CNA scope of practice?

[LoveMyBugs, BSN, CNA, RN]

I am looking for Washingtons States scope of practice for CNA's I have tried looking through the department of health and I only got a little blerb about scope of practice is there is documentation that they can do the task and the task must be delegated by the RN.

I am asking because I am a new(ish?) nurse. I worked as a CNA in Oregon and know Oregons CNA scope but not WA, when I became a RN the only job I could find was in a SNF in Vancouver WA.

The facility where I am at does not allow the CNAs to put dethamecsone cream or the Nystop powder on the residents the nurse must come in and do it at each diaper change.

I have no problem changing people and helping out, but I have 30 residents to pass meds/ assessments and dressing changes on. Plus now I am supposed to run room to room powdering and rubbing cream on them as well:eek: there just isn't enough time in the day.

In addition the some but not all the the CNAs will not get the O2 sats, stating that it too is not in their scope of practice, O2 sat is part of the vital signs (or so I thought) if they can get BPs then reading the number should not be an issue right

I guess I am just feeling very overwhelmed, I feel 30 residents is too much, I have former class mates working across the river with only 15-20, plus a med aide, if they don't change the nursing ratios is it too muc to ask to allow the CNAs to get a full set of vital, and put the cream on? and I know I am dreaming, but the CBG checks would be great.

I feel like I am a culture shock of what I could do in Oregon as a CNA vs what they can not do in WA as a CNA

[Queen Tiye, CNA]

hi lovemybugs,

just this week someone was kind enough to point me to bon website, there, under "rules & regulations" there were guidelines on what duties a nurse can and should not delegate to a cna.

try the washington bon site.

[jb2u, ASN, RN]

You will find what you need here at the Washington State Legislature's website

Also look at RCW 18.79.260 Registered nurse — Activities allowed — Delegation of tasks.

From the Washington State Legislature's website (WAC 246-841-405)....

(5) Nursing assistants shall not accept delegation of, or perform, the following nursing care tasks:

(a) Administration of medication by injection, with the exception of insulin injections;

(b) Sterile procedures;

© Central line maintenance;

(d) Acts that require nursing judgment.

Please note injecting insulin requires additional training/certifications. You must read the whole chapter from the legislature.

[SeattleJess]

NACs can certainly take pulse oximeter readings but only if s/he has a medical assistant endorsement to the basic NAC license. That requires taking a CEU class given by a nurse. I'm looking into work in adult family homes or through home health care agencies and in the process of obtaining one now because administering meds, giving insulin shots and taking all vitals, including pulse ox will be part of the job. The agency employing the NAC usually pays for it because it's not cheap. Maybe that's why your facility is trying to get you to do it; they'd rather not pay $500 or more to qualify your assistants.

As far as the nurse creaming and powdering resident bottoms, all the NACs at both the skilled nursing facility and the hospital where I did my clinical rotations took care of all aspects of pericare. At both facilities perianal care was clearly the responsibility of only the NAC. I did see a nurse step in once to assist a patient to the toilet when the NAC was engaged in other work at the other end of the hall and the nurse happened to be in the room doing a nurse-only procedure when the urge struck; it didn't make sense for her to hand off the patient and wait for the trainee to do it, I guess.

Your facility sounds like it's pinching it's pennies 'til the buffaloes scream. If they treat a nurse that way, I shudder to think what the NAC workload must be.

I hope you are able to talk your facility into empowering your assistants or cutting your patient load or that you find another job. Sounds way stressful and potentially hazardous to the residents.

Of course, I'm still in the process of finding my first NAC job so I may be grossly ignorant. You can't give much weight to my experience and opinion, I guess. In fact, I hope it's not out of line for me to share my opinions and limited experience.

[Jenngirl34RN]

"NACs can certainly take pulse oximeter readings but only if s/he has a medical assistant endorsement to the basic NAC license."

Since when? You do not have to be an MA too. NACs almost always take pulse oximeter as part of the vital signs- you just clip it on the end of the patient's finger. It requires no clinical judgement, is non-invasive, does not fall under "teaching," and is not a medication or sterile procedure- it completely falls within an NAC's scope of practice. If it is not in an NAC's scope of practice than pretty much every NAC at every hospital in the area is in trouble.

[Paws2people]

@SeattleJess... This post is from 2011. Just a heads up to check the original posting dates :-)