2.5 Scope of Practice

Scope of practice is defined as services that a trained health professional is deemed competent to perform and permitted to undertake according to the terms of their state professional license.^[1] Different states have some variability in what nursing assistants can legally perform based on their licensure. It is important to check state DHS regulations to know exactly what skills and care you are able to legally provide as a nurse aide.

The CMS defines acceptable scope of practice for nursing aides at the federal level. Federal regulation 42 CFR § 483 lists nine tasks that are allowable by each state. These tasks are as follows^[2]:

• Personal care skills
• Safety/emergency procedures
• Basic nursing skills
• Infection control
• Communication and interpersonal skills
• Care of cognitively impaired residents
• Basic restorative care
• Mental health and social service needs
• Residents’ rights

As you learned in the “Nursing Process” section of this chapter, many tasks in the Implementation phase can be assigned or delegated by the registered nurse (RN) to the nurse aide. To keep you and your residents safe, use the 4 S’s to verify that you are performing within your scope of practice when accepting delegated or assigned tasks: Scope, Supervision, Safety, and Supplies. It is important that you ask yourself these questions before performing any cares for a resident:

• Scope: Is this task within my scope of practice as defined by my state licensure? If it is a skill or task that you did not perform for evaluation by your instructor during your nursing assistant course, it may not be legal for you to carry out under your licensure. However, some states allow facilities to provide additional training on skills to improve resident care.
• Supervision: Do I have supervision available? Each task delegated to you must be clear and supervised. If you are unsure of exactly what you need to perform, you should have an RN supervisor to whom you can direct questions. Supervision can be in person or via telephone.
• Safety: Am I safe to perform the task? Patient safety is vital. Even though you may have competently demonstrated a skill when you took your certification course, there may be tasks that you do not perform consistently depending on your care setting. For example, if you haven’t recently used a mechanical lift, you may need additional training before you can safely perform this transfer technique with a resident.
• Supplies: Do I have the supplies I need? If you do not have the proper equipment needed for the task, it is unsafe to perform it. Supplies may include personal protective equipment (PPE) for infection control, transfer equipment and mobility aids, or personal items needed for resident grooming and hygiene.