RNs filling in for CNAs when a CNA calls out

anotherone, BSN, RN · Apr 13, 2012

TO me that is really stupid and a misuse of staff. I work in med surg, we are short aides often, if there is an extra nurse and we are short aides than instead of having that nurse be pooled or canceled we all get one less patient! and help each other, anything else is NONSENCE

Meriwhen, ASN, BSN, MSN, RN · Apr 13, 2012

I have had to serve as a mental health tech a few times due to staffing issues. We did things a bit differently though...all staff received the same report (essentially a nursing report), and even though patients were assigned to different staff, there was no "it's not my patient!" mentality: if you were free to help any patient, you did.

As far as paperwork went, I wasn't put down as the tech for the day; I was a RN whose assignment happened to be tasking for the unit.

I didn't mind as long as I got my RN pay :) And some days, it was a nice change of pace to be closer to the front lines.

To be honest, I feel that all nurses should have to do a couple of shifts as the CNA/aide/tech. It will give them a better appreciation of what these roles do and how they are as important to patient care as the nurse is. And perhaps walking a couple of miles in the tech's shoes may cause the nurse to rethink how they treat their supporting staff.

dudette10, MSN, RN · Apr 13, 2012

Is it the CNA role at RN pay? That's a waste of money to me. An agency CNA would probably be cheaper than an employee RN.

If it's CNA and RN role, i.e. you are the primary RN without CNA support, sounds like they are getting away with understaffing.

ETA: If it's a CNA role at CNA pay for someone licensed as an RN, you just report any concerning findings to the primary RN and leave it at that. All this talk about losing one's license due to occasional staffing roles like this is highly unlikely. It's more than just working below your license: it would also require a patient going bad, a lawsuit, and reporting of you to the BON.

DeeAngel · Apr 13, 2012

Is it the CNA role at RN pay? That's a waste of money to me. An agency CNA would probably be cheaper than an employee RN.
If it's CNA and RN role, i.e. you are the primary RN without CNA support, sounds like they are getting away with understaffing.
ETA: If it's a CNA role at CNA pay for someone licensed as an RN, you just report any concerning findings to the primary RN and leave it at that. All this talk about losing one's license due to occasional staffing roles like this is highly unlikely. It's more than just working below your license: it would also require a patient going bad, a lawsuit, and reporting of you to the BON.

It is an RN working as a CNA while getting RN pay and performing the duties of a CNA. The patients would be assigned a primary nurse, I would not be fulfilling both roles.

dudette10, MSN, RN · Apr 13, 2012

It is an RN working as a CNA while getting RN pay and performing the duties of a CNA. The patients would be assigned a primary nurse, I would not be fulfilling both roles.

That's a HUGE waste of money.

Pneumothorax, BSN, RN · Apr 13, 2012

That's crazy! Now are you being paid as an RN or as a Tech because that would be really ridiculous if it was the latter.

brillohead, ADN, RN · Apr 13, 2012

It may be a "huge waste of money" but which would the floor prefer -- no tech/aide/CNA at all, or an over-qualified one? (I also agree that it's a good idea to work "in the trenches" from time to time; teams work better when everyone understands everyone else's perspective, IME).

I don't see it so much as putting your license "on the line" if they're not expecting you to do any nursing duties that would require taking report. But if you notice that so-and-so is turning blue, they would expect you to use your RN-educated brain and do things that "just a tech" may not know how (or be licensed/authorized) to do. That's my understanding of the expectation of being held to the level of your license -- is it something that you, as an RN, should have known better than to do.

You're not going to be asked to pass meds or call the doctor and take verbal orders -- because those aren't "tech duties" -- but if someone codes and you're nearby, you're expected to "be an RN" (because you are one) and do whatever it takes to save that person's life (just like you'd do for any patient whether you're working as an RN or not, whether they're your patient or not -- you don't refuse to work a code because you never received report on that particular patient).

Merlyn · Apr 13, 2012

Where I work sometimes if there are not enough CNAs or float pool coverage available they will assign the RNs to work as aides. I have written my concerns about this to the nurse manager. They say we do the job of an aide but you "work to your license" which means I have as much responsibility legally to the patients in my care as their assigned nurse does yet I get an aide's report which usually does not even tell me why the patient is there, only the chores that need to be done!
Granted this doesn't happen all that often but I resent my license being put in potential jeopardy because of the hospital's lack of planning. This is what staffing agencies exist for! The last time this happened I told the person who made the assignments out that I didn't want to do the assignment, but I didn't refuse to do it, she just changed the assignment without any hassle.
This practice is illegal in some states but the state I live in (AR) is not one of them.
What are your experiences or thoughts on this issue?

If they pay you as a tech then you have a point, if you still get paid as a RN you don't. If they want you to run the floor and do this work, then that's crazy.

You need to tell them if you are going to work 'to your license' you need a full report.

Meriwhen, ASN, BSN, MSN, RN · Apr 13, 2012

Is it the CNA role at RN pay? That's a waste of money to me. An agency CNA would probably be cheaper than an employee RN.

Not necessarily. I worked through an agency (not nursing) several years ago so I have an idea of how the costs work.

Agencies charge higher rates because they can offer staff on short-notice or to suit the facility's particular needs. So they may charge the facility $30/hour for the CNA they send over, that your facility would pay $15/hour if she were an employee. Of course, the agency CNA isn't getting $30 an hour; she probably gets $20 or so and the agency pockets the rest...that's how they make money.

But if the agency charges the facility $30/hr for the agency CNA, while a RN on your facility's payroll makes $25/hr, its actually cheaper to use the employee RN.

Been there,done that, ASN, RN · Apr 13, 2012

So what's new? You will be fulfilling the CNA's role AND be responsible in the RN role.

We already do this 24/7.

anotherone, BSN, RN · Apr 13, 2012

So what's new? You will be fulfilling the CNA's role AND be responsible in the RN role.
We already do this 24/7.

i do not even know what the point of this is? i kind of get it I suppose ..... we are supposed to have 2-4 aides on days. sometimes we have NONE. so we work without them, often enough, if there were to be an extra rn/lpn that we are allowed to keep on our floor, that person would get an assignment, so a couple of people, would have 1 pt less and we would have a free charge. OP why don't you do this on your floor?