CNA scope of practice

Mrs. SnowStormRN, RN · May 9, 2011

Pain is considered a vital sign in some facilities, and CNAs usually assess vitals (just not the initial). Check your facilitys protocal and procedure manual to see if a CNA can ask pain level at your hospital.

Bobbkat · May 9, 2011

I was never a CNA, and being a nurse in the NICU our PCA's cannot record any sort of pain value, because the only way to complete it is through assessment and interpretation of patient signs, so this is only a guess (maybe someone more familiar could correct me?)

In the adult world if a patient states 'I have pain of 0/10', wouldn't that be allowed to be charted by a CNA as a vital sign? They wouldn't be able to do anything else with the information, such as interpret or decide on an intervention, but as long as there was no having to guess at facial expressions/crying/etc, wouldn't it be like recording any other vital sign that the RN/LPN has delegated to them to obtain? Again...just guessing.

hkrntobe · May 9, 2011

I was looking at one of my pt charts (paper charting) the other day and noticed one of the CNAs had charted a pain assessment on the flowsheet where they usually chart the vitals. There is a space for this allowing a numerical value. The CNA had charted 0/10. I thought about it later and started to get a bit worked up about it.
From what I remember in school CNAs can not assess pts. What do you all think? How would you approach this without making the person feel too bad?

Depends on the state. D.E. and C.A. they are allowed to (as long as it is permitted by your facility). May I ask if the assessment was inacurate. Was this person from a registry or an employee of the facility? What was it about this scenario exactly that got you "worked up"?

MidnightAzalea · May 9, 2011

I would think that since pain scale is a vital sign, and the only skill necessary is being able to ask "How would you rate your pain on a scale of 0-10" for that particular box on the graphic chart, that it would be fine. I've never worked anywhere that a CNA couldn't document what the client stated their pain scale was.

Neuro Guy NP, DNP, PhD, APRN · May 9, 2011

The PCTs in our facility simply ask if the patient is in pain and have the nurse follow up. They do not chart pain level, though it is a fifth vital sign because the nurse needs to do this in order to assess and interpret the data and give meds PRN. It may depend upon state or facility, though.

canigraduate · May 9, 2011

I work as a CNA and I am required to ask pain level every two hours. If it is over four or the patient asks for pain medicine, I am required to pass that on to the nurse. In my facility, it is considered the same as taking a BP.

k-t-did · May 10, 2011

I have worked two years as a CNA. We do report pain levels to our nurses and are required during hourly rounds to ask pain scale.

juliaann · May 10, 2011

I work as a CNA and I am required to ask pain level every two hours. If it is over four or the patient asks for pain medicine, I am required to pass that on to the nurse. In my facility, it is considered the same as taking a BP.

Exactly the same at my facility. I ask pain level when rounding q2, chart it with my vital signs, and report to the nurse as needed.

sweetnurse63, BSN, RN · May 10, 2011

A cna should be able to tell the nurse that a patient is in pain, but it should be the responsibility of the nurse to assess the pain level because the licensed nurse will be the one to medicate the patient. As a nurse, i want to know more then the pain level, what about the intensity, when did it start, where is the pain, if the patient is alert enough to tell me. Suppose the patient is alert, and tells the cna/pct that his pain is 7/10, the cna records it, then the nurse goes to patient room, lets say in 5 mins and the patient now says the pain is 10/10. I would rather write down my own pain value, because upon assessment, there may be an emergency, that is causing pain, such as, peritonitis or small bowel obstruction or anything. To write down a pain level is out of the scope of practice for a cna or pct in my opinion. I give kudos to all of the great cna/pcts who report pain or any abnormal findings to the nurses they work with which is a vital component of teamwork.

juliaann · May 10, 2011

...Suppose the patient is alert, and tells the cna/pct that his pain is 7/10, the cna records it, then the nurse goes to patient room, lets say in 5 mins and the patient now says the pain is 10/10. I would rather write down my own pain value, because upon assessment, there may be an emergency, that is causing pain, such as, peritonitis or small bowel obstruction or anything.

Why can't you just chart that? Chart, "Pain reported as 7/10 to CNA staff. When patient was assessed by nursing staff/me, patient's pain is now 10/10. _____ Intervention done/med given. Recheck 30 minutes later pain reported as x/10."

Pain scores are just numbers, easily relayed to give quick information about the subjective pain that patient is experiencing at that moment. Pain is the fifth vital sign, and as a CNA it is in my scope of practice to take and record vital signs, reporting anything abnormal to the nurse. It is reasonable for that number to change between reporting to the nurse and the nurse getting to assess the patient (just as pulse and BP and RR may change quickly - it doesn't mean not to record and report the abnormal value at the time it was taken!)...

To me it is no different than an abnormally high or low BP - I record it and report it to the nurse - then the nurse can reassess and treat using nursing judgment.

RNlvn · May 10, 2011

I think it is okay for the CNA in a LTC to ask the patient about pain level if it is clearly written in the Policies and Procedure of the facility. However farther assessment should be done by the nurse legally. It would be different in a hospital setting because the patients are acute and need more assessment.