Can an LVN assign a CNA to do something outside the CNA's scope of practice???

[ihollie]

A friend of mine is having a problem.

Here is the situation, one of the residents (at the LTC where she works) require high dosage of oxygen and the tank needs to be changed twice a shift. I was always told, as was my friend that only a licensed nurse can turn the oxygen back on and set the flow as this is a medication but the CNA may change the tank. She works both the day and night shift depending on the day. The nurse on day shifts says "oxygen is not really a medication, the flow never changes, it's so simple, of course you can do it." and night shift nurse say "CNA can never do the oxygen it's a medication and out of there scope of practice. I better never see you doing it either"

My friend is very worried licensing will come in and find her doing something wrong and that it will ruin her future career in nursing. I am confused as well. What are the rules on something like this??

[CT Pixie, BSN, RN]

If its not in the CNA's SOP they shouldn't be doing it. Your friend should check with the BON that regulates CNA's in her State to see if CNA's can change the tank/set the flow etc.

Back in the day, when I was a CNA, we couldn't touch the tank or the flow. But like many things, that might have changed too.

[linzz]

Another LPN friend of mine and I had this discussion the other day. We live in Canada so our board of nursing may differ. Recently our board has changed all the delegation rules. In short, certain controlled acts can be delegated, however the person who is delegating the act must be sure that the CNA is competetent to perform this act, safeguards are in place to manage all outcomes and here is the the big one, the licenced member of the board as in RN or LPN is accountable for the decision to delegate. Our board sent us an example: A RN or LPN decides to delegate a dressing change to a CNA, gives the CNA instructions on how to do it, documents this decision, yet the CNA uses the wrong dressing supplies, well apparently the RN or LPN is not to be held responsible for the CNA mistake. My thoughts are that I would be worried about harm coming to the patient and being held responsible despite what the board says. As a new nurse, I am not all that comfortable delegating to CNA's.

[catslave]

An LPN/LVN may delegate to a CNA only those duties within the state CNA scope of practice which may be further limited by the facility of employment and in which the CNA has been trained and demonstrated proficiency in.

Oxygen is considered a medication. A CNA may not regulate the flow but may turn on a preset concentrator or swap tanks where there is a preset regulator attached if the state CNS SOP and facility practice and procedures allows and of course the delegating nurse must be comfortable with this.

Be very careful. Be familiar with your state SOP and your facilities practice and procedure manual. You are responsible for what the CNA's do and do not do.