In North Carolina, the CNA II scope of practice covers delegated nursing tasks that require sterile technique in three clinical areas: elimination, oxygenation, and nutrition, along with limited wound care. The role is defined by 21 NCAC 36 .0403 and enforced by the North Carolina Board of Nursing (NCBON).1North Carolina Office of Administrative Hearings. 21 NCAC 36 .0403 An NA II is unlicensed assistive personnel, so every task is a delegated extension of a licensed nurse’s care, never independent practice.
What a CNA II Can Do
The NCBON publishes a specific task list that spells out what the role covers.2North Carolina Board of Nursing. Nurse Aide II Task List The tasks group into three categories plus wound care.
Oxygenation
An NA II may set up oxygen equipment in a patient’s room and monitor flow rates according to established orders. They perform oropharyngeal and nasopharyngeal suctioning to clear a patient’s airway, and they provide tracheostomy care.
Elimination
The elimination category covers inserting and maintaining urinary catheters and managing complex bowel care, including the manual removal of fecal impactions.
Nutrition
NA IIs handle care and feeding associated with gastrostomy tubes, delivering nutrition through these devices according to the care plan.
Wound Care
Wound care is part of the role, but with firm limits. 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 Debridement is not permitted (see below).
What a CNA II Cannot Do
Knowing the ceiling matters as much as knowing the floor. Several tasks that aides in other states or other roles may perform fall outside the North Carolina NA II scope.
Medications. The NA II role does not include administering prescription or over-the-counter medications, giving injections, or managing IV lines. North Carolina does not have a “medication aide” pathway that expands the NA II into drug administration.
Wound debridement. The NCBON explicitly prohibits delegating wound debridement to any unlicensed assistive personnel, including NA IIs. Topical medications used specifically for debridement are also off-limits. Only registered nurses and licensed practical nurses may perform debridement.3North Carolina Board of Nursing. Wound Care: Assessment and Debridement Position Statement
Nursing assessment. Assessment stays with licensed nurses. An NA II can collect data points such as vital signs and report observations, but interpreting those findings and making clinical judgments about a patient’s condition falls outside the scope entirely. If a task requires clinical judgment beyond following established protocols, it belongs to the RN or LPN.
Independent practice. An NA II never works without a licensed nurse’s delegation and supervision. Nothing on the task list is self-initiated.
Conditions Attached to Every Authorized Task
Being on the NA II registry does not, by itself, mean you can perform every task on the list in every setting. Before any delegated task is appropriate, three things must line up.
A licensed nurse must first assess the patient and decide that delegation to the NA II is appropriate under the circumstances. Under 21 NCAC 36 .0403, that decision takes into account the variables in Rule .0401, including patient stability, the complexity of the task, and the aide’s competency.1North Carolina Office of Administrative Hearings. 21 NCAC 36 .0403
The facility’s written policies must permit the specific task. Even if the regulation allows it, the employer has to authorize it.
The individual NA II must have received formal training and competency validation from an RN for that specific procedure.3North Carolina Board of Nursing. Wound Care: Assessment and Debridement Position Statement Blanket NA II training is not a substitute for sign-off on a particular skill.
Both RNs and LPNs may delegate nursing care activities to unlicensed personnel. The RN carries full accountability for delegation decisions under 21 NCAC 36 .0224. An LPN may also delegate under 21 NCAC 36 .0225, though the level of supervision the LPN themselves receives depends on whether the patient’s condition is stable or unpredictable.4Cornell Law Institute. 21 NC Admin Code 36 .0225 – Components of Nursing Practice for the Licensed Practical Nurse In practice, a licensed nurse must be physically available in the facility whenever an NA II is performing delegated tasks, and for more complex or higher-risk procedures the supervising nurse may need to directly observe the task. Responsibility for the care outcome stays with the licensed nurse regardless of who performed the procedure.
What Happens if You Work Outside the Scope
Working outside these boundaries creates risk for both the aide and the supervising nurse. The NCBON can investigate scope-of-practice violations and take action against the NA II’s registry listing. The nurse who improperly delegated the task also faces potential disciplinary consequences from the Board.
The NA II Credential Does Not Transfer
One point worth flagging if you are moving into or out of the state: the NA II listing is non-transferable. The NCBON states that it cannot be transferred to or from North Carolina.5North Carolina Board of Nursing. Nurse Aide II An advanced nurse aide credential from another state does not authorize practice in the NA II scope here, and an NC NA II listing will not follow you elsewhere. Terminology, scope, and qualifications for advanced aide roles differ significantly across state lines, so the North Carolina scope described above applies only in North Carolina.