Certified nursing assistants (CNAs) are authorized to provide basic patient care, assist with daily living activities, take vital signs, and document observations. Their scope of practice sits firmly in hands-on, day-to-day caregiving rather than medical decision-making. The exact boundaries vary by state, but a core set of allowed and prohibited tasks applies nearly everywhere.
Daily Living Tasks
The bulk of a CNA’s work involves helping patients or residents with activities of daily living. These are the routine personal care tasks that people need help with when they’re hospitalized, recovering, or living in a long-term care facility. Morning care alone can include toileting, changing incontinence briefs, oral and denture care, bathing or showering, dressing, grooming (shaving, hair care, applying makeup per the resident’s preference), helping with breakfast, and making the bed.
Evening care follows a similar pattern: assisting with lunch and dinner, helping with a bath or shower if scheduled, washing the face, removing makeup, changing into pajamas, and performing oral care before bed. Throughout the day, CNAs also provide hand hygiene, tidy rooms, and help residents get to activities, physical therapy, or occupational therapy sessions.
Mobility assistance is another major part of the role. CNAs turn and reposition patients in bed, transfer them between beds and wheelchairs, and help them walk. These tasks require proper body mechanics training to protect both the patient and the aide.
Vital Signs and Clinical Monitoring
CNAs are trained to measure and record four core vital signs: blood pressure, pulse rate, respiratory rate, and temperature. In nursing homes and hospitals, these measurements are taken on a routine schedule and help the care team monitor a resident’s status over time. CNAs record these numbers but do not interpret them or make clinical decisions based on them. If a reading looks unusual, the CNA reports it to a nurse.
Beyond vital signs, CNAs track and document other health information: urination and bowel patterns, food and fluid intake, weight changes, and behavioral observations. Skin observations made during bathing or repositioning are especially important, since early signs of pressure injuries or skin breakdown often show up during routine care. Thorough, accurate charting of these details feeds directly into the formal assessments that nurses use to build care plans.
Documentation and Reporting
CNAs don’t just provide care. They serve as the eyes and ears of the nursing team. Because they spend more direct time with patients than any other staff member, what they notice and write down carries real weight. Their documentation covers the amount of assistance a resident needs for dressing, bathing, eating, toileting, repositioning, transferring, and walking. They also document assistive devices in use, such as hearing aids, glasses, whiteboards, or communication charts.
This documentation matters beyond daily care. In long-term care facilities, a specialized nurse reviews CNA records when completing standardized assessments of each resident’s abilities, including communication skills, hearing, and vision. Inaccurate or incomplete charting from a CNA can lead to a flawed care plan, so precision is a core part of the job.
CNAs are also expected to listen to patients’ health concerns and relay them to nurses. If a resident mentions new pain, dizziness, or a change in how they feel, the CNA’s job is to report it promptly, not to evaluate it.
What CNAs Cannot Do
The clearest boundary is this: CNAs cannot perform any task that constitutes the practice of medicine or nursing. That line covers a wide range of clinical activities.
- Diagnosing or evaluating patients. CNAs observe and report, but they don’t determine what’s wrong.
- Interpreting test results. Recording a blood pressure reading is allowed. Deciding whether it’s dangerously high is not.
- Starting or disconnecting IVs. Any intravenous procedure is outside their scope.
- Inserting catheters. Urinary catheter insertion requires a nurse.
- Administering injections. Whether it’s medication, vaccines, or anything else delivered by needle.
- Recommending or changing treatment plans. CNAs follow the care plan. They don’t create or modify it.
- Performing invasive procedures. This includes anything from wound cauterization to spinal taps.
- Advising patients about their medical conditions. CNAs can provide emotional support, but clinical guidance comes from licensed providers.
The general rule: if a task requires clinical judgment, a license, or specialized medical training beyond CNA certification, it’s off limits.
Medication: A Gray Area
Medication administration is where CNA scope of practice gets complicated. Under federal guidelines, CNAs generally do not give medications. However, some states allow CNAs to assist with or administer medications after completing additional certification. The Bureau of Labor Statistics notes that depending on training level and state regulations, nursing assistants may dispense medication.
Massachusetts, for example, runs a Medication Administration Program that certifies direct care staff to give medications as part of a resident’s daily routine. Other states have similar programs with their own training requirements. If you’re a CNA interested in medication duties, you’ll need to check your specific state’s rules and likely complete a separate certification process.
Training Behind the Role
Federal law requires a minimum of 75 clock hours of training for CNA certification, including at least 16 hours of supervised practical training where students demonstrate skills under the direct supervision of a registered nurse or licensed practical nurse. Before any direct contact with a resident, trainees must complete at least 16 hours covering communication, infection control, safety and emergency procedures (including the Heimlich maneuver), promoting residents’ independence, and respecting residents’ rights.
Many states set their training requirements well above the federal minimum. California, for instance, requires 160 hours. After completing training, candidates must pass a competency evaluation that tests both knowledge and hands-on skills. This evaluation is what determines whether someone can legally work as a CNA, and it defines the boundaries of what they’re prepared to do.
The scope of practice ultimately reflects this training. CNAs are equipped to handle essential, high-frequency caregiving tasks safely and competently. The tasks reserved for nurses and physicians require education and clinical training that goes well beyond what CNA programs cover, which is why the lines exist where they do.