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  1. Brooke, Penny Simpson APRN, MS, JD

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I work in a small specialty clinic where a certified nursing assistant (CNA) works with the RNs. For years, he's been triaging patients over the phone, presenting his assessments to the physicians, taking direction from them, and implementing their instructions. He works hard and does a good job, but some phone calls require quick judgments based on nursing knowledge, and he's not an RN.


My supervisor (who isn't an RN), says that as long as the physicians are instructing the CNA, I needn't worry. My state board of nursing hasn't given me a clear answer about whether this constitutes practicing beyond the scope of CNA training. Can you advise me?-D.L., N.H.


The clinic should have a job description for the CNA spelling out his responsibilities and who supervises his work. Physicians in your state have the authority to delegate to medical assistants, so if his job description states that he reports directly to the physicians-in the capacity of a medical assistant-then your employer and the physicians would be held responsible if his actions injured a patient.


If the nurses are supposed to supervise the CNA, those who delegate to him would be vicariously liable if a patient were harmed. Keep in mind that you can't delegate nursing tasks to a nonnurse. If telephone triage is a nursing duty according to your state's nurse practice act, the CNA is practicing nursing without a license and should be reported.


According to The Joint Commission, the clinic should have an RN in administration with whom you can discuss your concerns. You deserve clarification-in writing-on whether your coworker is acting as a CNA or an unlicensed medical assistant. If he's working as a CNA, the nurses need to oversee his tasks and restrict his telephone advice.