CERTIFIED NURSE AIDE SCOPE OF PRACTICE: IMPACT ON QUALITY OF CARE, NURSING AIDE BELIEFS, AND CLINICAL PRACTICE.

Older adults utilize more health care services than various other populations due to the complex nature of their health care needs. As acuity in health conditions increase, experienced care providers such as Certified Nurse Aides (CNAs) will be needed to offer hands-on care including care for the treatment of complex conditions. CNAs are essential caregivers, providing care that directly impacts resident outcomes. CNAs are currently only trained to provide a basic level of care and are not permitted to handle complex care tasks. CNAs do not have a scope of practice but manage care under the guidance of the 42 CFR � 483. There is not a clear understanding of what are the allowable delegated activities for the CNA beyond that of the basic skills. The variation of allowable care tasks per state may result in confusion of what are the overall CNA job roles or scope. This dissertation described what are the allowable delegated activities for CNAs working in nursing facility settings. Further, this work determined if there was a difference in the clinical outcomes in states that had a basic versus states that had an expanded scope of practice for CNAs, and this dissertation described the self-efficacy expectations and care tasks performed among CNAs. Findings suggest that all states within the United States allow CNAs to manage basic care tasks, and 11 states allow CNAs to manage expanded care tasks. Findings also indicate that there was no difference in clinical outcomes, specifically the outcomes of ADLs, falls with major injury, restraint use, and pain when compared to the allowable care tasks managed by CNAs in each state. Finally, CNAs who worked in states that allowed for expanded care tasks had a stronger self-efficacy for performing expanded tasks when compared to CNAs who worked in states that only allow CNAs to manage basic tasks