When CNA Task Delegation Goes Wrong in Long-Term Care

How not to help a resident smoke

A young, new, untrained nurse aide reported that she had been instructed by someone at the long-term care facility where she worked to take a resident outside to smoke.

Once outside, the resident was unable to light their own cigarette. They also couldn’t inhale strongly enough to get it started. The aide said she was told it was her job to light the cigarette, inhale to start it, and then place it in the resident’s mouth.

So she did.

More than once.

She said she didn’t feel comfortable doing it, but she believed it was expected of her. Eventually, that discomfort turned into concern—and that concern made its way, appropriately, to the state.

I don’t know who told the new aide this was her responsibility. It may have been another aide. It may have been another staff member. It may even have been the resident. What was clear is that this was not something that could—or should—have been delegated. And the aide didn’t realize she had the option to say no.

She thought this was just part of the job.

In long-term care, nurses delegate tasks to aides. That’s the nature of the work. Care is shared. Routines develop. And sometimes practices are passed along informally, staff member to staff member, without much pause to consider whether they ever should have started in the first place.

No one sets out to teach an aide to do something so outrageous. But misinterpretations of care can spread easily in busy facilities—especially among staff who are new, untrained, or learning from others who are just as new.

Inhaling a cigarette for another person in a health care facility violates infection control, endangers health, and falls completely outside a nurse aide’s scope of practice. And yet, it happened.

I’m glad it reached the state. I’m glad someone listened. But I keep wondering how uncomfortable that aide must have felt each time she did something she knew was unreasonable, unsafe, and wrong—simply because she believed she had no choice.

I wish this weren’t an article that needed to be written.