RN's supervising CNA's

Nurses General Nursing

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I have a question and I'm hoping someone can help.

I am an RN, I work for a private employer in their home taking care of a disabled woman. I was a new hire about a year ago but we have two other RN's that have worked with this family for 15 years. Besides the 3 of us there are also 6 CNA's. Recently the family hired another nurse from an agency to do some care management, this is the only person involved in the care of the patient that is through a state agency.

Here is the issue:

The state agency claims that the family is in violation of state law. They claim that RN's are not allowed to work with CNA's in unlicensed private home care. They also say that the CNA's are in violation as well because, as they are saying, CNA's cannot work in private households either. Although they claim it is a state law, I cannot find this information anywhere, not even with the board of nursing.

This agency has told the family they have 2 options, either to hire the agency to oversee all cares and provide caregivers (which means we will all be fired) or to apply for a state license to become their own home health agency.

Does anyone know how I can find out what exactly the law states or if this information is accurate?

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This sounds like a bit of hoo-ha to me, but I am no expert. If the family is paying for the services directly out of their pocket they have the choice of whom they hire. If the state is paying, there may indeed be some restrictions under "managed care" programs. Consider the source of funding and therein you may find some definitive rules.

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Yes, the family pays us. The patient has a trust fund that her expenses are paid from.

When I searched online I did find several laws restricting RN's from certain duties if DHS is involved in funding but the family pays out of pocket and receives no state funding.

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Specializes in Med/Surg.

As far as this being a state agency there may be some difference but the whole thing makes no sense. If they don't want licensed nurses and they don't want CNA's then what do they want?

If it's a state run agency, I'd call the main number for whatever state you're in. Should be listed under government and ask from there who you should be directed to. Good Luck :nurse:

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CNA's can work by themselves. Usually called home health aids though when not in a professional setting.

But if you and them are really concerned about this have them site the laws they are referencing(they are legally bound to do this)

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The problem started because a C.N.A didn't like one of the RN's. There was some conflict about what was best for the patient (C.N.A. was challenging another RN's care decisions). The family decided to ask for outside help (that is where this agency comes in). But the mother of the patient just wanted some care advice and now it has turned into this huge issue. Apparently the agency wanted to turn in our supervising RN for overseeing the rest of us (including the C.N.A's) claiming that RN's are suppose to "know" that we can't oversee C.N.A's in an unlicensed facility. The family asked us to oversee the C.N.A.s and asked the senior RN to be a "supervisor" and now they are upset because they don't want to lose any of us but the agency says they aren't allowed to have RN's overseeing CNA's without applying for a state license to be their own home health agency.

My head is spinning. I can't get my brain around it. I've never heard of such a thing.

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If you all don't work for the same company (CNA and RN's), you really have no right to supervise the CNA's as they are private contractors. Nor are you responsible for what they do. Yes, I agree you guys should all be on the same page and coordinating care, but just as in a hospital setting not everyone wants to work as a team and some resent being delegated to perform certain duties. It is then up to the family to "coordinate" care with guidance from a knowledgeable source or find one agency (there comes that recommendation-tho I doubt it is law) where care can be coordinated and everyone is responsible for carrying out a standard of care and accountable to a higher level of authority.

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Thats the thing, this agency is claiming it is the law in our state. The mother of the family has asked me to help find the information to prove the agency wrong, or else she will be bullied into either going with the agency (and all 9 of us lose our jobs) or else applying for a license with the state to become her own agency, and she doesn't want the state overseeing her daughters care. She wants to maintain total control of that situation.

The Agency is saying that the RN's are required to supervise nurses but can't in an unlicensed facility. Claiming we are in violation of license regulations when we supervise CNA's and not only supervise, but even working with them in an unlicensed facility. Their reasoning is that supervisory responsibilities comes with being an RN whether we want to supervise or not. They are even claiming the CNA's are in violation of their state certification because they aren't allowed to work for non licensed agencies either.

I have no clue where to look to prove them wrong.

We aren't considered private contractors because we were hired under the Trust of the patient. They created their own business in order to hire CNA's. In the past they had gone through an agency and only had nurses but because of the nursing shortage they needed more caregivers, therefore, they hired CNA's and left their previous agency. The remaining two RN's came from an agency (which they are no longer with), I was hired independently as were the CNA's.

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What state do you live in?

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Specializes in Vents, Telemetry, Home Care, Home infusion.

nj has such a law ...

certified homemaker-home health aides (chha)

private duty aides not permitted unless arranged through an agency in nj

how can i find a homemaker-home health aide to assist my family?

certified homemaker-home health aides must be employed by a new jersey-licensed home health care services agency (http://www.njconsumeraffairs.gov/ocp/agency.pdf). a certified homemaker-home health aide may not work privately.

http://www.state.nj.us/lps/ca/hhh/hhhfaqs.htm

look for regulations re certified homemaker-home health aides as many boards of nursing do not regulate chha. you can email or private message re state you need info about. .

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The state agency may very well be right.

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I would call an employment law attorney in your state. They should be able to advise you. If you need to work through an agency all the family has to do is arrange to pay you through an approved agency. They can call and explain the situation. The agency essentially has all the work done for them because the family has the staff they would approve for hire. As long as everyone had a current and clean license and meet the agency requirements it shouldn't be a big deal. There is no need for all of you to lose your jobs, the family to be stressed, or the patient to lose out on medical staff who she is comfortable with. This isn't hard to rectify. The catch is the family will pay more because agency will have payroll costs, etc. costs.

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