Scope of Practice for Aides and Nursing Assistants
Know what aides and nursing assistants may and may not do, how delegation works and when to stop and call the nurse.
Table of contents
Scope of practice is the list of tasks you are legally allowed to do. It comes from your state, your training, your employer and the care plan for each person. Staying inside it protects patients from harm and protects you from losing your certification or your job. Saying "that is not something I can do, but I will call the nurse" is a professional answer, not a failure.
What You Will Be Able to Do
- Explain who decides what you are allowed to do.
- Sort common tasks into allowed, allowed only with training and delegation, and not allowed.
- Use the delegation rules to decide whether to accept a task.
- Respond when a patient, a family member or a coworker asks you to go outside your role.
- Know when to stop and call the nurse or 911.
Who Sets the Limits
Four layers decide what you can do, and the strictest one wins.
- Federal rules set minimums for workers in Medicare- and Medicaid-funded care. For example, certified nursing assistants and home health aides in those programs must complete training of at least 75 hours and show competence. Yearly in-service training is required as well. Many states require more.
- State law defines what each role can do, and it varies a lot. A task allowed in one state can be illegal in the next. Medication aides, for instance, exist only in some states and need extra training.
- Your employer can limit you further, through policies and job descriptions.
- The care plan tells you what is ordered for this specific person.
Your title also matters. A personal care aide, a home health aide, a certified nursing assistant and a medication aide all have different limits. Learn the rules for your role in your state, and ask your supervisor if you are unsure.
What Is Usually In and Out of Scope
This table shows the general pattern. Your state and employer have the final say.
| Generally allowed | Only with training, delegation and state approval | Generally not allowed |
|---|---|---|
| Bathing, dressing, toileting, grooming | Blood sugar checks | Giving medication, unless you are a state-approved medication aide |
| Help with eating | Medication reminders or help with self-administration | Filling a pill organizer |
| Help with walking and transfers | Emptying and caring for catheter bags | Inserting or removing a catheter |
| Vital signs, if trained | Simple clean dressing changes | Sterile dressing changes and wound assessment |
| Reporting and documenting observations | Applying some prescribed creams | Changing oxygen flow rates |
| Light housekeeping and meals in a home | Range of motion exercises from the care plan | Giving injections |
| Diagnosing, giving medical advice or changing any order |
Warning: Never adjust a medication, an oxygen setting or a diet order, even if the patient or family insists. Only a licensed provider can change an order.
How Delegation Works
A nurse may delegate a task to you, which means assigning it to you while keeping responsibility for the patient's care. Delegation has limits. Before you accept a task, check these points, which nurses often call the five rights of delegation:
- Right task: Is this a task that can be delegated in your state and setting?
- Right circumstance: Is the patient stable enough for you to do it?
- Right person: Are you trained and competent to do it?
- Right direction: Do you know exactly what to do and what to report?
- Right supervision: Do you know how to reach the nurse if something changes?
You have the right and the duty to speak up if you have not been trained or if something does not look safe. "I have not been trained on that. Can someone show me, or can a nurse do it?" is the correct response.
When Someone Asks You to Do More
Requests to go outside your scope usually come from kind people in a hard spot.
| Request | What to say and do |
|---|---|
| A family member asks you to change a sterile dressing | "That's a nursing task, and I can't do it. I'll call the nurse now." Then call. |
| A patient asks you to give them their medicine | Remind them if that is in the care plan. Do not take it out and put it in their mouth unless your role allows it. |
| A patient asks if they should stop a pill | "I can't advise you on that, but I'll tell the nurse right away." |
| A family member says a nurse "always lets aides do this" | Check with the nurse before you do anything. |
| A coworker asks you to do a task you have not been trained for | Say you have not been trained, and ask the nurse. |
Keep your tone friendly. Explain that the limit protects the patient, and then make the call so the request does not get lost.
When to Stop and Call
Stop what you are doing and call the nurse if:
- The care plan does not cover the task or the situation.
- You are asked to do something you have not been trained to do.
- The person's condition has changed since the plan was written.
- You feel unsafe, or you think the task may harm the patient.
- A piece of equipment is broken or a reading looks wrong.
- You made a mistake, even a small one.
Call 911 first for any life-threatening emergency, then the nurse. Emergency first aid within your training is always allowed.
Common Mistakes
| Mistake | What it costs |
|---|---|
| Doing a task because the family pressured you | Harm to the patient, loss of your certification |
| Assuming a rule from your last state or job applies here | A task that is illegal where you work now |
| Doing a task because "the nurse is busy" | You are responsible for a task you were not allowed to do |
| Not telling the nurse about a request | The real need stays unmet |
| Staying silent because you feel embarrassed about not knowing | A preventable error |
Check Your Understanding
1. A patient's daughter, who is a nurse in another state, tells you to turn up her mother's oxygen. What do you do?
Do not change the setting. Check the patient, call your supervising nurse right away and call 911 if the patient is struggling to breathe.
2. Your new state allows aides to check blood sugar with delegation, but you have never done it. The nurse asks you to start today. What do you do?
Tell the nurse you have not been trained. Accept the task only after you have been shown how and checked for competence.
3. The care plan says the aide reminds a client to take her pills. She asks you to open the bottle and hand her a pill. Is that okay?
It depends on your state and your agency's rules. Check the care plan and your supervisor's instructions. If it is not listed, call the nurse before you help.
4. Who is responsible for making sure you know what you are allowed to do?
You are. Your employer and nurse must direct you, but you must know your role and speak up.
Key Takeaways
- State law, your employer and the care plan decide what you can do, and the strictest limit applies.
- Aides observe, report and help. They do not diagnose, advise or change orders.
- A nurse can delegate only what your state allows, and only if you are trained.
- Speak up when you have not been trained, or when something is unsafe.
- A family request never changes your scope.