What an Ohio Nurse Aide May and May Not Do

This page describes how Ohio's rules are generally written. It is not legal advice, and it does not replace your employer's policies. On any real shift, the delegating nurse and the written care plan decide what a specific aide does for a specific resident or patient.

How Ohio defines the nurse aide's role

Ohio regulates nurse aide work in two places. The Ohio Department of Health's rules for nurse aide training programs, OAC chapter 3701-18, define what "nursing and nursing-related services" means when a nurse aide performs them. Rule 3701-18-01 describes those services as attending to people's personal care needs, providing personal care services, and carrying out activities assigned by a nurse (activities that do not require nursing assessment or the judgment of a nurse while they are being performed). The same rule says what that work excludes: anything requiring the specialized knowledge, judgment, and skill of a registered nurse, anything requiring the basic knowledge and skill of a licensed practical nurse, and anything Chapter 4723 of the Revised Code requires a licensed nurse to perform.

The second place is the delegation system run under the Ohio Board of Nursing. Nursing tasks move to unlicensed staff only by delegation: a licensed nurse transfers responsibility for one selected task to a person who has no independent authority to perform it (OAC 4723-13-01). Only a licensed nurse may delegate (OAC 4723-13-02), and a person who receives a delegated task may not hand it to anyone else (OAC 4723-13-03). In practice this is why a nurse aide always works under the supervision of a licensed nurse, and why the assignment sheet (not habit, and not a request from a family member) defines the job on a given day.

Chapter 3701-18 is written around long-term care settings and training programs. In hospitals, home care, and assisted living the numbers differ, but the boundary works the same way: tasks flow from a licensed nurse through delegation, and health-care settings require on-site direct supervision of delegated tasks (OAC 4723-13-07).

The three columns: may, may not, and it depends

A nurse aide may do

• Personal care: bathing, dressing, grooming, oral care, toileting, and helping residents eat and drink, following each person's care plan.
• Mobility support: transfers, walking, repositioning, and range-of-motion assistance as the care plan directs.
• Vital signs: taking and recording temperature, pulse, respirations, and blood pressure where the aide has been trained to do it and the task is allowed on the unit.
• Observation and documentation: reporting appetite, skin condition, mood, pain complaints, and any change in condition to the nurse, and recording what was observed, including intake and output.
• Safety work: answering call lights, following fall precautions, and completing safety checks under facility policy.

A nurse aide may not do

• Administer medications of any kind (pills, patches, eye drops, injections, or oxygen) unless holding a separate credential and supervision that specifically allow it (see the medication aide section below).
• Give injections or perform intravenous (IV) therapy.
• Run tube feedings or put anything through a nasogastric, gastrostomy, or jejunostomy tube.
• Perform sterile or invasive procedures, such as inserting urinary catheters, tracheostomy suctioning, or wound debridement.
• Assess, interpret, or decide. Nursing assessment, reading what vital signs or symptoms mean, and changing a plan of care belong to licensed staff.
• Take physician orders, accept verbal or telephone orders, or receive, transcribe, or alter a medication order.
• Re-delegate a task. An aide who receives a delegated task cannot pass it to another aide, student, or visitor (OAC 4723-13-03).

Depends on delegation and facility policy

Some tasks sit honestly in a middle column. Whether an aide performs them is not a matter of opinion. It is decided by the delegating nurse's documented decision and the facility's written policy. If the policy is silent, the task waits until a nurse answers the question.

• Blood glucose monitoring. Some facilities delegate finger-stick readings to trained aides with documented competency; others reserve meter work for licensed staff. Follow your facility's delegation and policy.
• Certain over-the-counter items. A licensed nurse may delegate only a narrow list: nonprescription topicals for intact skin, nonprescription eye drops, ear drops, suppositories, foot soaks, and enemas (OAC 4723-13-05). Anything beyond that list needs its own authorization.
• Help with self-administered medication. Reminding someone to take a medication, or handing them a labeled container, is permitted only in the limited situations rule 4723-13-02 describes, mainly in settings whose main purpose is not health care. Handing a person a dose to swallow is where the law draws the line.
• Repeats and simple rechecks. Taking a second temperature or reweighing a resident is fine when a nurse asks for it; doing it on your own initiative and charting conclusions is not.

The medication aide exception (MA-C)

Ohio creates one specific way a certified nurse aide moves into medication administration: a separate certificate as a medication aide, issued by the Ohio Board of Nursing under section 4723.651 of the Revised Code, with program and practice rules at OAC chapter 4723-27. It is a distinct credential, not an upgrade that happens automatically with time on the job.

Under ORC 4723.67, a certified medication aide may administer prescription medications to residents of nursing homes and residential care facilities, only under the supervision of a registered nurse or a licensed practical nurse acting at the registered nurse's direction. The allowed methods are oral doses, topical applications, drops and sprays to the eye, ear, or nose, and rectal or vaginal insertion. As-needed medications and first doses are permitted, and Schedule II drugs may be given only by mouth or topically.

The limits stay firm even with the certificate. Rule 4723-27-02 bars a medication aide from anything requiring dosage calculations, from injections except insulin given with a pen device that shows the dose after employer-provided training and competency verification, from IV therapy, from pill splitting, from administering anything through a feeding tube, from oxygen, from giving medications to pediatric residents, and from receiving, transcribing, or altering a medication order.

Where the CNA line sits on the career ladder

• Nurse aide (CNA). Personal care and delegated tasks that take no nursing judgment, under licensed supervision (OAC 3701-18-01; OAC ch. 4723-13).
• Certified medication aide. Everything above, plus a supervised medication pass in nursing homes and residential care facilities, on the board of nursing certificate (ORC 4723.67; OAC ch. 4723-27).
• Licensed practical nurse. Licensed practice carried out at the direction of a registered nurse, including administering medications and treatments and delegating tasks only as the registered nurse directs (ORC 4723.01(F)).
• Registered nurse. Independent licensed practice: assessing health status, building and evaluating the plan of care, supervising, and making the delegation decisions (ORC 4723.01(B)).

Frequently asked questions

Can an Ohio CNA give medications?

Not as part of the nurse aide role. Medication administration is licensed-nurse work, and the nurse aide definition expressly excludes it. The single exception is the separate certified medication aide credential, which permits supervised medication administration in nursing homes and residential care facilities under ORC 4723.67 and OAC chapter 4723-27. Assisting a resident who self-administers, in the narrow ways rule 4723-13-02 allows, is not administration.

Who decides which tasks I may perform on a shift?

A licensed nurse does. Delegation is the nurse's decision, made against the criteria in OAC 4723-13-05: the task must have predictable results, be performable by exact, unchanging directions, need no complex observation or critical decision, and carry minimal consequences if done wrong. The nurse names the individual and the time frame, stays accountable for the decision, and must intervene immediately if a delegated task is being performed incorrectly. Your care plan, assignment sheet, and facility policy turn that into your daily work.

Does taking vital signs cross my scope?

Measuring and recording vital signs is standard nurse aide work when you have been trained and the task is allowed on your unit. What an aide does not do is interpret: deciding that a blood pressure is "fine" or that a fever can wait is assessment and judgment, which belongs to the nurse. Record the number, report it, and let licensed staff draw conclusions.

What happens if a task is performed outside this line?

Rule 4723-13-03 treats an unlicensed person performing nursing tasks outside the delegation rules as engaging in the unauthorized practice of nursing, which ORC 4723.03 prohibits. For the licensed side, a nurse who delegates improperly faces board discipline, and facilities face survey deficiencies when assignments ignore the rules. When a request feels outside the line, the protective move is the same either way: stop, and ask the supervising nurse before continuing.