Yes, a CNA can change a colostomy bag in Florida, but the authority is narrow. Under Florida Administrative Code Rule 59A-18.0081, a certified nursing assistant may assist with placing or removing the pouch for a specific patient after a registered nurse has taught the procedure and documented the CNA’s competency.1Legal Information Institute. Florida Administrative Code R 59A-18.0081 – Certified Nursing Assistant and Home Health Aide The CNA cannot remove the flange, cannot manipulate the stoma site, and cannot irrigate the colostomy. Those tasks require a licensed nurse.
What the Pouch Rule Actually Covers
The rule draws its line at the adhesive skin barrier. Placing or removing the pouch itself is within reach for a trained CNA. Anything touching the flange or the stoma is not.1Legal Information Institute. Florida Administrative Code R 59A-18.0081 – Certified Nursing Assistant and Home Health Aide
Emptying or draining a pouch that’s already attached sits in a different category. Florida’s CNA training curriculum treats monitoring and assisting with drainage of colostomy and urostomy bags as a standard skill, so routine emptying is part of everyday CNA care and doesn’t require special patient-specific delegation.
If a CNA notices redness, bleeding, unusual discharge, or a change in the appearance of the stoma during a bag change, the task stops there. Assessing peristomal skin is a nursing judgment, not a CNA function, and the supervising nurse needs to be notified.
What Is Off Limits
Colostomy irrigation, which involves flushing fluid into the stoma to regulate bowel movements, is explicitly prohibited. It falls under the broader ban on irrigating body cavities.1Legal Information Institute. Florida Administrative Code R 59A-18.0081 – Certified Nursing Assistant and Home Health Aide The same rule also bars CNAs from changing sterile dressings, irrigating wounds, catheterizing patients, caring for a tracheotomy tube, administering medications outside narrow delegated exceptions, and performing any service that requires health care licensure.
The RN Training Requirement Is Patient-Specific
The administrative code phrasing does real work: the CNA must be “taught and documented by a registered nurse, concerning activities for a specific patient.”1Legal Information Institute. Florida Administrative Code R 59A-18.0081 – Certified Nursing Assistant and Home Health Aide A generic in-service on ostomy care doesn’t satisfy it. The RN has to train the CNA on that patient’s appliance, body, and care plan. Training on one resident’s two-piece system does not clear the CNA to change a different resident’s one-piece appliance.
The CNA then has to demonstrate competency, and the RN documents that demonstration before the CNA works independently. The RN can revoke the delegation at any time if the patient’s condition changes or the CNA’s technique slips.
How the Delegation Decision Gets Made
Only a registered nurse has authority to delegate this task. An LPN cannot. Florida Statute 464.0156 requires the RN to confirm, among other things, that the task follows an established sequence, produces a predictable outcome, and does not require ongoing clinical assessment or endanger the patient.2The 2025 Florida Statutes. Florida Statutes 464.0156 – Delegation of Duties
A stable, long-term ostomy patient with healthy peristomal skin can meet those conditions. A patient with frequent stoma complications, irritated skin, or an irregularly shaped stoma probably cannot, and in that situation the RN should handle bag changes personally rather than delegate.2The 2025 Florida Statutes. Florida Statutes 464.0156 – Delegation of Duties
What Happens if a CNA Steps Over the Line
A CNA who irrigates a colostomy, removes a flange, or manipulates the stoma is performing a prohibited task, and the Board of Nursing can act under Florida Statute 464.204.3The 2025 Florida Statutes. Florida Statutes 464.204 – Denial, Suspension, or Revocation of Certification Available penalties include:
- Suspension or revocation of CNA certification
- Administrative fines up to $150 per offense
- Probation or practice restrictions, which may include mandatory retraining
The fine looks small on its own. Losing certification does not: it ends the ability to work as a CNA anywhere in Florida. The RN who delegated the task inappropriately faces separate exposure under nursing practice standards, and if a patient is harmed, civil liability can follow for both.
When a CNA is asked to do something outside the boundaries above, the safe response is to decline, explain why, and notify the supervising RN. Documenting the refusal protects the CNA if the situation escalates.