Washington CNA Scope of Practice: What Nursing Assistants Can and Cannot Do

A Washington Nursing Assistant-Certified (NA-C or NAC) provides basic nursing care that a licensed nurse assigns and supervises: personal care, mobility, nutrition, vital signs, observation, and documentation. The nursing assistant never assesses, plans care, or administers medications on their own authority. Two mechanisms extend that base scope in specific settings: nurse delegation, where a registered nurse delegates defined tasks to an NA-C for a specific client in a community setting, and the medication assistant endorsement, which allows routine medication administration in nursing homes. Everything else, from injections to taking prescriber orders, stays with licensed nurses.

Who sets the scope

The Washington State Board of Nursing (WABON), formerly the Nursing Care Quality Assurance Commission, defines what nursing assistants are trained to do through the approved curriculum in Chapter 246-841A of the Washington Administrative Code. The 108-hour training minimum in WAC 246-841A-440 (35 theory, 33 skills lab, 40 clinical) is built around that task list, and the skills test checks it. The Department of Health (DOH) issues the credential and disciplines holders who practice beyond it.

Three layers stack on top of each other, and the narrowest one governs on any given shift:

1. State rules define the outer boundary.
2. Facility policy can narrow the list. A hospital may not let NA-Cs take blood glucose readings even though the training covers it; an adult family home may require additional sign-off before transfers with a mechanical lift.
3. Individual competency narrows it further. If you were never checked off on a task at your current employer, you do not perform it until you are.

Tasks within the standard NA-C scope

Every item in that table appears in an approved program's curriculum and can be a scored skill on the state test. The list of skills the evaluator may draw from is covered in our article on the Washington CNA skills test skills list.

Tasks outside the standard scope

These belong to licensed nurses or other licensed providers, and no facility policy can hand them to a nursing assistant:

• Assessment. Deciding what a change in condition means. An NA-C reports a resident is short of breath; the nurse assesses why.
• Care planning. Writing or changing the plan of care.
• Medication administration on the nursing assistant's own authority, including over-the-counter medications. Reminders and physical assistance with self-administration may be allowed by policy; administering is not, unless delegated or endorsed as described below.
• Injections and intravenous therapy, including starting, adjusting, or flushing IV lines.
• Sterile procedures such as sterile wound care or urinary catheter insertion.
• Taking orders from a prescriber by phone or in person.
• Tube feedings, suctioning, and tracheostomy care except where a specific delegation or facility competency program under nurse supervision explicitly covers them.
• Any task the NA-C has not been trained and checked off on, even if it appears in this article's first table.

When in doubt, the test is simple: does the task require nursing judgment, or is it a defined procedure with predictable steps? Judgment stays with the nurse.

How scope expands: delegation and endorsement

Delegation is the more common expansion, because thousands of Washington adult family homes depend on it. It is also the one most often misunderstood, since delegation attaches to the nurse, the client, and the task rather than to the aide. If the client moves or the RN leaves, the delegation ends. Our full explainer on nurse delegation for Washington CNAs walks through the process, and the endorsement is covered in medication assistant endorsement for Washington CNAs.

Scope for NARs and students

A Nursing Assistant-Registered (NAR) works under the same basic-care scope but only in a licensed facility under nurse supervision, and only for tasks the facility has verified the NAR can perform safely. Delegation and the medication assistant endorsement both require the NA-C, so a NAR cannot use either. Students in a training program perform tasks during clinical hours under their instructor's supervision, within the program's clinical agreement with the facility. For the difference between the two provisional statuses, see NAR vs NAC in Washington.

Setting by setting: how the same scope plays out

• Hospitals. Often the narrowest task list in practice. NA-Cs (frequently titled patient care technicians) handle personal care, vital signs, mobility, and sometimes phlebotomy or ECG after employer training. Medication tasks are almost never assigned.
• Nursing homes. The full basic-care scope, plus medication passes for aides with the endorsement.
• Assisted living and adult family homes. Basic care plus nurse-delegated tasks; the resident population often includes people with diabetes and complex medication schedules, so delegation is routine.
• Home care agencies. Usually staffed by Home Care Aides under DSHS rules rather than NA-Cs; an NA-C working there follows the agency's care plan and any delegation in place.

When you are asked to go beyond scope

Requests to exceed scope usually come from short staffing, not malice: a nurse is tied up and a resident needs a medication now. The right response protects the resident, the nurse, and your credential.

1. Decline clearly and briefly. "I am not able to do that as a nursing assistant. I can get the nurse or stay with the resident."
2. Offer what you can do. Stay with the resident, take vital signs, or call the charge nurse.
3. Document what happened in the format your facility uses, including who asked and when.
4. Report it up the chain if it recurs. Facilities are required to have a process for staff concerns, and repeated pressure is a management problem.

Performing a task outside scope is one of the most common grounds for a complaint against an NA-C, and "my supervisor told me to" is not a defense. How the DOH handles those cases is described in Washington CNA disciplinary actions.

Frequently asked questions

Can a Washington CNA give medications? Not on their own authority. An NA-C may administer medications in a nursing home with the medication assistant endorsement, or in a community setting when a registered nurse has delegated the task for that client.

Can a CNA give insulin in Washington? Only under nurse delegation in a community setting, after the DSHS delegation training that covers it, for a client the RN has assessed as stable and predictable. Never in a hospital or nursing home on the NA-C credential alone.

Can a CNA take blood glucose readings? Blood glucose monitoring is a commonly delegated task in community settings. In hospitals and nursing homes it depends on facility policy and competency sign-off.

Can a CNA change a dressing? Simple, non-sterile dressing changes may be assigned after training and check-off. Sterile dressing changes stay with the nurse.

Does my scope grow with experience? Not automatically. Experience earns you more independence within the same task list. Scope itself changes only through delegation, the endorsement, or a new license such as LPN.

Scope questions come up in every program's theory hours, and the four-week CNA Traditional program at Huduma CNA Programs spends time on them precisely because new graduates are the ones most likely to be asked to stretch.