CNA scope of practice issue on my unit

[nurseredd]

I am a LTC charge nurse on a psych/behavioral unit. CNA from another floor was moved to my floor as a regular. One patient has a foley, so she gets a leg bag during the day, then a larger bag at night for bedside. CNA last night refuses to change the bag from leg to bedside, stating it is "not in my scope of practice and I do not know how to do it". I'm big on education, so I told her I would gladly teach her how to do it, but she continued to refuse stating its not in her scope. Ultimately, she did watch me do it, but continued to repeat herself. Now, I've been a nurse for several years and this is the first time I have ever had a CNA tell me changing a foley bag isn't in their scope, this is not a skilled procedure. My supervisor agreed it is in the CNA scope. I have emailed my states BON to get scope clarification as I could not find any reliable information via the internet. Currently I am awaiting a response. CNA is aware I emailed the BON, however, she still is adamant she will not change the bag even if they say she can because "I googled it and google says I can't". Very frustrating!

Nevertheless, any other nurses had this issue with CNAs? Any advice?! I typically have a good rapport with my CNAs and this is honestly the first time I've had an issue like this. I will involve my supervisor if I must, but I prefer to handle things on my unit independently, especially petty issues.

[mrsboots87]

They can't pull an old one? That's different! In Texas they pull them all the time. However, if I have a 3 way with a 30 CC balloon that needs to be pulled, I will get it myself. Better than that than someone causing damage bc they didn't realize it was that full. Not chancing it.

I guess I meant they can't just pull one to put a new one in or whatever.

[Wrench Party]

Why is this even a question?? Of course she can change Foley bags. If she won't do her job, time to fire her and let her go.

[BuckyBadgerRN, ASN, RN]

Are you licensed? You don't have a "scope of practice" unless you are...

In Florida, it's not in our scope of practice.

[ComeTogether, LPN]

It really comes down to your facilities policy. CNAs are able to do anything that doesn't require a nursing licence if it's been delegated to them, but most facilites don't allow more than basic ADL care.

The only issue I see with a CNA changing a leg bag is with sterility, since its super important to ensure the tubing for both bags stay as sterile as possible.

However, as a nurse you're able to delegate whatever you deep appropriate, and if your unit manger agrees the CNA is out of line.

[KRVRN, BSN, RN]

It requires sterile technique, perhaps it is outside the scope.

[BuckyBadgerRN, ASN, RN]

Since when is changing a urinary catheter bag a sterile technique?!

It requires sterile technique, perhaps it is outside the scope.

[RNNPICU, BSN, RN]

Since when is changing a urinary catheter bag a sterile technique?!

Agreed! It sounds like the CNA did not want to do the task or maybe felt uncomfortable with the task. I thought how the OP showed the CNA how it was done was a great teaching point.

[Beautiful_Soul]

Oh plaeezee lol that's a bunch of bull. I was an aide and we change leg bags to beside bags ALL THE TIME! It's a piece of cake, you did exactly what I would've done even as a new nurse that I am...Write her up! People want to come to work and clock in, but not actually work. It doesn't work like that.

[Susie2310]

It really comes down to your facilities policy. CNAs are able to do anything that doesn't require a nursing licence if it's been delegated to them, but most facilites don't allow more than basic ADL care.

The only issue I see with a CNA changing a leg bag is with sterility, since its super important to ensure the tubing for both bags stay as sterile as possible.

However, as a nurse you're able to delegate whatever you deep appropriate, and if your unit manger agrees the CNA is out of line.

Besides coming down to facility policy, it comes down to what activities one's state Board of Registered Nursing permits to be delegated, per the Nurse Practice Act. Patient care activities in my state that can be delegated to CNA's are those that do not require substantial nursing judgement or involve using the Nursing Process, and there are additional criteria that are specified. Invasive procedures are excluded, and a specific list of prohibited procedures and activities that may be delegated is provided in the Nurse Practice Act. I would expect other state Nurse Practice Acts to provide similar direction in regard to delegating to unlicensed assistive personnel (UAP's). Nurses would be wise to read their Nurse Practice Act for specific information on what may and may not be delegated. Also, in my state, the RN is responsible for ascertaining that the UAP is competent to perform the delegated activity correctly/safely.

[Irish_Mist, BSN, RN]

Perhaps this is the cynical part of me but I think this is simply the CNA not wanting to do this particular task. The Board of Nursing is the final authority on this topic and not google. This absolutely sounds like a clear cut case of insubordination. I am glad you have decided to write her up.

[ComeTogether, LPN]

Besides coming down to facility policy, it comes down to what activities one's state Board of Registered Nursing permits to be delegated, per the Nurse Practice Act. Patient care activities in my state that can be delegated to CNA's are those that do not require substantial nursing judgement or involve using the Nursing Process, and there are additional criteria that are specified. Invasive procedures are excluded, and a specific list of prohibited procedures and activities that may be delegated is provided in the Nurse Practice Act. I would expect other state Nurse Practice Acts to provide similar direction in regard to delegating to unlicensed assistive personnel (UAP's). Nurses would be wise to read their Nurse Practice Act for specific information on what may and may not be delegated. Also, in my state, the RN is responsible for ascertaining that the UAP is competent to perform the delegated activity correctly/safely.

Every nurse practice act varies, of course, but this doesn't make what I said untrue.

[mmc51264, BSN, MSN, RN]

I had one tell me emptying an ostomy bag was not in her scope of practice. We have scopes of CNA and CNA II (we have 2 levels of aides in NC) posted in our workroom. If they need help learning a skill, we are more than willing to educate :)