Role of the Nurse Aide: Scope, Reporting, and Documentation
Know your scope of practice
The state nurse practice act and your training define what an aide may do. Within scope: ADLs (bathing, dressing, grooming, feeding, toileting), bed making, vital signs, intake and output, height and weight, specimen collection, simple transfers, and observation and reporting. Outside scope: assessing, planning or evaluating care, teaching residents or families about conditions, sterile procedures, administering medications, and performing any task you were not trained and delegated to do. Only a licensed nurse delegates; a nurse aide cannot delegate to another aide. If you are unsure, ask the nurse before acting.
Reporting and the chain of command
Report changes and refusals to the charge nurse promptly; follow your facility's chain of command. Suspected abuse, neglect, or misappropriation of property must be reported immediately - to the nurse and per facility policy, and you may contact the state directly. Never investigate on your own and never promise to keep a report secret.
Legal and ethical duties
Keep information confidential, refuse gifts and money politely, and remember that informed consent belongs to the nurse or physician, not the aide. Document promptly, objectively, and factually - describe what you saw and did, not opinions or guesses. Never chart for another person, never chart care before it is given, and correct errors with a single line, your initials, and the date rather than erasing or using correction fluid. Incident reports follow facility policy and are not part of the resident's progress notes.
Worked example: A resident offers you $20 "for being so kind." Decline politely, explain that you cannot accept gifts, and report the offer to the nurse - accepting money is a boundary and abuse-prevention issue.
Rule of thumb: If a task requires nursing judgment or teaching, it is not the aide's job.