When CNA Task Delegation Goes Wrong in Long-Term Care
Updated: Feb 24
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.
To protect resident privacy, identifying details in this story have been changed. The situations described reflect real issues encountered in long-term care.
This is a scenario that happens way more than people joining healthcare think. Sometimes you are doing something without noticing. New aides can be more vulnerable to these situations because they don't have the experience to fully understand all procedures or policies or may be afraid to ask questions.
this is a good message that people need to hear, it's a hard sistuation for the nurse aide to be in also an uncomfortable sistuation. this story shows us that if thier are things that feel like that we can always say no and thats a powerful tool for sistauations like the one in the article.
en realidad este escrito es impactante ya que las auxiliares de enfermeria deben tener totalmente claro que se pueden negar profecionalmente si creen que se esta o se va a cometer un error y asi tambien tener en cuenta que pueden realizar el reporte para poder evitar algun error grave y mas que ella acepta que se sentida incomoda no entiendo como no se dio cuenta de la falla que estaba cometiendo
This article really shocked me. I understand the aide felt like it was a part of her job because someone told her to do it, but aides need to understand that they can refuse tasks that they think are unsafe, especially something this unsafe. If she had went to the state sooner it wouldv'e been better. I'm not blaming the aide, because she does say she felt uncomfortable while doing it, but i hope this is a lesson to other nurses/aides!
It is important to remember that if you feel in doubt about something to go to the right source to answer your questions and concerns. Therefor feeling comfortable to perform the task as asked.