Can a CNA Do Wound Care? Scope of Practice Explained

You’re providing morning care, and as you help your resident turn, you notice it: a reddened area on their heels that wasn’t there yesterday. Your mind immediately races. What is this? What am I supposed to do? The question “Can a CNA do wound care?” pops into your head, fueled by a desire to help but also a fear of doing the wrong thing. This moment is where your professionalism truly shines. Understanding your CNA scope of practice isn’t about limitations; it’s about providing the safest, most effective care within your vital role. This guide will clarify your responsibilities, protect your license, and, most importantly, protect your patients.

What Is Scope of Practice and Why Does It Matter?

Think of your scope of practice as a detailed job description written not just by your employer, but by state law and certifying bodies. It defines the specific skills and procedures you are legally and ethically permitted to perform based on your training, certification, and the nurse practice act in your state. Why is this so important? Patient safety is the number one reason. Performing a task you aren’t trained for can cause serious harm. Secondly, it protects you. Working within your scope ensures you are protected legally and professionally. It’s a clear boundary that allows you to provide excellent care with confidence and integrity.

Clinical Pearl: Every action you take as a CNA should trace back to a clear answer to two questions: “Am I permitted to do this?” and “Is this in the best interest of my patient’s safety?”

The Golden Rule for CNAs: Observe, Report, Document

If you remember only one thing from this entire post, make it this: your primary role in any wound situation is to Observe, Report, and Document. This is not a passive role; it is an active, expert contribution to the healthcare team. You are the frontline, the eyes and ears of the nursing staff. Your keen observations can mean the difference between a simple skin irritation and a severe, infected wound.

Imagine you’re assisting Mr. Davis, who has limited mobility. As you wash his back, you feel a small, warm area of skin on his lower spine.

Observe: You look closer. The skin is intact but very red. You press on it, and the redness doesn’t fade (non-blanchable erythema). It’s about the size of a quarter.
Report: You immediately find the nurse and state, “I was providing care for Mr. Davis in room 204, and I noticed a new red area on his sacrum. It’s about two inches across, warm to the touch, and the redness doesn’t disappear when I press on it. It wasn’t there during my last shift.”
Document: You go to the chart and write exactly what you saw and who you reported it to. “14:30 – Notified RN Jane Smith of new non-blanchable erythema, approx. 2×2 cm, on Mr. Davis’s sacrum during perineal care.”

This three-step process is your superpower. It provides the critical information the nurse needs to assess, intervene, and prevent further injury.

CNA Responsibilities: What You ARE Expected to Do

Your role in wound management is proactive and focused on skin integrity and prevention. These tasks are not only within your scope—they are essential duties that form the foundation of good patient care. Mastering them makes you an invaluable asset to your team and your patients.

Your CNA wound care responsibilities include:

Performing Regular Skin Checks: This is your most important duty. Check every inch of your patient’s skin during baths, linen changes, and repositioning. Pay special attention to bony prominences like heels, elbows, hips, and the tailbone.
Assisting with Hygiene: Keeping skin clean and dry is the first step in preventing skin breakdown. Use gentle pH-balanced cleansers and pat the skin dry—never rub.
Turning and Repositioning: Follow the repositioning schedule for patients at risk. Use proper techniques and pillows or foam wedges to relieve pressure on vulnerable areas. This is a core part of what can a CNA do for a pressure ulcer—namely, prevent it from getting worse.
Ensuring Proper Nutrition and Hydration: Malnutrition and dehydration weaken skin. Encourage patients to eat and drink, and report any significant changes in appetite or fluid intake to the nurse.
Providing Support: Use specialty mattresses, cushions, and heel protectors as ordered by the nurse.

Your “What to Report About a Wound” Checklist:
– Size: How big is it? (Measure in centimeters if possible)
– Location: Where exactly is it on the body?
– Appearance: What color is the skin/wound bed? Is there swelling, redness, or discharge?
– Drainage: Is there any? If so, what color is it (clear, yellow, green) and how much is there (small, moderate, large)? Does it have an odor?
– Pain: Did the patient complain of pain or tenderness in that area?

Crossing the Line: Wound Care Tasks CNAs CANNOT Perform

Just as important as knowing what you can do is knowing what you cannot do. The line is drawn sharply at any task that constitutes assessment or treatment. Cross this line, and you are practicing nursing without a license, which carries severe legal and professional consequences. This is where questions like “is a CNA allowed to change a dressing” are answered with a definitive “no.”

You cannot perform the following wound care tasks:

Staging Pressure Injuries: Assigning a stage (Stage I, II, III, IV, etc.) is a nursing assessment.
Changing Sterile Dressings: This is a sterile procedure that requires specific training to prevent contamination and infection.
Applying Prescription Creams or Ointments: While you can apply barrier creams for prevention, applying medicated ointments to an existing wound is a treatment.
Packing Wounds: Filling a deep wound with gauze is a complex nursing skill.
Debridement: Removing dead or infected tissue is never a CNA duty.

Task	Can a CNA Do This?	Rationale & Scope of Practice
Perform a head-to-toe skin check	Yes	This is fundamental observation within the cna duties skin integrity scope.
Stage a pressure injury	No	Requires clinical judgment and is a formal nursing assessment.
Change a sterile dressing	No	Involves sterile technique and treatment of an open wound.
Reposition a patient every 2 hours	Yes	This is a key prevention strategy and a core CNA responsibility.
Apply a medicated ointment to a wound	No	This is administering medication and a form of treatment.
Report a new reddened area to the nurse	Yes	This is the critical “Report” step and is expected of every CNA.
Winner/Best For	The CNA’s Role	Becoming an expert in prevention and early detection, not in treatment.

Understanding Nurse Delegation

Nurse delegation is a specific process where a registered nurse (RN) authorizes a CNA to perform a specific task that is typically outside the CNA’s normal scope. However, it’s crucial to understand that wound care delegation is extremely rare and highly regulated. For delegation to be valid, it must meet strict criteria.

The nurse must ensure the Five Rights of Delegation:

Right Task: The task must be delegable for a specific patient. Many states do not allow sterile procedures like dressing changes to be delegated.
Right Circumstance: The patient’s condition must be stable and predictable.
Right Person: You, the CNA, must be competent and have the necessary training to perform the task safely.
Right Direction/Communication: The nurse must give you clear, specific instructions and a plan for supervision.
Right Supervision: The nurse must be available to monitor the outcome and provide support.

If a nurse asks you to perform a task you’re unsure about, it’s your duty to ask clarifying questions. Something like, “Can you walk me through that one more time? I want to make sure I understand exactly how you’d like it done.”

Pro Tip: If a task is delegated, a proper order should be in the patient’s chart. If there’s no order and you’re not absolutely confident in performing the task, it is always safest to decline.

How to Safely Handle an Out-of-Scope Request

Let’s be honest: being asked to do something outside your scope can be awkward and stressful. You want to be a team player, but patient safety comes first. Knowing how to decline respectfully is a professional skill. The key is to be polite, firm, and focused on safety.

Use a simple, professional script like this: “Thank you for asking me to help with that. I’m not trained or certified to change sterile dressings, and I want to make sure Mr. Garcia gets the best care and stays safe. Is there another way I can assist you while you perform the dressing change?”

This response accomplishes three things:

It acknowledges the request respectfully.
It clearly states the limit based on your training and patient safety.
It reinforces your role as a collaborative team member by offering to help in other ways.

Common Mistake: Silently performing the task out of fear of appearing difficult. This puts your license and the patient’s well-being at risk. A good nurse will respect your commitment to safety.

Conclusion & Key Takeaways

Your role as a CNA in wound care is not secondary; it’s foundational. By focusing on prevention through your cna scope of practice, you become the first line of defense against skin breakdown. Your vigilant observation of cna observing wounds and your clear, concise communication are skills that directly lead to better patient outcomes. Remember the golden rule: Observe, Report, Document. When you master this process, you provide an indispensable service. Your vigilance, attention to detail, and commitment to patient safety are your greatest contributions to the healing process.

Frequently Asked Questions (FAQ)

Q: My facility taught me how to change a simple dry dressing during orientation. Is that okay? A: This is a tricky area. Some states allow delegation of specific non-sterile dressing changes. However, you must have a valid order and proper delegation from the RN for that specific patient. If you haven’t been formally delegated that task today, for that patient, you cannot perform it. When in doubt, ask the nurse for the specific delegation.

Q: What’s the difference between a barrier cream and a medical ointment? A: Barrier creams (like A&D or zinc oxide) are used for prevention. They protect intact skin from moisture. Medical ointments (like antibacterial creams) are used to treat an existing wound or infection. You can apply barrier creams as part of routine care, but not medical ointments.

Q: Can I measure a wound if I find one? A: Yes! Getting a measurement (length, width, depth) is part of “observing.” This objective data is incredibly helpful for the nurse. Include the measurements in your verbal and written report.

Have you ever had to question a task related to wound care? Share your story (anonymously if needed) in the comments to help fellow CNAs navigate these common situations!

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