Ever feel that pressure during a chaotic shift, wondering if you can legally ask a CNA to help with “just one more thing”? You’re not alone. Understanding what can be delegated to a CNA is one of the most high-stakes challenges in nursing. A wrong decision doesn’t just affect workflow; it impacts patient safety, your license, and the entire care team’s well-being.
This guide is your definitive resource for navigating delegation with confidence and clarity. We’ll cut through the confusion and provide a clear framework based on legal standards and best practices. Get ready to build a stronger, safer, and more collaborative team.
The Legal Foundation of Delegation
Before we list specific tasks, we need to understand the “why” behind the rules. Delegation isn’t just about offloading work; it’s a defined nursing skill governed by law and professional ethics. The foundation rests on your state’s Nurse Practice Act, which outlines the scope of nursing practice and what can be delegated.
The core principle is that while you can delegate a task, you can never delegate your ultimate responsibility for the patient’s care. The RN is always accountable for the outcome.
This is where the Five Rights of Delegation become your daily safety net. Before you assign any task, run it through this mental checklist:
- The Right Task: Is this task allowed to be delegated? Does it involve assessment, evaluation, or nursing judgment? If yes, the answer is no.
- The Right Circumstance: Is the patient stable? Does the current situation on the unit allow for safe delegation and supervision?
- The Right Person: Does the CNA have the appropriate training, competency, and certification to perform this task for this specific patient?
- The Right Direction and Communication: Have you provided clear, concise instructions? Does the CNA know what to do, who to report to, and what to watch for?
- The Right Supervision and Evaluation: Are you available to supervise and follow up? Will you check on the patient and the task’s outcome in a timely manner?
Clinical Pearl: The biggest delegation mistake is confusing a procedure with a judgment. You can delegate the CNA to obtain a blood pressure (the procedure), but you cannot delegate the CNA to interpret the blood pressure and determine if it’s an early sign of shock (the judgment).
What CAN Be Delegated to a CNA? A Comprehensive List
Delegating appropriate tasks is the key to an efficient care team. When done correctly, it frees you to focus on complex assessments and critical thinking. Here is a categorized breakdown of tasks that safely fall within the cna scope of practice.
Activities of Daily Living (ADLs)
These are the cornerstone of the CNA role and are almost always appropriate for delegation.
- Assisting with bathing (bed bath, shower, or tub)
- Providing perineal care
- Assisting with oral hygiene
- Helping with dressing and grooming
- Providing toileting assistance, including using a bedpan or commode
- Skin care, including turning and repositioning patients every two hours
Vital Signs and Basic Monitoring
CNAs are trained to collect objective data—but never to interpret it.
- Measuring and recording blood pressure, heart rate, respiratory rate, and temperature
- Measuring patient height and weight
- Measuring intake and output (I&Os)
- Collecting a urine specimen, a stool specimen, or a sputum specimen
- Performing point-of-care glucose testing if the CNA has been specifically trained and certified in that procedure by the facility.
Mobility and Ambulation
Safe patient handling is a critical, delegable function.
- Assisting patients with walking, transferring from bed to chair, and using proper assistive devices (walkers, canes)
- Performing range-of-motion exercises (ROM)
- Applying anti-embolism stockings (TED hose) as per physician’s order and facility policy
Nutrition and Hydration
- Assisting patients with meals, including feeding patients who cannot feed themselves
- Passing fresh water and ice
- Distributing between-meal snacks
Patient Comfort and Environment
- Making an unoccupied or occupied bed
- Answering patient call lights and relaying information to the nurse
- Performing post-mortem care
Pro Tip: Create a unit-specific “task sheet” or reference card with your manager that lists exactly which tasks your facility delegates to CNAs, like glucose testing or EKG leads. This eliminates ambiguity for everyone on the team.
The Red Lines: What CANNOT Be Delegated to a CNA
Here’s the reality: there are firm legal and professional boundaries. Crossing these lines puts patients at risk and your license in jeopardy. These tasks require the advanced assessment, critical thinking, and specialized skills of a licensed nurse.
- Medication and IV Management: This is an absolute non-starter. It includes administering oral medications, giving injections, mixing IV medications, hanging IV bags, changing IV tubing, or managing IV pumps. The CNA should never even crush a pill. The only exception is a patient self-administering their own medication, where a CNA can remind them, but not give it.
- Sterile Procedures: Any task that requires a sterile field. This includes changing a sterile dressing, inserting a urinary catheter, or suctioning an airway (except in some very specific, state-approved emergency situations).
- Assessment and Evaluation: You cannot delegate the initial admission assessment, a focused physical assessment, or the ongoing evaluation of a patient’s condition. When a CNA says, “Mrs. Smith’s incision looks red,” you must go assess it yourself. The CNA can observe, you must evaluate.
- Care Planning and Teaching: Creating the nursing care plan, modifying goals, or teaching patients and families about their condition or medications are core nursing functions.
- Invasive Procedures: Anything that breaks the skin barrier beyond a simple fingerstick (if certified for glucose). Inserting NG tubes, changing tracheostomy tubes, or managing central lines are RN/LPN tasks.
- Tasks requiring independent nursing judgment: This is the catch-all that protects patient safety. If the situation is complex, the patient is unstable, or the outcome is unpredictable, the task belongs to you.
Common Mistake: A nurse is busy and asks a CNA, “Can you go check on Mr. Jones in room 204? His BP was a little low last time.” The CNA goes, finds Mr. Jones confused and pale, and reports back. This is inappropriate delegation. The nurse should have said, “Please take Mr. Jones’s blood pressure and heart rate and report the numbers to me immediately.” Framing the request as data collection, not assessment, is critical.
Special Situations and Grey Areas
Healthcare is rarely black and white. How do you handle those in-between moments? It comes down to communication, competency, and safety. If you are ever in doubt, the safest answer is to err on the side of caution and perform the task yourself.
Emergencies: In a Code Blue or similar emergency, everyone’s role can shift based on training, presence, and direction from the team leader. A CNA may be asked to fetch supplies, perform compressions (if certified), or assist with movement. However, this is directed emergency response, not routine delegation. The nurse leading the code remains responsible.
Ambiguous Tasks: What if a task isn’t on a list of Can or Cannot Do? That’s where your “Five Rights” come into play. Critically analyze the task for the “Right Task” and “Right Circumstance.”
The CNA’s Right to Refuse: A CNA has the right—and the professional responsibility—to refuse a delegated task if they have not been trained to perform it, they feel it’s unsafe for the patient, or they know it violates facility policy or state regulations. As the nurse, you must respect this. A refusal isn’t insubordination; it’s a commitment to safety. Your job is to find an alternative, safe solution.
Pro Tip: If you have to pause and wonder, “Hmm, should I be delegating this?”, the answer is probably no. That moment of hesitation is your professional judgment signaling a potential risk. Honor that instinct.
Real-World Scenarios: Delegation in Practice
Let’s see how these principles work in the real world.
Scenario 1: Successful Delegation
It’s 7 AM. RN Sarah has a patient, Mrs. Gable, recovering from hip replacement surgery who needs to get out of bed for the first time.
- Delegation: “Good morning, Alex. Mrs. Gable in 205 is cleared to get up to the chair with assistance using her walker. Can you please help her with that? I need you to get two people to help for safety. Once she’s up, please report if she has any dizziness, pain, or shortness of breath. I’ll be in to check on her in about 20 minutes.”
- Analysis: Sarah’s delegation was perfect. She specified the right task (transfer with walker), the right person (Alex, the CNA), and provided clear direction (two people for safety, specific symptoms to watch for). She also established the right supervision by planning to follow up.
Scenario 2: A Delegation Disaster
RN David is overwhelmed. A diabetic patient, Mr. Henderson, has a blood sugar of 65 and is awake but sleepy. David asks a CNA, Maria, to “go give Mr. Henderson some orange juice and a graham cracker from the kitchen and then check his sugar again in 15 minutes.”
- Analysis: This is a dangerous delegation. First, “give” implies administering a treatment, which is borderline. More importantly, re-checking a blood sugar after intervention requires an assessment of the patient’s response and judgment about further action. David delegated the evaluation. The correct delegation would have been: “Maria, please get me two cartons of orange juice and some graham crackers for Mr. Henderson in 308, and then come tell me when you have them.” The RN must administer the treatment and assess the result.
Conclusion: Fostering a Safe and Collaborative Care Team
Mastering delegation isn’t about memorizing a list; it’s about embracing a culture of safety and mutual respect. It’s built on the foundation that the licensed nurse is ultimately responsible for the patient, while recognizing that CNAs are skilled, essential partners in care. Clear, consistent communication is the tool that holds it all together. When nurses delegate thoughtfully and CNAs communicate effectively, the entire care team—and more importantly, every patient—benefits.
Frequently Asked Questions (FAQ)
1. Can a CNA remind a patient to take their own medication? Yes, this is generally acceptable. The key distinction is that the CNA is reminding the patient to self-administer a prescribed medication that is already at the bedside. The CNA should not bring the medication to the patient or be involved in its preparation.
2. What if I’m a CNA and a nurse asks me to do something I know I’m not allowed to do? You have the right and responsibility to politely refuse. You can say, “I’m not comfortable with that task because I don’t have the training. Could you show me how we should handle this according to our policy?” Always document the conversation and the refusal according to your facility’s procedure. Your priority is patient safety.
3. Can a CNA change a simple, non-sterile dressing like a dry gauze pad? This is a classic grey area and depends heavily on state regulations and facility policy. Many facilities consider ANY dressing change a de facto assessment and designate it as a nurse task. Unless your facility has explicitly trained and approved you for this specific task, the safe answer is no. Do not assume it’s delegable.
4. Is a CNA allowed to “disconnect” a patient from a telemetry monitor when they are discharged? No. Connecting to, disconnecting from, and interpreting any form of cardiac monitoring is a task that requires specific training and assessment skills beyond the CNA scope. This must be performed by a licensed nurse.
What’s your experience with delegation on your unit? Share a success story or a challenge you’ve faced in the comments below—let’s learn from each other!
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