Cna packing wounds / stoma powder to wounds

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Hello! I've been a Cna for 4 years, I've worked in ltc, inpatient hospice, then home health hospice for hospital systems. I recently moved back to Virginia and the hospital system I am working home health for now has me concerned. I was out with my preceptor shadowing as part of my orientation, and she was telling me she was going to do a dressing change for a sacral wound. I stated that this is not normally something an aide could do. She told me that as long as the care plan said sterile dressing change, and the nurse come out and you could do it. While I appreciate being trusted with tasks as this, it concerns me that I don't have the training that a nurse has to do it, nor the pay. She was packing the wound, another person she changed the dressing, applied stoma powder (along with pulling off skin from the wound) and applying other medications to them. Debrieding also.

I tried to see if this was in my scope of practice and laws for Virginia and I can't seem to find a list. I just have major concerns that if a wound gets worse it would come back on us, and that these nurses are using us.

Thanks in advance! I plan on getting my RN next year!

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Specializes in critical care, ER,ICU, CVSURG, CCU.

Wow, just wow, the ans. would begin at Virginia BON, crosswalk, on delegation to unliscened assistive personnel.....

i will research it for you......but in general, and my 45 years as RN, this does not appear right

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Specializes in critical care, ER,ICU, CVSURG, CCU.

Ok at Virginia BON website, CNA regulations may be founde at 18vac90-25

this section does cover towards the end delegation from lis nurse, and states task may be preformed that do not use independent nursing judgement......

apparently at 18vac90-25-140, there is advanced CNA program

requires Virginia CNA, 3 years experience, recommended by lis.nurse supervising directly the CNA for 6 months....

to complete advanced CNA training program, that is approved by the BON....

this is programis to be 120 hrs., with Bon approved competency demonstrated.....the advanced CNA can do what is delegated to a more involved care........

however the the rules on delegation by lis nurse still apply

independent nursing judgement task can not be done.....

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No this girl had no additional training. That is all I could find as well. It just didn't feel right.....

Forgive me for asking this but what are the "Rules on delegation by lisenced nurse". Does that mean she can delegate out any task? I found that last night but I couldn't find a good explanation.

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When a CNA was caught practicing nursing without a license at a facility where I worked, the responsible nurse was fired.

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Specializes in critical care, ER,ICU, CVSURG, CCU.

A lis. Nurse may delegate some nursing task, that the nurse knows the unlis.assistive personnel, (CNA, etc) can safely do, that does not require independent nursing judgement...... In Virginia, a simple dressing change, would be alright for a credentialed, advance. CNA...... Wound packing, debriedment, is a task procedure requiring nursing judgement...... I am not giving you legal adviser , simply as a very seasoned RN, intrepid the Virginia Bord of nursing nurse practice act....

Every lis.nurse should be cognizant of the details of their particular states nurse practice act.

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Specializes in critical care, ER,ICU, CVSURG, CCU.
No this girl had no additional training. That is all I could find as well. It just didn't feel right.....

Forgive me for asking this but what are the "Rules on delegation by lisenced nurse". Does that mean she can delegate out any task? I found that last night but I couldn't find a good explanation.

no, delegation of task only permitted, when lis nurse, knows the assistive personnel, can safely preform, and the task does not involve independent nursing (protective class) judgement.....

the delegating nurse is responsible for task delegated, both in my state of Texas and according to Virginia board of nursing.....that delegated task can not involve independent nursing judgement....

no no legal advise implied, just a responsible RN with knowledge of various state nurse practice acts...

best wishes

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Specializes in critical care, ER,ICU, CVSURG, CCU.

sylance, never apologize for seeking clarification , you are "my kind of CNA"... I say that as a compliment

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

In all the facilities where I have ever worked, CNAs could assist the physician or nurse with dressing changes as long as they were not doing the actual wound care.

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