Certified Nurse Aide scope of practice: state-by-state differences in allowable delegated activities

To gain a better understanding of the state-by-state differences in allowable delegated activities for Certified Nurse Aides (CNAs) working in long-term care settings, this exploratory descriptive study assessed what are the allowable tasks for CNAs based on findings from each state board of nursing. Specifically, findings from each state determined whether the care tasks allowed were consistent with those delineated by the 42 CFR § 483.

This descriptive study included data drawn from all 50 states' regulatory offices or health care services agencies. Data were obtained from the regulations listed on each state's board of nursing, department of health, department of aging, department of health professions, department of commerce, and office of long-term care, among like agencies.

The Code of Federal regulations (42 CFR § 483) listed 9 tasks that are allowable by each state. These tasks are identified as items 1 to 9: (1) personal care skills, (2) safety/emergency procedures, (3) basic nursing skills, (4) infection control, (5) communication and interpersonal skills, (6) care of cognitively impaired residents, (7) basic restorative care, (8) mental health and social service needs, and (9) residents' rights.

Nine tasks delineated in the 42 CFR § 483 were identified as allowable in each state. On data analysis, it was found that 11 states noted that CNAs were able to perform workplace tasks that could be considered "expanded" care tasks, tasks beyond the basic care tasks listed in the 42 CFR § 483.

Findings from this exploratory study aid in limiting the confusion around the application of workplace duties across states, providing a useful description of the care tasks CNAs are allowed to perform in an attempt to find uniformity state-by-state. Overall, states reported considering expanding the scope of practice or authorized duties for CNAs to strengthen patient care and safety. States may choose to expand CNA authorized duties so as to equip CNAs with specific training so that the CNA is able to provide a certain level of care when or if he or she is needed to do so. Without uniformity of CNA authorized duties, it is difficult to interpret whether expanding the scope of the CNA can result in outcomes such as improved patient care. State regulations vary and there were state boards of nursing that were not sure about the true extent of CNA workplace responsibilities.