have to complete your qualification and then still do clinical hours to become a CNA, but this depends also on the place you work. The federal government has regulated these hours to an extent.

As a CNA, your scope of practice and responsibilities will not be as much as a registered nurse for example, and the hourly rate of pay will reflect this. This is why so many CNAs choose to work and study at the same time. However, being a CNA comes with its own rewards, not the least of which includes making a big difference to people’s lives. You will find as a CNA that not only will you meet many people, but you will also see many people develop and grow, and this is a reward in itself.

What Is A Scope Of Practice?

The term scope of practice is used to refer to the tasks that a CNA needs to complete on a daily basis in order to do their job. If you know your scope of practice, then you know what to aspire to, which is why so many institutions insist on goal setting sessions for their staff. However, just because you know your scope of practice does not mean you know how to complete the tasks assigned to you. This is why it is vital for a CNA to determine what they should be doing and why.

Knowing your scope of practice will protect both the CNA and their patient, and in some cases, the employer too. If there are any errors on the part of the CNA, the patient is protected based on the scope of work given to the CNA and vice versa. If a CNA does something that is not in their scope of work, the hospital is within their rights to dismiss them or at least issue them with a warning.

The scope of practice for a CNA includes tasks such as:

  • Basic daily patient care – this includes doing all of the things for your patient that they cannot do themselves. These tasks are classified as ADLs or activities of daily living and are called this because they need to be done daily. This includes activities such as bathing, eating and dressing, but also smaller things such as grooming. You may be surprised to see how many patients who are bound to their beds want to do small things to feel normal, such as putting on makeup or attending to their hair.
  • Movement – a CNA will need to assist with bed transfers, mobility and even ambulation depending on the patients they have been assigned to. This does involve special training which those CNAs will receive in their education.
  • Exercises – a CNA may have to, as part of their daily routine, assist patients in exercising, especially when they are bound to their beds. This can include giving Range of Motion exercises that assist them in keeping their blood flowing and their muscles in use, as well as providing massages with the same objectives. They will also learn about skin care for the bedridden as well as the basic anatomy and nutrition requirements.

The scope of work does depend on where the CNA is employed. In a hospital where there are emergency situations constantly, there is a need for CNAs who can cope with the stress and the pressure. In an old age home however, there won’t be any dramatic situations and so the CNA will need to help those in the home with their basic daily activities.

To become proficient as a CNA, you will have to go through training within your workplace, and this training is also something that the falls into the scope of practice. For some CNAs working in specialised facilities, there is a need to complete training so that they can do their jobs better. Some of this training may include:

  • Mental health – dealing with those patients who have mental deficiencies or mental health problems is not the same as dealing with someone who is bed ridden. In this case, the CNA will have to have endless patience to be able to determine what the patient needs and how they can give it to them. In some cases, the patients will be unable to communicate well or at all, and if this is the case, some intuition may be needed.
  • Specialist facilities – a CNA may sometimes work in a hospital or institution where the patients have special needs, such as Parkinson’s Disease or other mobility limiting afflictions. In this case, they need to do all of the daily activities mentioned above, while also assisting the patient with any other activities.
  • Child care – dealing with children is not the same as dealing with adults. In many cases, the children are scared and feeling alone. This means that there is a need to emotionally bond with them, and make them feel more comfortable in the hospital or treatment facility. This is often difficult because of the patience required and the need to communicate on the child’s level.
  • Prison facilities – even in a prison infirmary there is a need for a CNA. This specialist is often allocated the same tasks they would be in a hospital, but they are dealing with criminals, some of whom may be violent or have mental difficulties.

What Does It All Mean?

All things considered, the amount of duties that a CNA has to perform may seem very confusing. To deconstruct this is quite simple though. All of the CNA’s duties will be allocated by the facility they work in. Some of these activities may need to completed daily, while others will be long term duties that need to be carried out once a week or even once a month. The duties based on time limit include:

  • Daily – on a daily basis, you will be expected to provide patient care based on needs. Some of the needs include eating, bathing and dressing, while with other patients, you may need to clean wounds and apply ointments on a daily basis, especially in the cases of burns or infections. Some of these duties may also be administrative, such as updating patient charts on a daily basis and checking for any deviations from the norm, which may include spikes in temperature, bed sores or any other afflictions the patients may be suffering from.
  • Weekly – some of the weekly activities for a CNA include updating charts and giving out immunizations. They can also include clinic work and any other assignments from a registered nurse.
  • Monthly – generally, a CNA will not have many monthly tasks to perform, but they may be asked to assist in stock take, or to help with reordering files and other administrative tasks, all of which are done on a monthly basis.

Some of the duties included here make the work of a CNA sound unappealing, but it is important to remember that with the day-to-day scope of work of a CNA, there is also a long term goal, or a bigger picture. For those CNAs who are willing to do this job, there is a lot of reward in the personal interactions and in seeing people grow and heal. There are also a lot of opportunities for development, and it is easier to become an LPN or RN once you have worked as a CNA.

Part of the scope of work of a CNA will include teaching others, so when you have a few years of experience on the job, expect to take other less experienced staff under your wing.

One thing that cannot be argued is that there is a real need for more CNAs, especially those who can competently do the job. Unfortunately though there is a lot of demand, there is not enough supply. Many who study to become CNAs quickly change careers when they see that the benefits are not as quick in coming as they may have thought. But this is a vital career and for some, a real calling. In many cases, a CNA will stay in their job for many years, based on the rewarding feeling of helping others.

Many CNAs are older and more experienced people who have attended a community college while engaged in another career path. This is because though the work is not easy and the payment is not the best, this is a more rewarding job than they may already hold. In these cases, the transition to becoming a CNA is quite easy, and the rewards may be more than just monetary.

For those who want to enter this field, it is important to note that your first job may not be an easy one. To complete your clinical hours you may be called upon to work in those hospitals that do not have enough resources, but this is all part of the joy of helping others.

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