Are CNA's considered "Nurses"?

rstewart · May 22, 2004

Tread cautiously, Sherry. Try to find from your state's scope of practice regulations if there is anything specific that a nurse can do but a medical assistant with other certification is not allowed to do. Can you clarify whether she is truly working inder the Doctor's license? Just make sure she isn't doing anything under YOUR license that is questionable.

Working under the .......'s license.

This phrase is oft used which is odd because quite simply nobody works under another's license.

On this board many RN's will state that they are worried because an LPN or CNA works under their license and not doing a good job. LPNs have their own license and must practice within the scope of that license. RNs may delegate duties to the LPN, but those duties must be within the scope of that LPNs practice and level of competency; conversely they may not delegate duties outside of the LPNs scope of practice with the understanding that they are being performed under the RN's license. Should they do so the RN could be disciplined for improper delegation and the LPN for practicing out of their scope of practice. The key here is since both have a license (and years of education invested) there is a viable means of control.

In the case of unlicensed providers, the situation is much the same whether it is a physician or a nurse performing the delegation. A doctor can not legally tell a CNA to go perform brain surgery as an extreme example. In the hospital environment the issue does not arise because the hospital requires privilages/credentialing of their non-employee providers, and since they won't grant the right to perform brain surgery to CNAs it doesn't happen. In the physician's office the responsibilities appear less clear cut when in fact they are not. Only the level of oversight has changed. The physician can delegate however he/she sees fit without a problem-----until someone complains or something goes wrong. But even then the unlicensed person is not working under the physician's license although they have none of their own. They (CNAs) may be sued or even arrested if applicable; most often they are not sued because their assets are so few it's not worth it.

So yes, I am aware that physicians ask others to do all sorts of things----but their license or even presence does not give them carte blanche rights to delegate tasks to individuals under that license.

NursesRmofun, ASN, RN · May 22, 2004

nope, i agree with those that say cnas are not nurses and should not say they are. however, in ltc, sometimes the elderly get very confused with the differences and do refer to cnas as nurses. not much we can do to change that though i do tell them the difference. i just don't like or want cnas saying they are nurses.

IamRN · May 22, 2004

Can you clarify whether she is truly working inder the Doctor's license? Just make sure she isn't doing anything under YOUR license that is questionable.

Unless she is a physician's assistance there is really no other scope to practice under an MD's license, that I am aware of.

Wouldn't simply knowing that this is going on and not reproting it jeopardize one's professional license? I would clarify that first and act accordingly.

rstewart · May 22, 2004

Unless she is a physician's assistance there is really no other scope to practice under an MD's license, that I am aware of.
Wouldn't simply knowing that this is going on and not reproting it jeopardize one's professional license? I would clarify that first and act accordingly.

See what I mean? lolol No....even in the case of PAs, the only one practicing under the physician's license is the physician. Now PAs must be supervised by physicians it's true, but they have their own "licenses" and scope of practice (although many times it's the medical board that also serves as their regulatory agency).

Take the case of the last couple of states which do not allow PAs prescribing authority. The physicians in those states can prescribe whatever they like but they can't delegate that authority to the PA whose own scope of practice does not permit prescribing drugs even though supervised by a physician. Should a physician in such a state improperly delegate prescribing authority they would be liable for doing so; likewise the PA could be disciplined by his/her regulatory authority for practicing outside the statutory scope of practice.

Stitchie · May 22, 2004

Working under the .......'s license.
This phrase is oft used which is odd because quite simply nobody works under another's license.
On this board many RN's will state that they are worried because an LPN or CNA works under their license and not doing a good job. LPNs have their own license and must practice within the scope of that license. RNs may delegate duties to the LPN, but those duties must be within the scope of that LPNs practice and level of competency; conversely they may not delegate duties outside of the LPNs scope of practice with the understanding that they are being performed under the RN's license. Should they do so the RN could be disciplined for improper delegation and the LPN for practicing out of their scope of practice. The key here is since both have a license (and years of education invested) there is a viable means of control.
In the case of unlicensed providers, the situation is much the same whether it is a physician or a nurse performing the delegation. A doctor can not legally tell a CNA to go perform brain surgery as an extreme example. In the hospital environment the issue does not arise because the hospital requires privilages/credentialing of their non-employee providers, and since they won't grant the right to perform brain surgery to CNAs it doesn't happen. In the physician's office the responsibilities appear less clear cut when in fact they are not. Only the level of oversight has changed. The physician can delegate however he/she sees fit without a problem-----until someone complains or something goes wrong. But even then the unlicensed person is not working under the physician's license although they have none of their own. They (CNAs) may be sued or even arrested if applicable; most often they are not sued because their assets are so few it's not worth it.
So yes, I am aware that physicians ask others to do all sorts of things----but their license or even presence does not give them carte blanche rights to delegate tasks to individuals under that license.

There was a doctor I went to that 'delegate' on-call obligations to her MA's because 'she's been with me for years' and 'this is like triage'. OMG! Her rationale? "Well, if anything had been really wrong that this MA couldn't handle, then she would have called me". Which tells me that she really didn't want to be bothered with her patients anyway.

Disgusting. BTW, she drives a porsche, has a mink, lives in an expensive downtown Chicago condo, shops for therapy and has stated to others that she went into her particular speciality because the 'hours are great and I'll make a s**tload of money".

Ah, the honorable profession of physicians.

Alnamvet · May 25, 2004

CNA's, NA, LPN....need to go by the way side....safe care comes from broadly "educated" and "trained" RN's and ARNP's. The time has come to eliminate so-called caregivers who's only training is how to do a BP, change a diaper, d/c an IV, and administer a limited amount of drugs. The times are a changin', and the need for poorly prepared wannabees is ending. What we need is to increase the standards, require that ALL health care providers take the same pre-reqs as a pre-med, pre-nursing, pre-PA...after the pre-reqs are met, one may choose the MD/DO route, nursing route, Paramedic route, PT route. This will place ALL on the same playing field, and eliminate further discussions about who is better prepared, better educated, better trained, etc. The only differences, in the end, may be compensation, but what you choose, after your pre-reqs, should not get in the way of having earned the respect and privilege of a well educated and trained health care provider.

SCRN1 · May 25, 2004

No, they are not nurses and I cringe every time I hear one of ours introducing themselves to as patient as their "nurse tech" because I just know that patient is going to be confused as to who their actual nurse is. I think they should change their title to something without the word nurse in it.

Another thing I think confuses the patients is because we all...including Respiratory, Lab, etc. wear the same kinds of uniforms and badges with the title being a small print. I'm not sure about the uniform solution, but I think the titles should be larger on the badges. Some patients' vision is not well enough to read what the badge says either because of poor eye sight and not wearing glasses, blurred vision from meds or from just waking up, etc.

We have boards in each of the patients' rooms where we write the date, room #, nurse's name & tech's name. Whenever I see that a tech has written Nurse Tech: (name), I erase the whole board & rewrite it just having Tech: (name) instead of nurse before it.

I really appreciate having techs because it would be nearly impossible for me to get all of my work done myself if I had to do everything that they do also. But, it does worry me that they are being given more & more duties that they are allowed to perform. When I was in nursing school and worked part-time as a tech, we were not allowed to do anything invasive whatsoever. Now, our techs are allowed to do things like BMGs and insert foleys. I try to take care of those myself because if the tech does something wrong with them, it comes down to me having to take the heat.

The other thing I cringe about with a couple of our techs and the patients thinking they are a nurse is when I have overheard the tech giving medical advice!!!!!!! Even though it may be well intentioned, lots of times, they are wrong, wrong, wrong!

When I worked in a doctor's office, we had Medical Assts who "worked under the physician's liscense". But, they were basically only allowed to put patients in the rooms and get a medical history. That was fine. When it comes to working in a hospital and a CNA/tech is assigned to care for the same patients as I, they are working under ME and it is ME they will come looking for if something is done in error. That is where I have the problem of them doing things they shouldn't.

smk1, LPN · May 25, 2004

I don't want to get the girl in trouble or anything. I did question her about the things she is doing and she said she was told that she is working under the Physicians Licenses which makes it ok. I told her that if she works outside her scope of practice as a CNA and hurts someone, she will be the one standing before the BON in danger of loosing her certification not to mention the legal ramifications.

are you sure she is a nursing assistant? maybe she is a medical assistant because they do work under the doctors license. In either case it is illegal for her or anyone else to call her a nurse. I would find out which one she truly is though because it seems to me that if you are the RN in the clinic and she is a "nursing" assistant she could be doing things that fall under the umbrella of delegation (even if you haven't officially delegated anything to her) in which case you possibly could be in hot water. If she is a "medical" assistant, then its the doc who might get into hot water. I would call the bon and find out if this scenario could affect you in any way, better to be safe than sorry. :uhoh21:

BadBird, BSN, RN · May 25, 2004

NO, a CNA is not a nurse and if one is calling herself one she/he should be corrected.

Marie_LPN, RN, LPN, RN · May 25, 2004

CNA's, NA, LPN....need to go by the way side....safe care comes from broadly "educated" and "trained" RN's and ARNP's. The time has come to eliminate so-called caregivers who's only training is how to do a BP, change a diaper, d/c an IV, and administer a limited amount of drugs. The times are a changin', and the need for poorly prepared wannabees is ending. What we need is to increase the standards, require that ALL health care providers take the same pre-reqs as a pre-med, pre-nursing, pre-PA...after the pre-reqs are met, one may choose the MD/DO route, nursing route, Paramedic route, PT route. This will place ALL on the same playing field, and eliminate further discussions about who is better prepared, better educated, better trained, etc. The only differences, in the end, may be compensation, but what you choose, after your pre-reqs, should not get in the way of having earned the respect and privilege of a well educated and trained health care provider.

Hate to burst your one-dimensional bubble, but an LPN is a nurse, that's kinda what the N stands for. :) And being an LPN does not make me some sort of "poorly prepared wanna be". I took the course i took because it offered way more classroom time, and almost 3 times the clinical time, plus a lot of my classes will transfer to whereever i choose to go to school next.

And unless you want to pay for all the Licensed Practical Nurses to go back to school for further education, then you're going to have to get used to it. Licensed Practical Nurses are needed and they are valuable. They may not be able to work everywhere, but if they are happy with where they are, more power to them.

As for "respect" (ironic that you used that word after being so insulting), it makes it way more difficult to earn the respect when someone already has the mentality that you're the dirt beneath their feet all because you're not an RN. But then again, if someone is that insulting to those who do not have the same nursing education, does it REALLY matter whether i'd get their respect, since they hold me in such little regard for being a CNA and then an LPN. Is it worth it fighting for the respect as a "poorly prepared wanna be"? No it's not. Life's too short to waste on supposedly 'fellow' nurses who are so disrespectful to others in healthcare.

Marie_LPN, RN, LPN, RN · May 25, 2004

Getting back to the OP: a CNA is not a nurse. For calling themselves that, they should be verbally warned once to stop it, then written up. To present yourself as a nurse when you aren't one is illegal.

MelissaRN · May 25, 2004

I work with a CNA "tech" who when introducing himself says he's one of the "nurses". Oh how I cringe when he does this and nobody has ever said anything to him. He has a lot of resentment being asked to do things when RN's ask him to and I for one don't ask meanly, just a fact that things need to be done.