59A-18.0081. Certified Nursing Assistant and Home Health Aide

The certified nursing assistant (CNA) and the home health aide shall:

(1) Be limited to assisting a patient in accordance with Section 400.506(6)(b), F.S.;

(2) Be responsible for documenting services provided to the patient or client and for filing said documentation with the nurse registry on a regular basis. These service logs will be stored by the nurse registry in the client’s file. The service logs shall include the name of the patient or client and a listing of the services provided;

(3) Be responsible for observing appearance and gross behavioral changes in the patient and reporting these changes to the patient’s health care surrogate or other person designated by the patient and the nurse registry or to the responsible facility employee if staffing in a facility;

(4) Be responsible to maintain a clean, safe and healthy environment, which may include light cleaning and straightening of the bathroom, straightening the sleeping and living areas, washing the patient’s dishes or laundry, and such tasks to maintain cleanliness and safety for the patient;

(5) Perform other activities as taught and documented by a registered nurse, concerning activities for a specific patient and restricted to the following:

(a) Assisting with the placement or removal of a colostomy bag, excluding the removal of the flange or manipulation of the stoma’s site;

(b) Assisting with the application and removal of anti-embolism stockings and hosiery prescribed for therapeutic treatment of the legs.

(c) Assisting with the use of devices for aid to daily living such as a wheelchair or walker;

(d) Assisting with prescribed range of motion exercises;

(e) Assisting with prescribed ice cap or collar;

(f) Administer simple urine tests for sugar, acetone or albumin;

(g) Assisting with the use of a glucometer to perform blood glucose testing;

(h) Measuring and preparing special diets;

(i) Measuring intake and output of fluids;

(j) Measuring vital signs, including temperature, pulse, respiration or blood pressure;

(k) Assisting with oxygen nasal cannulas and continuous positive airway pressure (CPAP) devices, excluding the titration of the prescribed oxygen levels; and

(l) Assisting with the reinforcement of dressing.

(6) A home health aide or CNA shall not perform the following activities:

(a) Administer any nursing or therapeutic service that requires licensure as a health care professional;

(b) Change sterile dressings.

(c) Irrigate body cavities such as giving an enema;

(d) Perform irrigation of any wounds (such as vascular ulcers, diabetic ulcers, pressure ulcers, surgical wounds) or apply agents used in the debridement of necrotic tissues in wounds of any type;

(e) Perform a gastric irrigation or enteral feeding;

(f) Catheterize a patient;

(g) Administer medications;

(h) Apply heat by any method;

(i) Care for a tracheotomy tube;

(j) Provide any service which has not been included in the plan of treatment; or,

(k) Providing assistance with a pill organizer, such as removing medication from a pill organizer and placing the medication in the patient’s hand or filling a pill organizer with the patient’s medication(s).

(7) CNA Qualifications.

(a) For every CNA, a nurse registry shall have on file a copy of the person’s State of Florida certification.

(b) Individuals who earn their CNA certificate in another state must contact the Florida Department of Health, Board of Nursing to inquire about taking the written examination prior to working as a CNA in Florida, pursuant to chapter 464, part II, F.S.

(c) A CNA may work as a home health aide.

(8) Home Health Aide Qualifications.

(a) For every home health aide registered with the nurse registry since May 4, 2015, a nurse registry shall have on file a certificate or documentation of successful completion of at least forty hours of home health aide training, pursuant to section 400.506(6)(a), F.S., from a public vocational technical school or a nonpublic post-secondary educational institution approved by the Florida Department of Education, Commission for Independent Education.

(b) Home health aides registered with the nurse registry since May 4, 2015 who complete their training in another state must provide a certificate of completion of home health aide training from a vocational technical school or a post-secondary educational institution licensed in that state.

(9) CNAs and home health aides referred by nurse registries must maintain a current cardiopulmonary resuscitation (CPR) certification from an instructor or training provider that is approved to provide training by the American Heart Association, the American Red Cross, or the Health and Safety Institute, and that provides CPR training in which the student is required to demonstrate, in person, that he or she is able to perform cardiopulmonary resuscitation.

(10) Licensed practical nurses and registered nurses that are licensed in Florida or another state may work as home health aides. Also, persons who have completed the licensed practical nurse or registered nurse training from a public school, college, or university or a nonpublic post-secondary educational institution approved by the Florida Department of Education, Commission for Independent Education but are not yet licensed may work as home health aides.

(11) CNAs and home health aides referred by nurse registries may assist with self-administration of medication as described in Section 400.488, F.S.

(a) Home health aides and CNAs assisting with self-administered medication, as described in Section 400.488, F.S., shall have received a minimum of 2 hours of training covering the following content:

1. Training shall cover state law and rule requirements with respect to the assistance with self-administration of medications in the home, procedures for assisting the resident with self-administration of medication, common medications, recognition of side effects and adverse reactions and procedures to follow when patients appear to be experiencing side effects and adverse reactions. Training must include verification that each CNA and home health aide can read the prescription label and any instructions.

2. Individuals who cannot read shall not be permitted to assist with prescription medications.

(b) Documentation of training on assistance with self-administered medication from one of the following sources is acceptable:

1. Documentation of 2 hours of training in compliance with subsection 59A-8.0095(5), F.A.C., from a home health agency if the home health aide or CNA previously worked for the home health agency;

2. A training certificate for assisted living facility staff in compliance with Section 429.52(6), F.S.;

3. A training certificate for at least 2 hours of training from a post-secondary educational institution approved by the Florida Department of Education;

4. Documentation of at least 2 hours of training by a provider approved by the Florida Department of Health, Board of Nursing.

(c) Documentation of the training must be maintained in the file of each home health aide and CNA. who assists patients with self-administered medication.

(d) In cases where a home health aide or a CNA will provide assistance with self-administered medications as described in Section 400.488, F.S., and paragraph (e) below, an RN shall conduct an assessment of the patient and patient’s medications for which assistance is to be provided to ensure that a patient receiving such assistance is medically stable and has regularly scheduled medications that are intended to be self administered as required in s. 400.488(2), F.S. and the CNA and home health aide are able to assist in accordance with their training and with the medication prescription. If the patient will not consent to a visit by the nurse to conduct an assessment, a written list with the dosage, frequency and route of administration shall be provided by the patient or the patient’s health care surrogate, family member, or person designated by the patient to the home health aide or CNA to have reviewed by the nurse. The patient or the patient’s surrogate, guardian, or attorney in fact must give written consent for a home health aide or C.N.A. to provide assistance with self-administered medications, as required in Section 400.488(2), F.S.

(e) The trained home health aide and CNA may also provide the following assistance with self-administered medication, as needed by the patient and as described in Section 400.488, F.S.:

1. Prepare necessary items such as juice, water, cups, or spoons to assist the patient in the self-administration of medication,

2. Open and close the medication container or tear the foil of prepackaged medications,

3. Assist the resident in the self-administration process. Examples of such assistance include the steadying of the arm, hand, or other parts of the patient’s body so as to allow the self-administration of medication,

4. Assist the patient by placing unused doses of solid medication back into the medication container.

(12) Pursuant to section 400.506(19), F.S., a nurse registry may not monitor, supervise, manage, or train a registered nurse, licensed practical nurse, certified nursing assistant, companion or homemaker, or home health aide referred for contract under this chapter.  In the event of violation of state laws that comes to the attention of the nurse registry, the nurse registry shall take action in accordance with section 400.506(19), F.S. A nurse registry is not prohibited from reviewing records and may do so per section 400.506(20), F.S.

Rulemaking Authority 400.488, 400.497, 400.506 FS. Law Implemented 400.488, 400.497, 400.506 FS. History–New 1-27-94, Amended 12-24-00, 8-10-06, 3-15-07, 5-4-15, 2-8-16, 1-11-24.