A Certified Nursing Assistant (CNA) is a non-licensed member of the healthcare team who provides direct care to patients under the supervision of a licensed nurse. The CNA role focuses on assisting patients with daily needs and ensuring comfort and safety. Generally, a CNA is not permitted to insert a urinary catheter, whether indwelling or intermittent. Catheter insertion is considered an invasive medical procedure requiring advanced clinical skill and judgment that falls outside the standard scope of CNA practice.
Defining the CNA Scope of Practice
The scope of practice for a Certified Nursing Assistant is a defined set of tasks and responsibilities CNAs are legally authorized to perform based on their training and certification. CNA programs primarily focus on basic patient care, often called Activities of Daily Living (ADLs), such as bathing, dressing, grooming, and assisting with mobility and feeding. CNAs are also trained to perform routine tasks like checking and documenting vital signs and monitoring intake and output.
Catheter insertion is a skilled procedure that requires maintaining a sterile field and an understanding of human anatomy to prevent injury and infection. The procedure involves inserting a tube through the urethra into the bladder, which carries a significant risk of introducing bacteria and causing a Catheter-Associated Urinary Tract Infection (CAUTI). Because of this risk and the need for clinical assessment, catheter insertion is reserved for licensed personnel, such as Registered Nurses (RNs) and Licensed Practical Nurses (LPNs). Licensed nurses receive extensive training in sterile technique, anatomical landmarks, and the critical thinking necessary to manage potential complications.
Catheter Care Tasks Allowed for CNAs
While CNAs cannot insert a catheter, they play an important role in the maintenance and care of patients who already have an indwelling urinary catheter. This routine care is essential for patient comfort and preventing infections. One of the most frequent tasks is emptying and measuring the output from the catheter drainage bag. CNAs must ensure the drainage bag remains positioned below the level of the patient’s bladder to prevent the backflow of urine.
CNAs are also responsible for routine perineal and catheter site hygiene, which involves cleaning the area with soap and water. This cleaning should extend several inches down the length of the catheter tubing to prevent bacterial travel. They also monitor the tubing to ensure it is free of kinks or obstructions that could impede urine flow. Furthermore, the CNA observes the patient and reports any changes, such as signs of infection, leakage, or changes in the urine’s color or odor, to the supervising nurse. In some facilities and states, a CNA may be permitted to remove a catheter, but this is often a delegated task requiring specific training and supervision.
State-Specific Regulations and Delegation
The specific duties a CNA can perform are not uniform across the United States; they are governed by the Nurse Practice Act and the Board of Nursing in each state. While the general rule prohibits catheter insertion, some states may allow specific advanced tasks for CNAs who have completed additional, state-approved training, sometimes referred to as a CNA II certification. This variation emphasizes the necessity for CNAs to strictly adhere to the regulations of their employing state and facility.
The mechanism by which CNAs may perform any task beyond their basic training is through a process called “delegation.” Delegation occurs when a licensed nurse, typically an RN, transfers the authority to perform a specific task to an unlicensed person, like a CNA. The RN maintains accountability for the outcome, so the task must be appropriate for the CNA’s skill level and the patient’s condition must be stable. For a CNA to perform tasks related to catheters beyond basic care, the task must be legally delegable in that state, and the CNA must have received training and demonstrated competence.