Scope of Practice
Key Points
- Scope of practice defines which tasks a trained professional can legally and competently perform.
- State rules vary, so CNA task boundaries must be checked in current jurisdiction and facility policy.
- The 4 S check (Scope, Supervision, Safety, Supplies) prevents unsafe or illegal task acceptance.
Pathophysiology
Scope of practice is a legal-governance concept. It protects residents by ensuring care tasks are completed by personnel with appropriate training, oversight, and accountability.
Scope violations increase risk of harm, documentation defects, and legal exposure. Structured delegation checks reduce error likelihood and preserve continuity of safe care.
Classification
- Legal boundary domain: State/federal regulation and licensure-linked task permissions.
- Delegation domain: RN-directed assignment with clear supervision requirements.
- Operational safety domain: Task competency, current skill readiness, and equipment adequacy.
Nursing Assessment
NCLEX Focus
Priority questions ask whether a delegated task should be accepted, clarified, escalated, or refused for safety/legal reasons.
- Verify task is explicitly within CNA legal and facility-approved scope.
- Confirm supervising nurse availability for clarification and escalation.
- Assess personal competency currency for the specific task.
- Check required supplies/PPE/equipment before starting care.
Nursing Interventions
- Apply 4 S pre-task check for every delegated intervention.
- Clarify ambiguous instructions before proceeding.
- Decline or escalate tasks outside scope or without supervision.
- Request retraining before performing infrequent high-risk tasks.
Out-of-Scope Harm Risk
Performing unapproved or unsupervised tasks can cause direct resident harm and professional/legal consequences.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| high-alert-medications | Medication-administration contexts | Medication administration generally remains outside routine CNA scope unless explicitly authorized by state/facility role. |
| insulin | Glycemic-management contexts | Even when assisting with monitoring tasks, escalation must follow licensed-supervision rules. |
Clinical Judgment Application
Clinical Scenario
A CNA is asked to perform an unfamiliar transfer using a mechanical lift without available supervision and with missing sling components.
Recognize Cues: Scope/safety uncertainty, no immediate supervision, and incomplete supplies. Analyze Cues: Proceeding would violate safe delegation standards. Prioritize Hypotheses: Immediate priority is preventing resident and staff injury. Generate Solutions: Pause task, notify RN, gather proper equipment, and request supervised support. Take Action: Resume only after 4 S criteria are fully met. Evaluate Outcomes: Transfer is completed safely without injury.
Related Concepts
- nursing-process - Delegated implementation depends on scope verification.
- ethical-and-legal-responsibilities-of-the-nursing-assistant - Scope adherence is an ethical and legal duty.
- communication-within-the-health-care-team - Clear escalation communication resolves delegation uncertainty.
- safe-patient-transfer - High-risk physical tasks require correct competency and equipment.
- documenting-and-reporting-data - Reporting variance and escalation protects continuity and accountability.
Self-Check
- Which 4 S element is most commonly missed before urgent task execution?
- What should a CNA do if supervision is unavailable for an unclear delegated task?
- Why can an otherwise familiar task become out-of-scope in a specific situation?