[LPN01112005]

To be clear, I have worked in the hospital med surg unit. We were "total care", there were no CNA's, so the nurses did work as a team to provide all the care necessary to care for the patients. However, what I'm referring to here is a LTC setting where there are two LPN's and 5 CNA's assigned to 66 residents, 90% if whom are totally dependent with ADL's. The LPN's pass meds and assess the residents. The CNA's do all the ADL's, turning, toileting, incontinent care, feeding. So, although I have the skills necessary to "know how" to do the job, that doesn't necessarily mean that I can be effective or safe in a job I've never done before. To be clear, this is not about me not wanting to change incontinent briefs. I help out with that on a near daily basis even though I am in an administrative position. My concern comes with the transferring, bathing, etc. of immobile residents. I don't feel comfortable being thrown into a situation that has the potential to be harmful to me and to the resident. Ultimately, I am responsible for any assignment I accept, so I'm probably not going to be accepting this "assignment" out of fear that I'll jeopardize the resident and in turn, my license.

Another thing, what about being forced into a subordinate position to those nurses that I supervise on a daily basis? Exactly who is the supervisior? Are they without one? How do I take on the role of nursing assistant to a nurse that I am actually supervisor to?

[racing-mom4]

Originally Posted by LPN01112005

To be clear, I have worked in the hospital med surg unit. We were "total care", there were no CNA's, so the nurses did work as a team to provide all the care necessary to care for the patients. However, what I'm referring to here is a LTC setting where there are two LPN's and 5 CNA's assigned to 66 residents, 90% if whom are totally dependent with ADL's. The LPN's pass meds and assess the residents. The CNA's do all the ADL's, turning, toileting, incontinent care, feeding. So, although I have the skills necessary to "know how" to do the job, that doesn't necessarily mean that I can be effective or safe in a job I've never done before. To be clear, this is not about me not wanting to change incontinent briefs. I help out with that on a near daily basis even though I am in an administrative position. My concern comes with the transferring, bathing, etc. of immobile residents. I don't feel comfortable being thrown into a situation that has the potential to be harmful to me and to the resident. Ultimately, I am responsible for any assignment I accept, so I'm probably not going to be accepting this "assignment" out of fear that I'll jeopardize the resident and in turn, my license.

Another thing, what about being forced into a subordinate position to those nurses that I supervise on a daily basis? Exactly who is the supervisior? Are they without one? How do I take on the role of nursing assistant to a nurse that I am actually supervisor to?

I guess I just dont get it, do you not think you can transfer a patient safely to the bathroom? Safe transferring is part of basic nursing skills, bathing is also part of basic nursing care, so you must be skilled in this area, so you would be fine working in that role.

As far as supervising, if you were there working as a CNA, you would not be the supervisor per say. Iam assuming someone else would be taking on the role of "supervisor" during that shift. Or their would be no supervisor that shift, many times our "supervisor" is not on the unit, but we have a house supervisor that we can utilize. FYI our nursing mgr many of times has taken on the CNA role if a CNA called in.

In my opinion it sounds to me like you dont want to be one of 5 CNAs taking care of 66 patients. I would not either, but what a wonderful opportunity it would be for you as a supervisor to see how challenging the CNAs role is in your facility. Maybe if you take on this challenge you as a supervisor can implement some much needed changes, and you will have 1st hand experience to draw from.
Also---I cant help but think your subordinate nursing staff would have an increased respect for you to take on this challenging role.
I think it would be a wonderful opportunity for you.

[racing-mom4]

Another thought I have is, if I heard through the grape vine that one my nursing supervisors refused to work as a CNA, my respect for her would plummet. My 1st thought would be "oh is she too good to do CNA work?"
That is just my
I really hope you reconsider.

[JeanineLPN1984]

It has happened a few times over 23 years, but I volunteered. One Mothers Day we were so short, I took an assignment with 10 patients and the supervisor took my medcart. We actually had a blast, all my patients got showers that day and the supervisor ( she was 70 and hadnt passed meds in a longtime) said she hadnt had such a good time in a while, by the afternoon the remaining aides split my patients and I did the treatments. We got it all done and it was fun that day.

[michelle126]

As an RN, I've done it on an 11-7 shift. I would love to be able to do it more often, just for the change of pace and hands on care. You see and learn so much more about your residents, families and cna team.

I think I see your point about the safety part of it. CNA work in LTC is back breaking. If you haven't done it in a while..you are out of shape. Honestly...I help out all the time, but doing it for a complete shift....wow. CNAs are just about the strongest bunch of workers I know. Also...Some nurses don't know how to properly lift and transfer residents. Yes....they should know this, but you watch some of them and no wonder they get hurt.
As far as other nurses supervising you in when you work as a CNA...you are still a licensed nurse, so if you mess up...yes, you would be under your LPN or RN licenses. AS a CNA..you would still need to take direction from the supervising nurse. If they tell you so and so needs changed or please do XYZ...yeah..they are the boss that day.

[yajaira]

I agree, I don't see what the confusion is all about. i have worked as an NA on my unit basically because we had the staffing just no CNA. That means I am responsible for the duties of a CNA. As far as acting as an RN- I don't do anything for any patient without the permission of the RN with the assignment.

I say this for a few reasons. You can place both you (NA) and the RN in a compromising situation.

If a patient needs medication I need to inform that patient's nurse. They received report, they know how to care for their patient. I would ask 'do you want me to see if the patient has something ordered? Would you like me to give it?" If so, I do and document it as an RN

It really isn't that big of a deal. Some nurses don't feel comfortable doing that and that's ok too. then just stick with patient care, vital signs etc, all things we were taught in nursing school.

[MichaelFloridaRN]

Originally Posted by Tanzanite

I am an RN and I fill in on call for CNA's when needed. CNA duties are ultimately the nurses resposibility, so yes we do have this situation as well. I don't mind, I get paid the same RN wages.

Same here, I really love it when I do more real hands on work and less paper work.

[suespets]

yes, been there I refused. once u do it, they expect u to do it more often, It's not a good idea,one reason, the cnas eventually demean your authority, when u are working as an lpn. also, if they can get lpns to do it, they won't they very hard to hire more needed cnas. It's not that your better than the cna, but hey,you got your lpn to be an lpn. my don tried the guilt trip w/ me, didn't work. all we lpns met w/ don re this, & no one has been told their working as an cna since!!!!!!!!!

[jjjoy]

Originally Posted by suespets

yes, been there I refused. once u do it, they expect u to do it more often, It's not a good idea,one reason, the cnas eventually demean your authority, when u are working as an lpn. also, if they can get lpns to do it, they won't they very hard to hire more needed cnas. It's not that your better than the cna, but hey,you got your lpn to be an lpn. my don tried the guilt trip w/ me, didn't work. all we lpns met w/ don re this, & no one has been told their working as an cna since!!!!!!!!!

I don't understand why they would want the nurses to take the full NA role for a full shift more often. It costs them more to have the nurse do that than for the NA so they'd be wasting money to put off hiring a NA because the nurses are filling in.

In regard to NAs "demeaning your authority", that's not necessarily the case. In fact, they may be more respectful because they know that you understand just how heavy their workload is.

[LPN01112005]

Ok, I did it. I worked as a CNA last evening/night with a resident load of 17 due to another unexpected CNA call out. I was also the supervisor on duty. I was able to get everyone changed, toileted and put to bed without any injuries to myself or the residents. I was NOT able to adhere to the turn schedule, and the residents did not get changed q2h. Nor was I able to spend enough time with the residents who required feeding to get them to eat more than a bite or two. The LPN was busy passing her medication and dealing with the behaviors. She simply didn't have time to assist me so we could have "fun" making sure the residents were properly cared for. Add to this the fact that I was still the supervisor on duty and had all those fires to put out too. Most notably, trying to find staff to cover the call outs for the overnight shift, however I was unsuccessful, so I had to stay until 4 a.m. As soon as I got home and got to sleep, I get a call....someone has called out for 7AM, they were already short, I need to come back in. This time to cover for a nurse who called out. Are you kidding me? Can one on call person be expected to cover for the entire facility?