This chapter is not applicable to and does not restrict or limit: Other health care practitioners who are authorized to perform these duties under their respective acts; The provision of gratuitous care by self, family, or friends; A nurse from delegating a nursing task to an unlicensed individual if acceptance of delegated nursing tasks does not become a routine part of the unlicensed individual’s job duties; or A cognitively capable adult from employing an unlicensed caregiver in the adult’s home to assist the adult in treatments of a routine nature and in self-administration of medication. In this chapter, the following terms have the meanings indicated. Terms Defined. “Assessment” means a comprehensive, dynamic process by which the registered nurse collects and analyzes data through interaction with: The client; The family; Significant others; and Other health care providers. “Certified nursing assistant (CNA)” means an individual certified by the Board to practice as a nursing assistant. “Delegate” means the nurse: Authorizes the CNA to act on behalf of the nurse; Authorizes the CNA to augment and supplement the care the nurse provides; and Retains the accountability and responsibility for the delegated act. “Health care team” means a group of individuals that includes licensed health care providers, CNAs, and unlicensed personnel working in collaboration with the client, family, and friends to achieve identified outcomes. “Health status data” means and includes, but is not limited to: Biophysical status to measure: Height; Weight; and Vital signs; Cultural, religious, and socioeconomic background; and Activities of daily living. “Nurse” means a licensed registered nurse (RN) or a licensed practical nurse (LPN). “Nursing plan of care” means an established set of goals, priorities, and methods designed to solve, prevent, and manage a client’s identified problems. “Outcome” means a measurable, expected, client-focused goal which is observable by the client’s behavior or status. Responsibility. A CNA: Works under the delegated authority from a nurse to perform a nursing function; Assists the nurse in collecting data for a nursing assessment; and Is under the supervision of a nurse. In a team relationship with a registered nurse, and under the instruction, direction, and supervision of a nurse, the CNA shall: Collect and record routine health data identified by the nurse on assigned clients; Orally report the health status data as required by the nurse; Identify when the client’s condition or behavior has changed from one day to another or from one part of the assigned shift to another and report any change to the nurse; Provide feedback to the nurse regarding the nurse-directed plan of care which is being implemented; Provide feedback to the nurse about the client’s expressed wishes concerning the plan of care; Provide assistance with activities of daily living as delegated by the nurse; Perform interventions as delegated by a registered nurse; Record routine data and care provided on appropriate documents; Identify the need for assistance and request assistance when the CNA: Is unsure about a client’s condition; Does not know how to do an activity; Is aware that client circumstances have changed; Is working in a new practice or work setting; or Is working with a new client in an unfamiliar situation; Report the client’s response and the client’s progress to the nurse: At designated times; and When client circumstances have changed; Make suggestions or recommendations on how the nursing plan of care can be modified based on observations of the client’s performance and statements; and Demonstrate competency in safely performing CNA functions, which include, but are not limited to: Participation in quality of care activities; Performance self-appraisal; Continued learning; Collaboration; Completion of delegated assignments; and Refusing or accepting an assignment based on one’s knowledge or experience. Confidentiality. The CNA shall: Adhere to local, State, and federal guidelines and regulations regarding client confidentiality and privacy rights; and Direct all client requests for information to a nurse. Advocacy. The CNA shall: Advocate for the client by reporting to the nurse statements expressed by the client or family regarding: Any request for information; Concerns about care; and Client needs; and Collaborate with other health care team members by reporting information and data regarding the client in a timely, truthful, and complete manner. Teaching. The CNA shall: Reinforce the nurse’s health teaching: In accordance with the: Facility; Employer; or Agency policy; and At the direction of the registered nurse’s written instruction; Report the client’s response to the teaching; and Report any request by the client for additional information. Accountability. The CNA shall: Comply with all policies and procedures of the: Facility; Employer; and Agency; Comply with all local, State, and federal guidelines and regulations governing nursing assistant practice; Perform competently all activities as assigned or delegated; Report to the nurse; Provide the client with a safe therapeutic environment; Recognize the CNA’s individual limits of knowledge and experience; As needed, request assistance, direction, and supervision from the nurse; Recognize the CNA’s responsibility and accountability to perform functions safely and competently; Comply with the CNA code of ethics in accordance with COMAR 10.39.07; Report all errors, omissions, or incidents which may have occurred during the CNA’s own practice or the practice of others; and Follow the basic principle of nursing practice: “First, do no harm to the client”. Health Occupations Article, §§8-205(a)(1) and (2) and 8-6A-05(a)(1), Annotated Code of Maryland Effective date: November 15, 2010 (37:23 Md. R. 1611)