The CNA II scope of practice in North Carolina covers advanced nursing tasks that a licensed nurse delegates to the aide, centered on sterile technique in three areas: oxygenation, elimination, and nutrition. The role sits under the North Carolina Board of Nursing (NCBON) and is defined by 21 NCAC 36 .0403.1North Carolina Office of Administrative Hearings. 21 NCAC 36 .0403 Everything an NA II does is a delegated extension of nursing care, not independent practice, and the boundaries around the role are enforced by the Board.
What an NA II Is Allowed To Do
The NCBON publishes a specific task list for the NA II role.2North Carolina Board of Nursing. Nurse Aide II Task List The authorized tasks fall into a few clear categories.
For oxygenation, an NA II may set up oxygen equipment in a patient’s room and monitor flow rates according to established orders. They may perform oropharyngeal and nasopharyngeal suctioning to clear a patient’s airway, and they provide tracheostomy care.
For elimination, the scope covers inserting and maintaining urinary catheters and managing complex bowel care, including the manual removal of fecal impactions.
For nutrition, an NA II handles care and feeding through gastrostomy tubes, delivering nutrition according to the care plan.
Wound Care, With Limits
Wound care is part of the role, but the boundaries are strict. An NA II may perform sterile dressing changes and cleansing wound irrigations on stable wounds that are more than 48 hours old.3North Carolina Board of Nursing. Wound Care: Assessment and Debridement Position Statement Wound debridement is off-limits. The NCBON explicitly prohibits delegating debridement to any unlicensed assistive personnel, including NA IIs, and topical medications used specifically for debridement are also prohibited. Only RNs and LPNs may perform debridement procedures.
What Every Authorized Task Requires
No task on the list happens automatically. Before an NA II performs any of these procedures, a licensed nurse must assess the patient and decide that delegation is appropriate. Facility policy must permit the specific task, and the individual aide must have received formal training and competency validation from an RN for that procedure.3North Carolina Board of Nursing. Wound Care: Assessment and Debridement Position Statement The NA II does not choose which procedures to perform.
What an NA II Cannot Do
Several tasks sit firmly outside the scope, and the list matters because scope violations put both the aide and the delegating nurse at risk.
An NA II cannot administer prescription or over-the-counter medications, give injections, or manage IV lines. North Carolina does not have a medication aide pathway that extends the NA II role into drug administration.
An NA II cannot perform a nursing assessment. Collecting data points such as vital signs and reporting observations is fine, but interpreting those findings and making clinical judgments about a patient’s condition stays with the licensed nurse. If a task requires clinical judgment beyond following an established protocol, it belongs to the RN or LPN.
An NA II cannot perform wound debridement in any form, as noted above.
Supervision Is Not Optional
An NA II never works independently. Under 21 NCAC 36 .0403, a licensed nurse must delegate each task after weighing the patient’s stability, the complexity of the task, and the competency of the aide.1North Carolina Office of Administrative Hearings. 21 NCAC 36 .0403 Both RNs and LPNs can delegate nursing care activities to unlicensed personnel, with the RN carrying full accountability for delegation decisions.4Cornell Law Institute. 21 NC Admin Code 36 .0225 – Components of Nursing Practice for the Licensed Practical Nurse
Practically, a licensed nurse must be available in the facility while an NA II performs delegated tasks. For higher-risk procedures, the supervising nurse may need to directly observe the task. Responsibility for the outcome stays with the delegating nurse regardless of who performed the procedure.
What Happens if You Work Outside the Scope
Scope-of-practice violations are not paperwork problems. The NCBON can investigate and take action against the NA II’s registry listing. The supervising nurse who delegated an improper task also faces potential disciplinary consequences from the Board. That shared exposure is why facilities require documented competency on each task and why nurses check the registry before delegating.
An NA II Listing Does Not Cross State Lines
The NA II credential is tied to North Carolina. Unlike the Nurse Aide I credential, the NA II listing cannot be transferred to or from the state.5North Carolina Board of Nursing. Nurse Aide II If you hold an advanced nurse aide credential from another state and move to North Carolina, you will need to complete a Board-approved NA II program here and apply for a new listing. A North Carolina NA II listing will not follow you to another state either, and terminology and scope for advanced aide roles differ significantly elsewhere.