CNAs do NORMAL.
Read that again. CNAs do NORMAL. “Normal” means that CNAs perform Routine Tasks on Stable Patients, according to the Care Plan. This frees nurses up to perform higher-level tasks, and care for unstable patients.
This all goes back to the delegation rules that a nurse must abide by to delegate any skill to another individual. Because, at the end of the day, the licensed nurse still retains all responsibility for all care provided to the patient – no matter WHO is actually performing the tasks.
There are rules that have to be followed – and those rules determine what can actually be delegated to a CNA. And it all boils down to one word…”ROUTINE.”
So, let’s break this down to it’s most simple components:
- The nurse retains all responsibility for planning and implementing care
- But the nurse can’t possibly DO all the tasks that need to be done
- So, the nurse delegates some tasks to other staff members
- But the tasks must be ROUTINE (according to the rules to the left)
- And the patient must be STABLE
If you read the rules (according to the American Nurses’ Association), any task the nurse wishes to delegate has to be able to be accomplished without judgment and can only be performed on stable patients.
The Nursing Process
So, the nurse assesses the patient, figures out what needs to be done, develops the care plan and the CNAs follow the care plan. The nurse will delegate routine tasks on stable patients to other trained staff members to free up their time for higher level tasks. But some of these skills may require very specific accommodations to meet the needs of this particular patient – and that information will be included in the care plan.
CNAs are not legally permitted to alter the tasks they are assigned to perform. They either do the tasks as instructed…or they tell the nurse why they couldn’t.
This is a fundamental principle of nursing assistant training, but it all goes back to that care plan.
We all know that CNAs can help a patient use a bedpan. Seems like a pretty routine task, and one that the CNA has been trained to do. But there are situations that this action might be life-threatening. If you had a bradycardic patient in the ICU on a dopamine drip who needed to have a bowel movement on the bedpan – well, we know that vagal nerve stimulation may slow the heart rate. The nurse would need to monitor the patient’s heart rate during the toileting process. This task clearly shouldn’t be performed by a CNA. While toileting a patient is a routine task, toileting a patient on a dopamine drip is not a routine task on a stable patient. That is not a NORMAL task with predictable results.
Your students will have a lot of “What if…” questions during training. Most of these questions will revolve around unstable patients or unpredictable results. When presenting the information, relieving that student anxiety is key to promoting learning. If they understand early that they will not have to make decisions, that reduces anxiety and they are more likely to retain the information being taught.
Reducing this to an easy to remember statement, “CNAs perform routine tasks on stable patients according to the care plan,” that you can refer back to during the numerous “What if…” questions provides a sense of security for the students.
But this statement helps instructors, as well. There is a lot of material to cover in your curriculum framework. The topics covered are often diverse and complex. It is very easy to lose your way and begin teaching students to think like nurses. This statement also makes sure you are remaining within their scope of practice with your lessons – which will be important during the test.
Much of the written test will gauge the student’s understanding of their role. If the student has this one simple sentence to go back to when they encounter a difficult question, it can help them narrow down the choices. Most students that fail the written exam do so because they don’t clearly understand their role in the healthcare system. An easy way to remember this is simply, “CNAs do NORMAL.”