Ever had that split-second of panic when an LPN assigns you a task you’re not 100% sure about? You pause, questioning if it’s within your CNA scope of practice, and worry about saying the wrong thing. This moment of uncertainty is something every CNA faces. Mastering the rules of lpn delegation to cna isn’t just about passing a test—it’s your primary tool for protecting your patients, your license, and your professional confidence. This guide will give you the clear, practical, and legally-sound answers you need to navigate delegation with clarity and strength.
The Foundation: Your CNA Scope vs. the LPN Scope
Before we can discuss delegation, we need to understand the playing field. Think of it like this: the LPN is the architect and the CNA is the skilled builder. The LPN (architect) assesses the patient’s condition, creates the care plan, and makes clinical judgments. The CNA (builder) takes that blueprint and performs the hands-on tasks that bring the plan to life.
Your scope of practice as a CNA is legally defined. It centers on providing direct care for predictable, stable patient needs. This includes assisting with activities of daily living (ADLs), taking vital signs on stable patients, and observing for changes you can see, hear, or feel. The LPN’s scope is broader, encompassing assessments, creating care plans, and performing tasks that require nursing judgment.
Key Takeaway: Delegation transfers the authority to do a task, but the LPN always retains the responsibility for the overall outcome of that care.
The Golden Rules: Mastering the Five Rights of Delegation
Every safe delegation decision, whether you’re giving or receiving an assignment, should pass through this safety filter: the Five Rights of Delegation. If any one of these is a “no,” the delegation is unsafe. Let’s break them down.
1. The Right Task
Is the task something a CNA can legally perform? It must be repetitive, non-invasive, and have predictable outcomes. For example, helping a patient ambulate is a right task; inserting a urinary catheter is not.
2. The Right Circumstance
Is the patient stable? Is the environment appropriate? Delegating a complex task during a code blue is the wrong circumstance. Delegating a simple hygiene check on a stable patient is the right circumstance.
3. The Right Person
Are you competent and trained to perform this task? Have you done it before? Do you feel comfortable with it? Your facility must ensure you’re competent, but you also have a responsibility to know your own limits.
4. The Right Direction/Communication
The LPN must give you clear, concise instructions. This includes why the task is needed, what the expected outcome is, how to do it, and when to report back. Communication is a two-way street. You must understand the instructions completely.
5. The Right Supervision/Evaluation
The delegating LPN is responsible for providing appropriate supervision and evaluating your performance and the patient’s response. They are not off the hook once they’ve handed you the assignment.
Pro Tip: Here’s what experienced CNAs know. When receiving a task, always do a quick “repeat-back.” Say something like, “Okay, just to confirm, you want me to help Mr. Smith ambulate to the bathroom, and you want me to report back immediately if he feels dizzy or weak.” This confirms your understanding and protects everyone.
The Green Light: Tasks LPNs CAN Safely Delegate to You
This is where we get to the practical “yes” list. These are foundational tasks that fall squarely within the tasks LPN can delegate to a competent CNA.
- Activities of Daily Living (ADLs): Assisting with bathing, dressing, grooming, toileting, and eating.
- Mobility: Helping patients turn in bed, transfer from bed to chair, and ambulate with appropriate assistive devices.
- Vital Signs: Measuring blood pressure, heart rate, respiratory rate, and temperature on stable patients.
- Intake and Output (I&O): Recording all fluids a patient consumes and excretes.
- Basic Patient Observation: Reporting objective changes. Your job is to report what you see, not to interpret it. For example, “Mr. Jones’s skin on his back looks red,” not “Mr. Jones has pressure ulcer.”
- Simple Feedings: Assisting patients with meals who can swallow safely.
- Specimen Collection: Collecting non-invasive specimens like a clean-catch urine sample or a stool specimen.
- Oral Hygiene: Providing routine mouth care for dentate or edentulous patients.
These tasks are the bread and butter of CNA work. They are essential, valuable, and fall well within your scope.
The Red Line: Tasks LPNs CANNOT Delegate to CNAs
Knowing what’s off-limits is just as important as knowing what’s allowed. These tasks a CNA cannot do require nursing judgment, sterile technique, or advanced skills that are beyond CNA training.
- Medication Administration: This is absolute. No administering oral, topical, IV, or any other type of medication. This includes handing a patient their “as-needed” medication if the nurse hasn’t personally prepared and dispensed it.
- IV Therapy: Starting, discontinuing, or managing IV lines. This is a strict no-go.
- Wound Care: Performing sterile dressing changes, packing wounds, or assessing wound healing. You may apply a simple, pre-packaged non-sterile dressing over intact skin if specifically told to do so, but never if the wound is open or requires sterile technique.
- Invasive Procedures: Inserting urinary catheters, nasogastric tubes, or any other invasive device.
- Patient Assessment: Performing a head-to-toe assessment, listening to lung sounds, or interpreting EKG strips. You can observe and report data (like respiratory rate), but you cannot assess or diagnose.
- Care Planning: Developing or modifying a patient’s care plan. You provide input, but the LPN or RN develops it.
- Blood Glucose Monitoring: This is a tricky one. While some states allow CNAs to perform fingersticks, many do not. This is a task that absolutely must be verified with your state’s Nurse Practice Act.
| Task Category | Delegable Example | Non-Delegable Example |
|---|---|---|
| Skin/Wound Care | Applying lotion to intact skin | Performing a sterile dressing change |
| Medication | Passing water to a patient | Administering oral, IV, or topical meds |
| Assessment | Reporting “patient seems pale” | Performing a focused cardiac assessment |
| Specimens | Obtaining a stool sample | Drawing blood for a lab test |
| Tubes/Lines | Emptying a urinary drainage bag | Inserting a urinary catheter |
| Winner/Best For | Direct, predictable, hands-on care tasks | Tasks requiring sterile technique or clinical judgment |
Clinical Scenarios: Putting Delegation into Practice
Theory is great, but let’s apply it to the real world.
Scenario 1: An LPN asks, “Can you go get 81 mg of aspirin for Room 202 from the med cart and give it to her? She has a headache.” Your Response: This is a clear “no.” The task involves medication administration. You can say, “I’m not able to administer medications, but I can inform her that you’re on your way to assess her headache.” Thinking it through: This fails the “Right Task” rule.
Scenario 2: You see a patient’s abdominal surgical incision. It looks a little red where the staple is. You report this to the LPN, who says, “Okay, just put a gauze dressing over that for me and let me know if it gets worse.” Your Response: This is a gray area that leans toward “no.” Applying a dressing to a fresh, potentially healing surgical site borders on wound care. A better response is, “I’m concerned about covering an incision I’m not sure how to assess. Could you please take a look at it so we can decide on the right dressing together?” Thinking it through: This could fail the “Right Task” and “Right Circumstance” rules. It requires the LPN’s assessment first.
Scenario 3: An LPN asks you to perform a blood sugar check on a patient who just returned from surgery. Your Response: You must know your state’s policy. If you are not certified to perform fingersticks, you respond, “I’m not authorized to perform blood glucose monitoring. Can you or a certified staff member do that?” If you are certified and have been trained, you must verify the order and perform the task using the “Right Direction/Communication” rule, confirming the patient’s identity and the reason for the check. Thinking it through: This hinges entirely on the “Right Person” rule as defined by state law and facility training.
When in Doubt: The State Rules and Your Right to Refuse
The single most important principle is this: what can lpn delegate to cna can vary by state. Your state’s Board of Nursing Nurse Practice Act is the ultimate rulebook. Not your facility’s policy, not what “everyone else is doing,” but the official state regulations.
This leads to your right, and indeed your responsibility, to refuse any task that falls outside your scope of practice. Refusing doesn’t have to be confrontational. It’s about professional advocacy for your patient and yourself.
Clinical Pearl: Always frame your refusal around patient safety and your scope. Use phrases like: “For patient safety, I need clarification on that task,” or “I’m not comfortable performing that task as it may fall outside my scope. Could we review the procedure together?”
If you feel pressured, follow the chain of command: speak to the charge nurse or your supervisor. Document the situation objectively.
Common Questions About LPN to CNA Delegation
Can an LPN delegate medication to a CNA under any circumstances? No. Administering medication requires nursing assessment and judgment regarding dosage, contraindications, and side effects. This is a fundamental nursing responsibility and is not delegable to a CNA.
What if my facility policy says I can do something my state says I can’t? Always follow the more restrictive rule, which will be your state’s Nurse Practice Act. A facility policy cannot legally expand a CNA’s scope of practice.
Is the LPN still responsible if I make a mistake on a delegated task? Yes. The LPN maintains accountability for the delegation decision and for the overall patient outcome. However, you are still accountable for performing the task correctly and for communicating if something is wrong. It’s shared responsibility.
Conclusion
Understanding cna delegation rules empowers you to be a safer, more effective, and more confident professional. Remember these three core principles: always operate within your defined scope of practice, use the Five Rights of Delegation as your personal safety checklist for every task, and never be afraid to seek clarification or respectfully refuse a task that puts a patient at risk. Your commitment to these rules doesn’t just protect you—it makes you a true advocate for the patients in your care.
Have you ever faced a tricky delegation situation? Share how you handled it (or wished you’d handled it) in the comments. Your story could help a fellow CNA!
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