Sec. 10.39.05.03. Scope of Practice

A. Responsibility.

(1) A CNA:

(a) Works under the delegated authority from a nurse to perform a nursing function;

(b) Assists the nurse in collecting data for a nursing assessment; and

(c) Is under the supervision of a nurse.

(2) In a team relationship with a registered nurse, and under the instruction, direction, and supervision of a nurse, the CNA shall:

(a) Collect and record routine health data identified by the nurse on assigned clients;

(b) Orally report the health status data as required by the nurse;

(c) Identify when the client’s condition or behavior has changed from one day to another or from one part of the assigned shift to another and report any change to the nurse;

(d) Provide feedback to the nurse regarding the nurse-directed plan of care which is being implemented;

(e) Provide feedback to the nurse about the client’s expressed wishes concerning the plan of care;

(f) Provide assistance with activities of daily living as delegated by the nurse;

(g) Perform interventions as delegated by a registered nurse;

(h) Record routine data and care provided on appropriate documents;

(i) Identify the need for assistance and request assistance when the CNA:

(i) Is unsure about a client’s condition;

(ii) Does not know how to do an activity;

(iii) Is aware that client circumstances have changed;

(iv) Is working in a new practice or work setting; or

(v) Is working with a new client in an unfamiliar situation;

(j) Report the client’s response and the client’s progress to the nurse:

(i) At designated times; and

(ii) When client circumstances have changed;

(k) Make suggestions or recommendations on how the nursing plan of care can be modified based on observations of the client’s performance and statements; and

(l) Demonstrate competency in safely performing CNA functions, which include, but are not limited to:

(i) Participation in quality of care activities;

(ii) Performance self-appraisal;

(iii) Continued learning;

(iv) Collaboration;

(v) Completion of delegated assignments; and

(vi) Refusing or accepting an assignment based on one’s knowledge or experience.

B. Confidentiality. The CNA shall:

(1) Adhere to local, State, and federal guidelines and regulations regarding client confidentiality and privacy rights; and

(2) Direct all client requests for information to a nurse.

C. Advocacy. The CNA shall:

(1) Advocate for the client by reporting to the nurse statements expressed by the client or family regarding:

(a) Any request for information;

(b) Concerns about care; and

(c) Client needs; and

(2) Collaborate with other health care team members by reporting information and data regarding the client in a timely, truthful, and complete manner.

D. Teaching. The CNA shall:

(1) Reinforce the nurse’s health teaching:

(a) In accordance with the:

(i) Facility;

(ii) Employer; or

(iii) Agency policy; and

(b) At the direction of the registered nurse’s written instruction;

(2) Report the client’s response to the teaching; and

(3) Report any request by the client for additional information.

E. Accountability. The CNA shall:

(1) Comply with all policies and procedures of the:

(a) Facility;

(b) Employer; and

(c) Agency;

(2) Comply with all local, State, and federal guidelines and regulations governing nursing assistant practice;

(3) Perform competently all activities as assigned or delegated;

(4) Report to the nurse;

(5) Provide the client with a safe therapeutic environment;

(6) Recognize the CNA’s individual limits of knowledge and experience;

(7) As needed, request assistance, direction, and supervision from the nurse;

(8) Recognize the CNA’s responsibility and accountability to perform functions safely and competently;

(9) Comply with the CNA code of ethics in accordance with COMAR 10.39.07;

(10) Report all errors, omissions, or incidents which may have occurred during the CNA’s own practice or the practice of others; and

(11) Follow the basic principle of nursing practice: “First, do no harm to the client”.