The Poured Cup: A Delegation Request at 2015
You are a CNA on the 3–11 shift with 11 residents. At 2015 the LPN, who is in another room doing a wound treatment, calls to you: 'Mr. K's 2100 oxycodone is already poured in the cup on the med cart - just hand it to him so I don't fall behind.' Mr. K is alert, has no swallowing precautions, and has been asking for pain relief since 1945. Ten minutes later Mr. K's daughter calls the unit phone and asks you to explain why her father's potassium was low on this morning's labs. Meanwhile, Mr. Diaz, who has dementia, is standing in his doorway tugging at his brief and saying he needs the toilet.
1. The LPN asks you to hand Mr. K the already-poured oxycodone. What do you do and say, and what makes that the right call?
Read the worked answer
Decline clearly, then offer a workable alternative.
- 'I can't give medications. I can bring Mr. K to the cart, or I can cover your other call light while you come out - which do you want?'
- Leave the cup exactly where the nurse set it. Do not carry it, do not hand it over, do not 'just hold it' while you do something else.
Why this is the answer, not a preference:
- Medication administration is not in the CNA role. The accountability for right resident, drug, dose, route, time, and documentation belongs to the licensed nurse and cannot be handed off mid-task.
- 'It's already poured' changes nothing. The rule protects the resident from the parts of med pass an aide cannot do - assessing the response, watching for a reaction, and being present for the controlled-substance count and waste.
- An opioid given by someone who cannot assess or intervene is a genuine harm, not a technicality.
If the nurse pushes back: stay calm, repeat the boundary once, then use the chain of command - charge nurse or RN supervisor - and report what you were asked to do. Document factually: time, who asked, what was requested, what you did instead.
2. How do you answer Mr. K's daughter about the potassium result?
Read the worked answer
Do not confirm, deny, explain, or guess.
- 'I'm not able to discuss lab results - that has to come from the nurse or the provider. I'll take your name and number and have the nurse call you back.'
- Do not say 'it was a little low but they're watching it,' and do not say 'I don't know anything about any labs.' Both leak information.
Reasoning:
- Lab values are protected health information. Even a friendly, well-meant interpretation is a disclosure you are not authorized to make.
- A CNA cannot explain what a low potassium means or what will be done about it. Guessing creates fear or false reassurance and undermines the nurse's plan.
- Being the daughter's healthcare proxy does not change who answers the phone - it changes who the nurse is allowed to talk to after verifying identity per facility policy.
What to actually do: take a message with the time, write it down, hand it to the nurse, and tell the nurse the daughter is waiting for a call. If the daughter is upset, that is worth reporting too.
3. You cannot do all three things at once. How do you sequence the next few minutes, and what do you document?
Read the worked answer
Sequence:
- Answer the nurse first, briefly. 'I'm not giving the oxycodone. Mr. K is asking for it - he's due at 2100.' This prevents the worst outcome: the nurse assuming the dose was given and it never being given or charted.
- Go to Mr. Diaz. He has an immediate need, standing, and is at risk of a fall or a skin injury. Toileting and cleaning him is squarely within your role and takes a few minutes.
- Take the daughter's number and tell her the nurse will call.
- Tell the nurse Mr. K is still waiting and give the message.
Why this order: the un-given medication is a safety issue you solve by reporting, not by doing. Mr. Diaz is the only need you can actually meet yourself, and he is the one at risk of falling right now.
Document: the time of the request and your refusal, the resident's pain complaints and time, the toileting care provided and any skin findings, the daughter's call and message relayed, and the name of every person you notified. Facts and times, no opinions about the nurse.