Duty of care, scope of practice and accountability for care staff

For CNAs, LPNs, medical assistants, DSPs and home health aides: know your duty, stay within your scope, accept delegation safely and report what you must.

For: CNAs, LPNs, medical assistants, direct support professionals and home health aides

  • 2 contact hours
  • 8 modules
  • 9 interactives
  • 4 job aids
  • Updated October 11, 2026

What you will be able to do

  • Explain duty of care and the four elements of negligence (duty, breach, causation and harm) as they apply to care work.
  • Determine whether a task is within your scope of practice using state law, training, job description, employer policy and the care plan.
  • Apply the NCSBN/ANA five rights of delegation and your responsibilities as a delegatee, including when to decline.
  • Balance duty of care with a person's rights and choices, including refusals and risky choices, without coercion.
  • Report incidents, near misses, abuse, neglect and suspected crimes within required timelines, including 42 CFR 483.12(c) and Section 1150B, and describe protections against retaliation.
  • Document accurately and maintain professional accountability, including boundaries, social media and current competence.

Learn what duty of care means in everyday care work, how negligence happens, where your scope of practice comes from, and how delegation works under the NCSBN/ANA National Guidelines for Nursing Delegation (2019). You will practice saying no safely, balancing duty of care with a person's right to choose, reporting incidents and near misses, and meeting federal abuse and crime reporting deadlines.

Written for nurse aides, LPNs, medical assistants, direct support professionals and home health aides in nursing homes, assisted living, clinics, group homes and home care. Every module uses realistic U.S. scenarios and explains what is yours to do, what belongs to the licensed nurse or provider, and how state rules differ.

Scope and accountability questions come up every shift: a task you haven't been trained for, a busy nurse asking for help, a resident who refuses care, a coworker's mistake. This course gives you a clear way to think through them, tied to 42 CFR 483.12, Section 1150B of the Social Security Act and state nurse practice acts.

What you’ll be able to do Monday morning

  1. Run the four scope questions before doing any new or unusual task.
  2. Ask the nurse what to report, and when, for every delegated task.
  3. Respond to refusals by informing, offering options, reporting and documenting, never forcing.
  4. Report near misses as well as incidents before the end of your shift.
  5. Know the 2-hour and 24-hour reporting clocks and your facility's Section 1150B process.

Curriculum

8 modules · 24 lessons · about 2 contact hours

01What does duty of care mean for care workers?Free preview14 min
  1. Duty of care in plain language
  2. To whom do you owe a duty, and when?
  3. Why duty of care matters for workers too
  • Sort activity: Whose task is it?

Diagram · In practice checklist · 2-question knowledge check

02What is negligence, and how do small lapses become harm?14 min
  1. The four elements of negligence
  2. Acts and omissions
  3. Documentation as evidence
  • Spot the issue: Spot the problems in an incident report

Diagram · In practice checklist · 2-question knowledge check

03What is scope of practice, and where does it come from?15 min
  1. What scope of practice means
  2. Nurse aides, registries and competence
  3. How to check scope, and how to say no
  • Decision tree: Can I do this task?

Diagram · In practice checklist · 2-question knowledge check

04How does delegation work, and what are your responsibilities as a delegatee?14 min
  1. Delegation versus assignment
  2. The five rights of delegation
  3. Your responsibilities as a delegatee
  • Spot the issue: Spot the problems in a delegation handoff

Diagram · In practice checklist · 2-question knowledge check

05How do you balance duty of care with a person's rights and choices?14 min
  1. Two duties that can pull in different directions
  2. A step-by-step approach
  3. Best interests, capacity and representatives
  • Branching scenario: Mr. Purcell's shower

Diagram · In practice checklist · 2-question knowledge check

06How do you report incidents, errors and near misses?13 min
  1. What counts as an incident or near miss?
  2. How to report well
  3. Accountability without fear
  • SBAR builder: SBAR: a possible missed medication

Diagram · In practice checklist · 2-question knowledge check

07What are your duties to report abuse, neglect and crimes?15 min
  1. Federal reporting rules in nursing homes
  2. Penalties, protection and state laws
  3. What Kelechi does next
  • Decision tree: Do I need to report this, and how fast?
  • State rules selector: Nurse aide renewal and continuing training: state examples

Diagram · In practice checklist · 2-question knowledge check

08How do documentation, boundaries and accountability fit together?13 min
  1. Professional accountability in everyday terms
  2. Professional boundaries and social media
  3. Putting it together: a scope and accountability checklist
  • Self-assessment: My accountability habits

Diagram · In practice checklist · 2-question knowledge check

Final assessment: 23 questions, 80% to pass, then your certificate

Try it now, no account needed

Mr. Purcell's shower

A branching scenario from this course. Your choices are not saved.

Free sample activity

Mr. Purcell's shower

You are Nadezhda Fomina, a CNA at an assisted living community in Florence, South Carolina. Mr. Augustine Purcell, 79, who has capacity, broke his wrist in a fall in the shower last month. His plan says standby assistance. Today he says, "I want to shower alone. I don't need a babysitter."

Inside the course

Practice activities

  • Sort activity1
  • Spot the issue2
  • Decision tree2
  • Branching scenario1
  • SBAR builder1
  • Self-assessment1
  • State rules selector1

Job aids you keep

  • Scope and Accountability Care ChecklistChecklist
  • SBAR and Stop-and-Watch Template: Scope, Incident or ChangeTemplate
  • Duty of Care and Scope Reflection WorksheetWorksheet
  • In-Service Sign-Off Record: Duty of Care, Scope and AccountabilityLog

Credit and approval status

Certificate of completion

This course awards a certificate of completion for 2 contact hours of instruction. It is not approved or accredited by any board of nursing, nurse aide registry, state agency or continuing education accreditor. Nursing homes plan their own nurse aide in-service programs, and states set their own rules for aide, medication aide, medical assistant and DSP training. Check with your employer, board or state agency whether this course meets your specific requirement.

Pathways we may pursue include review by state agencies that accept nurse aide in-service content and nursing continuing professional development accreditation. None of these approvals exists today; the course page will show an approval only after it is granted.

Our full approvals list

State notes

Scope of practice and reporting duties vary by state:

  • Nurse practice acts and board rules define what RNs and LPNs/LVNs may do and what they may delegate, to whom and in which settings.
  • Unlicensed staff: rules for nurse aides, medication aides, medical assistants, home care aides and DSPs differ, especially for medications, blood glucose checks, insulin, tube feedings and treatments.
  • Registries and renewal: states run nurse aide registries and set renewal requirements. For example, Nevada requires 24 hours of CNA-related continuing training per renewal period; New Hampshire requires LNAs to complete at least 12 contact hours per year; Tennessee requires verification of at least 8 hours worked in the past 24 months for registry renewal (see the state lookup in Module 7).
  • Adult protective services laws decide which workers must report suspected abuse, neglect or exploitation of vulnerable adults, to whom and how fast. Federal timelines in 42 CFR 483.12(c) and Section 1150B apply in certified nursing homes in every state.
  • Good Samaritan and duty-to-assist laws differ by state.

This is not a state-specific edition. Ask your employer, board of nursing or state agency which rules apply to your role.

Questions about this course

Does this course count toward continuing education or in-service hours?

This course awards a certificate of completion for 2 contact hours of instruction. It is not approved or accredited by any board of nursing, nurse aide registry or continuing education accreditor today. Many employers use courses like this in their in-service programs, but the employer decides what counts. Check with your employer, board or state agency before relying on it for a requirement.

Will this course tell me exactly what tasks I'm allowed to do?

No single course can, because scope depends on your state's laws, your credential, your training and your employer's policy. This course teaches a reliable way to check scope, gives general examples and explains delegation, so you know which questions to ask your nurse, supervisor or board.

Who is this course for?

CNAs, LPNs, medical assistants, direct support professionals and home health aides in nursing homes, assisted living, clinics, group homes and home care. LPNs will find the delegation content useful from both sides: as delegators to aides and as delegatees from RNs.

Does it cover abuse reporting requirements?

Yes, at an awareness level. It explains the federal nursing home reporting timelines in 42 CFR 483.12(c) and the Section 1150B crime reporting duty, and notes that state adult protective services laws add duties. A separate course covers elder abuse recognition and reporting in depth.

How long does it take, and how is it assessed?

Plan on about 2 hours across eight modules with scenarios, knowledge checks and a final assessment of 23 questions. You need 80% to pass and can retake the assessment if needed.

What will I receive?

A certificate of completion for 2 contact hours and four printable job aids: a scope and accountability checklist, an SBAR and stop-and-watch template, a reflection worksheet and an in-service sign-off record.

This course is general education and training awareness from CE Courses Hub on duty of care, scope of practice and professional accountability. It is not legal, medical or professional advice and does not replace your employer's policies, your state's nurse practice act and aide rules, your licensing board's or registry's rules, or advice from a qualified professional or attorney. Completing it earns a certificate of completion for the stated contact hours; it is not approved or accredited by any licensing board, state agency or accreditor unless an approval is shown on the course page. Check with your board, employer or state agency whether this course meets your specific requirement.