CNA as a NURSING SUPERVISOR?

[militarymom06]

How would you, as an LPN, feel about a CNA being YOUR supervisor? I've been a nurse for almost 20 years, and this really ticks me off. Is this even legal? I recently started a new job, at a new facility, and the staffing coordinator has the title of Nursing Coordinator. The chain of command....her then the D.O.N. I have no problem with an LPN being my supervisor, I was a nursing supervisor for a few years, but a CNA? PLEASE!!!!!! She and the D.O.N are good friends, but still she should not have the title as Nursing Coordinator AND be the direct "supervisor" of LPN's, or can she? I just don't agree with this, and it has me totally upset, ticked. That would be the samething as me supervising RN's, atleast I would think so. She is a CNA, never has been to nursing school, so how can she tell US what to do, or how to do it? Something is totally wrong with this picture. Thing is, she even acts like she's an LPN. Honestly, I thought she was until the other day when I found out different. Just wanted to know what someone else's oppinion is on this. Thanks.

[txspadequeenRN, BSN, RN]

i promised myself that i would only read this thread and not comment but this right here needs some attention. i just have to know what this means and possibly get some short examples. i read your other thread and just amazed....

administratively i own them.

[Atheos]

i promised myself that i would only read this thread and not comment but this right here needs some attention. i just have to know what this means and possibly get some short examples. i read your other thread and just amazed....

the word? if you owned something it means you dominated it. slang...

what i meant was that nurses learn nursing. they don't learn leadership or managerial skills. maybe in continuing education or class (bsns) but it isn't something you learn from nursing or class. it is like everything else and must be taught on the job. being a nurse alone does not make one more suited to manage. i am pretty sure learning to leading squads/platoons/etc in any branch of the us military better prepares someone for management and leadership than nursing school or a hospital.

sure some people are natural talents. some people learn it on their own. many do not, hence the usually 'management' complaint threads.

of course the other reason i am still there is because we changed the culture of the building. all of our patients have some tie to the military and it is run like the military. i have no problem holding people accountable for things they are supposed to get done. a person that went from high school to college to nursing most likely won't have that same attitude. i didn't have it until the military put it there.

why does that amaze you? there are other people besides nurses that can do the non clinical things.

*note* i mean the nurses in my facility... i can't comment on the skills or training of nurses i do not know. obviously...

[Hopeslayer]

In the facility where I work, the scheduler is a CNA. And that is the extent of her duties. She does not have any supivisory role over any nurse. And she shouldn't, regardless of what her leadership skills may be.

Before i became a nurse I was a CNA for 5 years. Before that I was a Marine. When I was discharged I was a Staff Sergeant. During my time in the Corps, I had attended numerous Leadership Schools up to an including Staff NCO Academy. So anyway, I am qualified to lead an entire nursing dept, no sweat. BUT, this in no means translates to where I work now, nor should it. As a CNA, I could run circles around anyone where I worked when it came to leadership, but I certainly did not. As an LPN now, does it mean because I have superior leadership training and skills that I should become the DoN? No, it dosen't Why? Well, having a military background should be enough for you to know about a rank structure, or a hierarchy in this case.

A cna has no business whatsoever supervising any nurse in any facility period. The nurse, by definition and licensure has the power to delegate, and by that lead. I wouldn't put up with a CNA supervisor for one second, and neither should any nurse.

[Atheos]

The reality is that while the officer leads, any real officer takes their cues from senior ncos, especially in wars.

It still seems that the problem is that the person in charge is a CNA and nurses are offended by that. Elitism is not very becoming. These very same nurses get angry when BSNs say only they should be in charge...

[txspadequeenRN, BSN, RN]

i'm not looking for a definition of the word ..i know what it means. but what does it mean to you. what do you administratively own? the nurses because as a ltc nurse there is not one part of my job that is considered admin . i can link everything i do to a clinical task of some sort. i just dont get where you are coming from here . as a cna that is responsible for staffing your job should be limited to that or if you need to solve some squabbling between cna's thats ok to , i as a nurse don't have time for all that. in your previous post you said you supervised all the cna's, lvn's and rn's in your facility. once again we are talking admin right... (please overlook the poor spelling and grammer . i am so tired i am falling asleep as i type) . give me some examples... schedules ...mispunches....?????

- let me also point out that nursing schools do have courses on managment .

the word? if you owned something it means you dominated it. slang...

what i meant was that nurses learn nursing. they don't learn leadership or managerial skills. maybe in continuing education or class (bsns) but it isn't something you learn from nursing or class. it is like everything else and must be taught on the job. being a nurse alone does not make one more suited to manage. i am pretty sure learning to leading squads/platoons/etc in any branch of the us military better prepares someone for management and leadership than nursing school or a hospital.

sure some people are natural talents. some people learn it on their own. many do not, hence the usually 'management' complaint threads.

of course the other reason i am still there is because we changed the culture of the building. all of our patients have some tie to the military and it is run like the military. i have no problem holding people accountable for things they are supposed to get done. a person that went from high school to college to nursing most likely won't have that same attitude. i didn't have it until the military put it there.

why does that amaze you? there are other people besides nurses that can do the non clinical things.

*note* i mean the nurses in my facility... i can't comment on the skills or training of nurses i do not know. obviously...

[pagandeva2000, LPN]

I have heard of LPNs supervising RNs administratively, LPNs even being ADONs, etc...and this is shocking to me because it is not the traditional trend that I was aware of. Now, I am hearing this...and again, this is not what I am used to. But, since I am not interested in having the headaches related to these tasks, whoever wants it is okay with me. In other words, my disinterest in any of those administrative jobs is enough for me to let them do what they wish. But, I can understand how this can cause conflict for others. It should be made clear in writing what the duties are and they should be signed by each employee for future reference and call it a day.

[bluegeegoo2, LPN]

Does this CNA tell you how to do your job as a nurse? I had a similar situation yesterday with our staffing coordinator. She brought an order I had taken to me and pointed out what needed to be "fixed". (The order itself is a whole other situation, I may thread about it shortly). Anyway, I was offended d/t the fact that she can not, for any reason, take or write orders, and here she is telling me how to do it. Once I got over myself, I realized that she takes care of entering orders for the MARS and TARS, and was merely trying to get that order straightened out to update the new books coming out. She has been doing that job for quite awhile, and I suppose would know what a "good" order would look like by now. That being said, if she came to me and told me to make sure I got a BP on whosie-whats-it because of whatever, it would certainly ruffle my feathers. I agree with pagandeva

that there needs to be a very clear-cut outline of duties available for reference so as not to run into problems such as those described above.

[ink10300]

I have 2 CNA's and an Activities coordinator, who are constantly trying to tell me how to do my job- as a nurse.

Ordering me, take the VS, don't forget to chart that, telling me also what I should tell a family member when a situation they have complained about arises.

I have a responsibilty to provide the best care for my patients using the knowledge that I worked hard to get. Which translates to pulling rank over the CNA's when it comes to patient care.

I am ultimately responsible and my license is on the line. This gives me the authority to pull rank when I need to, because that is my responsibility to my patients.

It's hard to be diplomatic, I have had to put my foot down without appearing to stomp.

The CNA is telling me when to take a lunch break? How does she know when my med pass is done? Or what I need to accomplish with each patient..

I try to take everything with a grain of salt. I have learned to bite my tongue and at times say no, I don't explain my reasons unless I absolutely have to.

The last thing I need to worry about is giving a rationale to someone who has an idea of how nursing is but has not yet scratched the surface. And at times i am just to busy.

That is another reason why a CNA is not appropriate to supervise nurses.

I'm sorry CNA's, nothing personal. But clinically, it's hard to relate. And in management you have to effectively relate to what each other does.

Correct me if I'm wrong, but a manager needs to be able to step in and do your job when they need to. Or correct you when your not doing something right or time management issues. Something a CNA can't do effectively for a nurse unless directed or delegated by a nurse.

On the other hand the LPN, could step into the "staffing coordinators" role with out batting an eye, provide patient care, (which I am very proficient and not afraid to do), and conduct her nursing responsibilities as well.

And part of the nurses responsibility is supervising and delegating interventions to the CNA's for the care of their patients..

So who is really the "manager"?

As far as leadership, ect. ect.- not to be rude, but that is part of the nursing curriculum, at least it was for me. Actually named leadership. We had a whole book devoted to that and even a grade for it. With opportunities in clinical rotations..

Leadership is obviously a great quality to have.

But, as a subordinate, you have to have a leader you can relate to, who knows your job- how to do it- so they know how to help you best.

For me, that is not a CNA. That is a panic attack, a reality check and then a resignation letter.

I'm not trying to be offensive, It's all a matter of perspective.

It would be as if a pharmacy tech were to supervise a pharmacist. It makes no sense and it's scary.

Sorry for my rant, I did get carried away...

[Atheos]

So then the facilities administrator, who is usually NOT a nurse, has no business running the facility???

A good supervisor won't tell you what to do. We have very specific roles that are laid out.

As far as relating to the supervisor. Relating isn't necessary. Most of our staff is very long term (+10) years. The only people that quit after I came were, frankly, bad employees. One actually told me a CNA shouldn't supervise nurses. I terminated the same nurse for passing meds from memory. The MAR was never looked at during the entire med pass.

I understand your concern. A cna trying to tell you how to nurse is ridiculous. An administrator telling you how to nurse is as well. A supervisor shouldn't be telling you what to chart or when to take lunch. In my situation that falls under the purview of the DON.

Any situation that is not directly related to 'nurse' only activities can however be handled by anyone. Discipline, management of staffing levels, education on anything not nursing specific, enforcement of corporate policies (even if they are nursing specific) all fall under me, a cna.

If your attendance is bad, I handle it. If a unit manager (an RN) informs me that you are making med errors I handle it. If the unit manager informs me that your nursing practice is putting us out of compliance I handle what I can and pass the rest to the DON. While I won't go and find the errors or bad actions, since I am not a nurse and won't even know to look, I don't look for them. These things are passed up the chain to me. I decide on the facts of the issue and then either act on them or pass them to the DON. At all times I am under the supervision on the DON.

It is a separation of duties. Nurses should be able to focus on nursing duties and not have to worry or have their time taken up by things that someone else can handle. That is the sole reason I am doing what I am doing. Our nurses like it because at least 50% of their time has been freed up. They don't have to deal with silly non nursing issues. Another benefit is that employees no longer resent other employees for writing them up. Our compliance with labor law and policy has improved. Morale has improved.

Not sure what the problem is...

*NOTE* I meant to add that we have nurse managers on the units... They of course are under me in the way previously described. They would be the ones to step in or handle a nursing issue. It is still passed to me and then either I or the DON handles it. We have different pathways to handle things but nurses and nurse managers don't worry about those. They pass everything to me and then from me it goes to the DON/Administrator or stays with me. The DON of course has final say over anything and anything I know I can't handle or involves something that requires nursing knowledge or nursing experience automatically goes to the DON. Even I have specific rules under which I operate.

[pagandeva2000, LPN]

I guess the problem for some people is that it is not traditional; based on what is told to people in school or (at least from what I witnessed, over the years I have been employed as a CNA). This, I am sure, would cause confusion, because it did for me when I first started reading about this in allnurses forum threads. I was talking about this issue just this afternoon with a friend who also agreed that the role of the unit manager, or whatever position it is called should be written, distributed, signed and explained by the powers that be in order to alleviate confusion.

Now, for the CNAs/LPNs that hold these positions, what is the exact title? StanleyRN2Be, maybe you can share that with us. My friend was saying that she saw this as well, and what they have done is given them a specific title-may it be unit manager, coordinating manager, or whatever else. If you look at it that way, it can be said that this person is the Unit Coordinator, who happens to be an LPN or CNA, however, this is not what they are hired to do, here. Maybe looking at it in another way would help...for example, hospitals that no longer use LPNs may hire them as surgical technicians, etc... They are licensed nurses, but they do not work in that capacity in that particular facility...having no level of responsibility that is supposed to be performed by the Registered Nurses and other licensed personnel. Most of them are employed elsewhere on their days off (per diem or part time), and there, they are functioning under the positions they are certified or licensed to do, but not at the place they hold their main positions. Now that I think of it, I know a CNA that worked in a nursing home that was promoted to the position of Recreational Assistant. The facility she worked for does do the courtesy of renewing her CNA certification every two years, in case she wanted to work as one elsewhere, but in that case, again, she is a Rec Assistant that happens to be a CNA, but not functioning to that capacity at this place.

[ink10300]

Again, no offense, but a CNA disciplining me on my nursing duties is not only inappropriate, but condescending as well. Med errors? Do you know enough about meds to discipline me on this? Not that it is rocket science, but, certanly takes extra knowledge and experience..Not just scatty knowledege of policy and procedure.

A nursing unit manager, I can handle. The DON, great.

Even this would be ok, in small doses:

"Any situation that is not directly related to 'nurse' only activities can however be handled by anyone. Discipline, management of staffing levels, education on anything not nursing specific, enforcement of corporate policies (even if they are nursing specific) all fall under me, a cna."

I would question the DON that gives this power over the nurses, especially on a clinical level. If it's a clinical issue, it is not your decision, it is your responsibility to hand it off to the DON.

"These things are passed up the chain to me. I decide on the facts of the issue and then either act on them or pass them to the DON. At all times I am under the supervision on the DON."

For instance, I am not legally authorized to "withold a medication". I have to seek the advice of the physician, and put into order his recommendations.

For instance a high PT for a coumadin patient. I just can't say, well I'm not giving it, and leave it at that. The answer is obvious. But I still need the advice and recommendation of the physician.

Everything else administrative you can have...

Question?

Are you still on the floor? Are you working as a CNA?

I'm glad you cleared up the fact that:

"he DON of course has final say over anything and anything I know I can't handle or involves something that requires nursing knowledge or nursing experience automatically goes to the DON. Even I have specific rules under which I operate."

But the way you keep saying your "over" people is really scary. You are making yourself sound like the hall monitor. I know your not trying to come across that way. We are all a little defensive.

You are administrative. Not clinical.

I have an administrative director over me, and of course their are non clinical managers, but not they do not supervise, or claim to, clinicals.

[Atheos]

again, no offense, but a cna disciplining me on my nursing duties is not only inappropriate, but condescending as well.

in our organization anyone can write up anyone. it works out better because it stops people with certain licenses from thinking they are 'above' others without. assuming i can't supervise you because i am a cna is quite condescending...

med errors? do you know enough about meds to discipline me on this?

i don't need to. the unit manager finds out about the med error. she documents what happened and investigates. it then comes to me. based on the employees previous med errors and previous performance and recommendations of the unit manager i decide on a course of action. does the nurse make a lot of errors? is this the first error? is this a new error? i speak with the unit manager to discuss possible causes of this error. high acuity? not enough orientation? depending on the outcome, i decide a course of action.

i would question the don that gives this power over the nurses, especially on a clinical level. if it's a clinical issue, it is not your decision, it is your responsibility to hand it off to the don.

"these things are passed up the chain to me. i decide on the facts of the issue and then either act on them or pass them to the don. at all times i am under the supervision on the don."

if it is a clinical issue it would immediately go to the don. however in a case like you mentioned, the unit manager would handle that. that is a clinical issue and does not need to go up the chain.

are you still on the floor? are you working as a cna?

i do not work as a cna on the floor. this is my fulltime position. i can if it is needed such as a weekend or holiday but i do not operate in my supervisor role at that time.

if they tried to pass clinical stuff to me i would run screaming. no need to jeopardize getting a license i don't yet have. besides, many times i consult with the unit managers and/or don to get an idea of what would be an appropriate action in an event that i am unfamiliar with.

i am not a dictator. much of my time is spent collaborating with clinical staff and hr. if the unit manager of 20 years thinks it is a good idea to take a certain action i would be a fool to ignore their experience and judgment.

remeber, they whole point of my position was to make things easier on the clinical staff. they are the whole point of the facility.