RN's and LPN's working as Nursing Assistants?

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BSN16

389 Posts

Specializes in ICU, trauma.

We usually call it resource or ancillary nurse. no pts-help out with the unit. But also can still give meds and do other things to help out

Horseshoe, BSN, RN

5,879 Posts

When I was working my first job as an RN, I had the worst of all worlds---I was the charge nurse for 28 residents, *plus* I was the CNA for a group of eight patients whom I had to get up and do their AM care, take them to breakfast, lay them down between breakfast and lunch etc. This was done to make the staffing look like it conformed to state law regarding ratios. Needless to say, it was on top of the morning med pass, treatments, doctor calls and so on. It wasn't that I minded doing CNA work, it was simply an unsustainable way to work. I left that first nursing job after three months. You couldn't have paid me enough to stay there.

That is a different scenario than the OP's, but I agree with you that it was crazy unsafe and highly disingenuous. The more I read about LTF, the more I believe that I would rather flip burgers than work at one.

mtmkjr, BSN

453 Posts

I do not understand why there would be a need to assign a nurse to full CNA duties.

If there is an extra nurse, while short a CNA, why not just spread the CNA duties among all of the nurses?

As an example: A 24 bed unit when full, will staff 4 nurses and 4 CNAs. If one day there are 5 nurses and 3 CNAs, Instead of assigning one nurse to CNA duties, why not have each nurse assigned to 5 patients, with one of those patients as "total care". The CNAs would still have 6 patients each (roughly - the extra patient could go to the nurse with 4 patients. She would have 2 total care)

This scenario actually happened on my unit a while back.

blackmamba123

97 Posts

Did you just pull that out of a hat? Where did I say or imply that "things can't get crazy in one shift???" I made no such reference.

Let's put it this way: Do you, working in the capacity as an RN, refuse to answer call bells of patients assigned to other RNs because once you interface with them you are now "responsible" for anything that happens to them for the rest of the shift? I doubt it.

Being assigned 8 patients as a CNA with your RN license doesn't mean that you have total responsibility for those patients at all times when you are not dealing with them. Their RN is top dog in that scenario and if Mr. Johnson is 1st on your list for his bath and you are now working on your 8th patient in a different hallway, you are not going to be held in the same light as his primary RN if Mr. Johnson begins to bleed out and his assigned RN doesn't act in a prudent and reasonable manner. If Mr. Johnson was perfectly fine when you did his vitals and bath and you have documented that, you just won't be held liable for something that happened down the line that you would not have been witness to. The same applies if you as an RN answer a call bell for your colleague's patient and he is stable and sans complaints. If that patient later bleeds out, you are not going to be held liable for that just because you walked in hours earlier and did something for him as a favor to your colleague unless you did something imprudent and unreasonable in your scope as a registered nurse.

You, while legally held to the standard of an RN, actually have less risk on the days you are working as an adjunct with another responsible RN than you have when you are working as an RN on your own with a CNA to help you. JMO.

You mentioned in your previous post that you didn't see an issue with working as a CNA once in a while (paraphrasing). I was saying it can crazy in that very day. Excuse me if the wording made it seem otherwise.

I appreciate your opinion and your argument, and respectfully disagree. You brought up a scenario about answering a call light for another RN, which I have done frequently, as I'm sure you have. Let's say that person who's call light you answered died unexpectedly and an investigation is done. Every staff member who came in contact with that patient would be questioned, may need to provide statements etc. Would you agree? That brings your interaction and license in to play. Now spread that out among a CNA patient load. In my opinion, it increases your risk. But you know, I personally find this topic and everyone's input so interesting and varied that I want to go a step further than my opinion, and consult a nursing board and a nurse attorney. I'm just curious like that. I'll post what I find out.

Horseshoe, BSN, RN

5,879 Posts

You mentioned in your previous post that you didn't see an issue with working as a CNA once in a while (paraphrasing). I was saying it can crazy in that very day. Excuse me if the wording made it seem otherwise.

I appreciate your opinion and your argument, and respectfully disagree. You brought up a scenario about answering a call light for another RN, which I have done frequently, as I'm sure you have. Let's say that person who's call light you answered died unexpectedly and an investigation is done. Every staff member who came in contact with that patient would be questioned, may need to provide statements etc. Would you agree? That brings your interaction and license in to play. Now spread that out among a CNA patient load. In my opinion, it increases your risk. But you know, I personally find this topic and everyone's input so interesting and varied that I want to go a step further than my opinion, and consult a nursing board and a nurse attorney. I'm just curious like that. I'll post what I find out.

Yes, if something happens in the scenario you describe, all personnel who interacted with that patient will be looked at. Of course. If you have performed your duties as a reasonable and prudent nurse would, you are fine, whether you are the primary nurse or the one who checked on another person's patient. Look at your BON's site or newsletter which lists nurses in your state who have lost their license. You will see very very few (if any at all) which involve malpractice. What you will see are tons of drug offenses and diversion. Actions against nurse licenses for situations you are worried about are almost nil, and it usually only involves really really egregious acts that someone who is as conscientious as you appear to be will just not commit.

Again, I think you are overstating the liability involved. But I think you are on to a good idea. If you are this worried about it, talk with a nurse attorney who specializes in this field. If she thinks your license is seriously at risk every time you take on a CNA role and you should be shaking in your clogs the entire time, then at least you will have written ammunition to supply to your employer.

I used to work for a medical malpractice attorney before I worked as a nurse. When a suit is initiated, pretty much everyone who even looked at a patient is initially listed in the suit. But eventually, almost everyone ends up being dropped except the physician and MAYBE the supervising nurse who has done something clearly negligent. It was never ever ever a nurse who just walked in and answered a call bell. And my firm completely stayed out of the BON reporting business. They wanted money from deep pockets, and those pockets belonged to insurance companies representing the hospitals and physicians. Beyond that, they didn't care, and their clients didn't seem to either.

blackmamba123

97 Posts

Again, I think you are overstating the liability involved. But I think you are on to a good idea. If you are this worried about it, talk with a nurse attorney who specializes in this field. If she thinks your license is seriously at risk every time you take on a CNA role and you should be shaking in your clogs the entire time, then at least you will have written ammunition to supply to your employer.

/QUOTE]

Shaking in your clogs the entire time...:roflmao: I'm a nurse, a mother, and grandmother....it takes a lot more than that to shake me up. But I am cautious about my license because I worked too hard for it, and love and respect what I do far too much to put it at risk even a little. Overstating the liability? Possibly. But I'd rather err on the side of caution than understate when it comes to my license or my livelihood. Just my two to three cents.

Specializes in Neuroscience.
If I showed up for work and was told I would be doing only CNA duties for my regular RN pay I would consider it a gift from the gods. Of course I would be held accountable as a nurse if the situation arose, but otherwise I would have no patients to be completely responsible for. I'd get to take breaks! What's not to like?

And the charting would be so much easier!

TriciaJ, RN

4,328 Posts

Specializes in Psych, Corrections, Med-Surg, Ambulatory.
You mentioned in your previous post that you didn't see an issue with working as a CNA once in a while (paraphrasing). I was saying it can crazy in that very day. Excuse me if the wording made it seem otherwise.

I appreciate your opinion and your argument, and respectfully disagree. You brought up a scenario about answering a call light for another RN, which I have done frequently, as I'm sure you have. Let's say that person who's call light you answered died unexpectedly and an investigation is done. Every staff member who came in contact with that patient would be questioned, may need to provide statements etc. Would you agree? That brings your interaction and license in to play. Now spread that out among a CNA patient load. In my opinion, it increases your risk. But you know, I personally find this topic and everyone's input so interesting and varied that I want to go a step further than my opinion, and consult a nursing board and a nurse attorney. I'm just curious like that. I'll post what I find out.

First of all, a CNA is not responsible for any patients. A CNA is responsible for completing the tasks assigned by the RN and for communicating pertinent info to the RN in a timely manner.

If an RN is told she'll "be the CNA" that day, that means she will not have her own patient assignment for which to be responsible. She may be responsible to complete certain tasks for a certain group of patients, but the buck will not stop with her for any of them.

If a patient has a negative outcome, she will be held to the standard expected of an RN, not a CNA. But since she does not have a patient load for which to be ultimately responsible, she incurs less risk of being named in a lawsuit.

blackmamba123

97 Posts

First of all, a CNA is not responsible for any patients. A CNA is responsible for completing the tasks assigned by the RN and for communicating pertinent info to the RN in a timely manner.

If an RN is told she'll "be the CNA" that day, that means she will not have her own patient assignment for which to be responsible. She may be responsible to complete certain tasks for a certain group of patients, but the buck will not stop with her for any of them.

If a patient has a negative outcome, she will be held to the standard expected of an RN, not a CNA. But since she does not have a patient load for which to be ultimately responsible, she incurs less risk of being named in a lawsuit.

I'm well aware that CNA's are not responsible for patients in the same way nurses are. A licensed nurse, even if acting as a CNA, COULD be held responsible. And that is my point.

MunoRN, RN

8,058 Posts

Specializes in Critical Care.
Occasionally happens at my work (though they try to avoid it due to cost/budget). What typically happens if the nurse is assigned to be the unit clerk so she answers phones and helps with discharge papers most of the day. She does "CNA work" to cover people's breaks or help with the total care patients. They will also help pass meds if the staff nurse is behind. Also when the nurse is training a new employee they will help out the CNAs and other nurses if their trainee is doing well or close to being done with orientation.

In my state we are held liable to our highest licensure so if something were to happen she would have to respond as a nurse, can't say oh I'm just an aide let me get your nurse.

That's not actually what "held to the highest licensure means", it doesn't mean you are actually the patient's nurse in any state's interpretation of liability, it's generally concerning that nurses can be granted a nursing degree without a basic understanding of this.

What this means is that you can't pretend to know less than you do, it's doesn't mean you're responsible for overall nursing care for the patient's in your care when working as a CNA. As an example, if you are doing vitals on a patient and note that their HR is 20 you would be expected to respond with the same urgency that a nurse would (by immediately notifying the nurse) rather than saying you didn't know a HR of 20 is really bad which a CNA might be able to get away with.

MunoRN, RN

8,058 Posts

Specializes in Critical Care.
I'm well aware that CNA's are not responsible for patients in the same way nurses are. A licensed nurse, even if acting as a CNA, COULD be held responsible. And that is my point.

You're held to the same knowledge level, not the same role, those are two very different things.

GeminiNurse29

130 Posts

At the psych facility I worked at, the techs/CNAs were protected status, meaning if they got hurt by a patient, the facility was willing to cover it and all that Jazz. Nurses were not protected status. Yet regularly, if they were short staffed on techs, a nurse would be "working down" as a tech. The workload is fine but if I'm gonna work down and get hit and be expected to be the first to respond as techs are supposed to, then I better get covered as well! í ½í¸’

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