CNA scope of practice issue on my unit

Nurses General Nursing

Published

Specializes in LTC, PACU, Psych, OB/GYN, ED.

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.

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Specializes in Med/Surg, Ortho, ASC.

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."

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CNA has used "not in my scope of practice and I do not know how to do it".. many times to get out of her duties.

Supervision agrees it IS in her scope, you should not do any further follow up. It is not your place to contact the BON.

The next time CNA refuses your direction... write it up.

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Specializes in SICU, trauma, neuro.

Funny, we changed leg bag to bedside bag every single day when I was a CNA. I agree, she is being insubordinate after several attempts at coaching. You have handled it to the best of your ability...time to let management handle it as a disciplinary issue.

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Specializes in LTC, PACU, Psych, OB/GYN, ED.

Thank you all so much for your responses :) As the charge nurse I do have the authority to discipline & write the CNA up, which I will be doing tomorrow when I see her. Additionally, state BON responded, of course stating CNA's can most certainly change leg bag to bedside bag.

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Specializes in ICU, LTACH, Internal Medicine.

According to my observations, "it is not within my scope of practice" should be read as "I heck do not want to do it, whatever the reason" in like 8 cases out of 10.

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Specializes in LTC, PACU, Psych, OB/GYN, ED.

Oh yes, you are very correct! Haha. What I REALLY wanted to say to her vs what the professional me said are two very different things! ;)

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Thank you all so much for your responses :) As the charge nurse I do have the authority to discipline & write the CNA up, which I will be doing tomorrow when I see her. Additionally, state BON responded, of course stating CNA's can most certainly change leg bag to bedside bag.

I'm curious to hear how she responds. She can't argue with the BON. Will you give us an update?

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Specializes in Psychiatric, Med-Surg.

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

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

What kinda scope is that? You are not even touching the patient.

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

this quite simply is not true. Can you produce a source for you believing this. I can save you time and tell you that you will not find it.

I I did a basic search of the nurse practice act for Florida, and the only thing listed that a CNA cannot do with a catheter is insert a new one, pull an old one, or irrigate it. A CNA is NOT prohibited from merely changing a leg bag. Second, just in case that wasn't clear enough I found a CNA practice exam asking what a CNA should do when asked to change a urinary leg bag if they haven't done it before. The answer was to have the nurse watch the CNA perform this skill for the first time. That, to me, implies it is within a CNA "scope."

CNA's please take the time to understand what you can and cannot do. A CNA can basically perform pretty much any task that does not requires an invasive procedure (read that as inserting something into a patient's body) or advanced knowledge. I can tell you that changing a urinary leg back take minimal skill, no advanced knowledge, and is not invasive. While there may be a state out there that actually doesn't allow for this, I am fairly certain it is no common. More than likely the FACILITY has a restriction and it is not an actually scope issue.

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Specializes in Ortho, CMSRN.

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.

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