CNA scope of practice issue on my unit

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.

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

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

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.

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

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

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

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.

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.

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.

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.

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.

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 :)

I am always confused by the use of "CNA scope of practice." It is my understanding that "scope of practice" refers only to one who holds a professional license. At least in my state, CNA's do not hold a license. Perhaps it is different in other states.

I guess what I would do in your place is give the CNA x days to produce said scope of practice to bolster her position. If she can't/won't produce that and continues to decline your delegation, then I think you have a simple matter of refusal to perform her delegated assignment, whatever the ramifications of that would be.

If I, as an RN working on a Med/Surg floor, declined (out of fear of making a mistake) to give IV push medications, and always had to bother others to push meds for me, I couldn't get away with claiming "outside my scope of practice."

"Certified" Nursing Assistant. Yes, CNAs most definitely have a scope of practice. Education on what is in their scope of practice is one of the biggest differences between CNAs and nursing assistants who learn on the job.

We throw the term CNA around a lot and use it as a blanket statement for all nursing assistants. Most in hospitals are just assistants, not certified. Some employers require them to get certified though. This is much more common in LTC (yeah, it goes against the grain of most LTC practices, to require a higher standard) but some hospitals seeking magnet status will require it too.

The theory is, hospitals avoid making their assistants get certified because they (the hospital admin) believe CNA's are more likely to unionize if they are all certified.

Anyway, as far as the CNA of this topic goes: Never try to rationalize with someone whose intention is to misinterpret you.

CNAs will try to be passively insubordinate by throwing out the "It's not in my scope of practice" line when they don't like something. As you found out, whether that is true or not is of no significance to them. They're telling you "no" in a way they feel you can't write up.

I have to agree with Been there, done that on this one. Contacting the BON was not the proper follow up to this CNA challenging you.

I've dealt with this exact issue too many times to beat around the bush with it. Educating and "lifting up our coworkers" is not what this situation calls for. They challenged you to make them do the task, and you either call them out on it or don't. You have to draw the line and make it clear that saying "no" with more words and some technical lingo is still saying "no".

In my experience, the best way to respond is to get clarification first: "To be clear, are you refusing to............(empty the urine cath in your case)" then write it up if they continue with the song and dance.