BSN vs CNA in long term care

caliotter3 · May 7, 2011

Can an RN work as a CNA in your state? You could get an RN license but continue to work as a CNA if it would make you more happy and you could find a willing employer. You must remain aware that you would be held to the higher standard of practice should you do so, but it is possible. I definitely would not quit nursing school at this point. Finish it and get an RN license. You never know what the future might hold. The RN license could prove to be necessary some day.

caliotter3 · May 7, 2011

Another possibility is to work extended care home health for elderly patients. You get the benefits of that one on one contact and an entire shift to help the patient with all ADLs as well as skilled nursing tasks.

ImThatGuy, BSN, RN · May 7, 2011

Around here CNAs are minimum wage/dime a dozen people who are routinely fired (sometimes arrested) for neglecting patients. Heck, I've arrested at least two for drug possession and one for domestic battery. Is that the peer group you want to make a career out of?

Moogie · May 7, 2011

It's normal to question and feel discouraged in nursing school, especially your first year. There's so much to learn, an enormous amount of stress, and the realities of what you see and do in clinicals don't always match up with the ideals you're being taught in the classroom. If your first clinical is being done in a nursing home, which is common in many programs, you might easily get the idea that all a nurse does in LTC is pass pills and do treatments. Yes, that does happen in many facilities, but I want to assure you that as an RN, especially one with baccalaureate preparation, you can do far more that will make an even greater impact on the lives of elderly persons.

With the aging of the baby boomer generation, there will be more elderly people in the hospital as well as in LTC in the future. With the exception of a few specialties like trauma, pediatrics and OB, the majority of the patients in acute care are elderly. Many nurse leaders feel that today's nurse is, by default, a gerontological nurse because of the high proportion of elderly patients. You will see elderly with dementia in the hospital setting and, as you've learned, it takes a special set of skills and a great deal of patience to work with persons with cognitive impairments. Because of your interest in dementia care, you could be a real asset to an orthopedic floor (broken hips), to telemetry, to ICU, neuro, or gero psych.

You are right that in a LTC facility, the bulk of the nurse's day is taken up with medication administration, treatments, and charting. You may find, though, in a dementia care unit that you would have more direct care and be able to build relationships with your residents. Trusting relationships and consistency of care are imperative in dementia care units and you may find that this is well-suited to your interests.

Additionally, as a BSN, you're in the catbird seat to move into a different kind of role, one in which you could make a difference to many more people. You can be an assistant director of nursing or a DON (not right out of school, of course!) You're also in a good position to consider an advanced practice role. You could become a gero nurse practitioner. You could go into education as a staff development coordinator, teaching nurses and CNAs at your facility how to better care for persons with dementia or you could become an academic nurse educator, teaching the next generation of nursing students. I student taught an introductory gero course to BSN students this spring and it was so gratifying to see through their papers and their discussions that what I taught actually made a difference in the way they felt about gerontology. In the fall, I will start a PhD in gerontological nursing and my research will focus on dementia.

What I'm saying to you is that as an RN, especially with baccalaureate preparation, the sky is the limit for you. If you quit now and remain a CNA in LTC, you are always going to wonder what you might have done had you finished nursing school. I think you would regret it. Please give it a little more time and get more exposure to nursing before you decide to quit school.

vanillacupcake17 · May 7, 2011

some nurses only swoop in 3 times a day to pass meds b/c that's all they want to do. no offense to the many RN's who truly care and make a huge difference in pt's lives by getting to know them and spending quality time taking care of them. however, i work on a rehabilitation floor in the hospital and many of the RN's rely on the NCT/CNA to do everything and the nurse just comes in to pass meds and ask about pain. I think being a nurse is what you make of it. if you want to be an RN in an LTC facility you should do it. I'm sure your CNA would appreciate you doing more than passing meds! I'm sure you CNA would love for you bath and feed your pt's if you have time. I think you should finish out your BSN. It's well worth it! Congrats on being in nursing school and making it as far as you have. and good luck

Moogie · May 7, 2011

I agree with ImThatGuy. I've seen administrators and managers with the "dime a dozen" mentality, too. Unfortunately, many LTC facilities do not treat their CNAs well. They're viewed as disposable and expendable. I worked with one CNA who had the most amazing gift of being able to relate to the person underneath the dementia. She could calm the most aggressive, agitated individual and she was well-loved by the residents. However, the DON and some of the other staff disliked her because she was "slow" and was often seen talking to the residents rather than rushing her cares.

LTC can be very hierarchal and political. If you have little power within a facility, you will not be allowed to make much of a difference. Change agents are not always welcome at every facility. Many of the nurses and CNAs with whom I worked wanted to make changes but were always shot down by administration. Eventually they quit trying. They're beaten down.

I see many LPNs and CNAs who end up bouncing from one nursing home to another in my area because they get frustrated with one facility, quit (or get fired) and then move onto another. The facilities can get by with treating them poorly because they know the LPNs and CNAs have few other options. As an RN, you do have options. As a BSN, you have even more.

Please don't quit.

CNM2B201? · May 7, 2011

Around here CNAs are minimum wage/dime a dozen people who are routinely fired (sometimes arrested) for neglecting patients. Heck, I've arrested at least two for drug possession and one for domestic battery. Is that the peer group you want to make a career out of?

HARSH!! I was a CNA for 2 years, along with both my sister in laws, and two friends..none of us have been arrested, are drug addicts or have ever been fired from a CNA job or any job for that matter! You should not generalize CNA's in such a way.

ImThatGuy, BSN, RN · May 7, 2011

HARSH!! I was a CNA for 2 years, along with both my sister in laws, and two friends..none of us have been arrested, are drug addicts or have ever been fired from a CNA job or any job for that matter! You should not generalize CNA's in such a way.

Which is why I qualifed that with "around here."

studentgolfer · May 8, 2011

With a BSN, you could virtually run many LTC's. Think about it, all the things that didn't "work" before you could have the power to change. I agree with others, with your RN you can make an even bigger difference in their quality of life. Plus why waste this time investment? It is one of those things in life you could really look back and regret if you drop out.

Hello Allnurses.
I am a junior in nursing school and have been reading through the threads here about school problems and the decision to press on vs. drop out. Like many other people who've posted, I'm trying to figure out whether I'm really not cut out for nursing, or if I just hate nursing school. What's a little bit different about my situation is that I know for sure that if I quit school, I'll want to keep working in direct patient care (as either an LTC CNA or an HHA). I like the long-term relationships I've been able to develop in this type of work, and just knowing that the way I go about feeding, washing, and talking to a demented older adult can make the biggest difference in his/her quality of life. I can't imagine giving this up and going through all the trouble of finishing nursing school, just so I can swoop down on a patient 3 times a day with pills (or other treatments) and fill out paperwork in between! At one time I thought being an RN would somehow allow me to "do more" to improve the lives of old people, but now it doesn't seem that way to me.
Do you think I'm right? I would fight through all sorts of nursing school nonsense if I thought my license could really make a difference for the population that I want to help.
Thank you in advance for any advice you may give!

blackandyellow · May 8, 2011

There are many thing's you can do with a BSN besides passing out meds and seeing a patient a few times. You just need to find the right field for you. I have been a CNA for six years and it has been a great way for me to get my foot in the door, learn a bunch of stuff, and form a deep connection with many people but the pay is horrible. I have been lucky to get a decent paying job that I have now but it supports me and myself only. I could not afford to have a child and continue paying my rent, tuition, and car payment. I worked with a nurse in a nursing home that was wonderful with the residents she would pass her meds and talk to each of them. She had a sense of humor that all of them loved about her. Instead of sitting at the desk once she was done she would go around and answer call lights. She was very hands on and that was what made her well respected and well liked.