Graduate asked to work in PCA position?

Sour Lemon · Jul 21, 2020

2 hours ago, ACNH_PRN said:
Hey everyone. I’m a recent BSN graduate who has already passed NCLEX. I’m hired at a hospital as a graduate nurse as part of the hospital’s nurse residency program. Initially, the orientation portion of the residency was intended to be 3 months long and about a year of nursing practice before we finish the program.

For the first week, I was able to follow my preceptor as anticipated. However, today my manager informed me that they are trying to do something where rather than following our preceptors, the graduate nurses will be asked to help the PCAs. She assured me that every day that I am to work with the PCAs will be kept track of and added to my time in the residency program so that I won’t lose time out of my residency.
This is all new to me and I don’t know how I should feel about all of this. I didn’t study for 4 years and take NCLEX during a pandemic to miss out on having a proper residency experience (especially with all of this C*VID stuff going on). I have all the love in the world for PCAs and what they do but I’m worried that accommodating for this shortage will hurt my residency experience or cause my orientation to become too prolonged.
How would you react? Do I even have a choice? My manager told me that this is per the CNO’s request, so I’m not sure if I can say no. I have no nursing experience so any insight from more experienced nurses is well appreciated.

This is one of those tricky situations that people have dramatically different feelings about. It seems to be somewhat common, though ...and not just for new graduates. I've been "the CNA" even with ten years of experience, ironically, it's usually when precepting new graduates who are close to finishing orientation. Everything a CNA does is nursing work, after all. And sometimes, the CNAs need more help than my preceptees do.

If you're being paid your nursing salary, and you'll ultimately receive a proper amount of nursing orientation, it might be worth sticking around. You can always "say no", but find a new job first if that's the route you decide to take.

beekee · Jul 21, 2020

You likely don’t have a choice. If you are in a hard hit state, they likely don’t really have the resources to properly orient you right now. They are also short staffed every where, so NA it is! There’s no “normal” right now. It sucks. Everything sucks. But, do the best you can with a smile on your face. Learn the NA skills and ask to be involved as much as you can, while still fulfilling your duties as a NA. If you are doing a 1:1, for example, if the patient needs an IV, NG, Foley, or other skill, tell the nurse you are a new grad and you’d love to do it if they’d help walk you through it. Most nurses will.

Even in “normal” times, you will do a lot of NA work. You won’t have a NA, or the NA gets pulled, is busy, on break or whatever. You will also become more familiar with the charting system, where supplies are, and various hospital policies.

Good luck. Now is a tough time to be in nursing, and even tougher to start in nursing. But hopefully, this too will pass. On the back end, hold them to their promise to do a proper orientation.

JKL33 · Jul 21, 2020

8 hours ago, ACNH_PRN said:
However, today my manager informed me that they are trying to do something where rather than following our preceptors, the graduate nurses will be asked to help the PCAs.

How long is this going to last? Will it be every day for a while or will it be determined day by day according to their staffing? They should know what their general plan is and it isn't unreasonable that they would give you some idea of what that is.

Did you sign a contract for this position?

You still need an orientation even if they've decided that for the next X number of weeks or months you will be helping the PCAs. PCAs get orientation, too. I don't think it is acceptable to put a newly-hired brand new RN into a PCA role and conveniently skip any kind of orientation at all. Your liabilities are higher than that of a PCA regardless of what your employer implies or how they choose to assign you. This type of switcheroo could be deceiving with regard to that. You are licensed as an RN, you were hired to perform the RN role, and having you help a PCA instead doesn't officially change any of your responsibilities/liabilities.

This has nothing to do with whether or not the RN role encompasses the PCA role; we all know the RN role does encompass the PCA role and we all know there is plenty of nursing stuff to be learned in the PCA role. But this particular scenario has to do with putting a completely novice newly-licensed RN into a patient care role with no formal orientation and (it sounds like) no formal preceptor for now.

[It also doesn't necessarily have anything directly to do with covid].

Jedrnurse, BSN, RN · Jul 21, 2020

Good chance to see how the hospital works from a different view. If you're being paid, not losing time from residency hours, AND have no prior direct care experience, I think it's not a bad deal.

I do have to say, though. You don't get any "extra points" for "taking the NCLEX during a pandemic"- that's awfully dramatic. Now working on a COVID unit during a pandemic, that'll get you some props.

dream'n, BSN, RN · Jul 22, 2020

Wait, from what I'm reading in the OP, your supervisor said the PCA hours you work WILL count toward your total nursing orientation hours? No, I would not be OK with that. Now if they wanted me to work as a PCA for a defined period of time (a month or so) while receiving my nurse pay and then would begin my nursing orientation, I would be fine with it and think of it as a good learning opportunity. But if they were saying my working as a PCA would be counted as part of my nursing orientation, then that would be a hard no. A new nurse needs all of the scheduled orientation hours to focus on their nursing role.

JKL33 · Jul 22, 2020

On 7/20/2020 at 9:33 PM, ACNH_PRN said:
She assured me that every day that I am to work with the PCAs will be kept track of and added to my time in the residency program so that I won’t lose time out of my residency.

14 minutes ago, dream'n said:
Wait, from what I'm reading in the OP, your supervisor said the PCA hours you work WILL count toward your total nursing orientation hours? No, I would not be OK with that.

I think what s/he is saying is that (for example) if the orientation portion of residency was supposed to last 3 months but two of the months were spent helping the PCAs, those two months will be added back so that the new grad still gets the promised 3 months of residency orientation once s/he is done being a PCA helper.

RebelNurse, BSN, RN · Jul 24, 2020

On ‎7‎/‎21‎/‎2020 at 11:33 PM, dream'n said:
Wait, from what I'm reading in the OP, your supervisor said the PCA hours you work WILL count toward your total nursing orientation hours? No, I would not be OK with that. Now if they wanted me to work as a PCA for a defined period of time (a month or so) while receiving my nurse pay and then would begin my nursing orientation, I would be fine with it and think of it as a good learning opportunity. But if they were saying my working as a PCA would be counted as part of my nursing orientation, then that would be a hard no. A new nurse needs all of the scheduled orientation hours to focus on their nursing role.

I think this is a very good answer! Make sure you're being paid fairly, and that you are NOT losing hours that should be for your RN orientation. If it's simply going to be counted as residency hours BUT will not decrease the amount of nursing orientation you'll get, I'd stick it out.

FolksBtrippin, BSN, RN · Jul 25, 2020

I would have appreciated knowing the tech's job better from the beginning. When you have a good idea what their workflow is like without delegated tasks, it helps you delegate more effectively.

I would recommend that you stick it out and see it as a valuable part of your orientation.

ACNH_PRN, BSN, RN · Jul 26, 2020

On 7/21/2020 at 6:03 AM, Jedrnurse said:
Good chance to see how the hospital works from a different view. If you're being paid, not losing time from residency hours, AND have no prior direct care experience, I think it's not a bad deal.
I do have to say, though. You don't get any "extra points" for "taking the NCLEX during a pandemic"- that's awfully dramatic. Now working on a COVID unit during a pandemic, that'll get you some props.

Alright, maybe I was a bit dramatic about the NCLEX part but do you not think that preparing for boards while under quarantine during a pandemic is a bit stressful? And yes, my unit is 100% COVID so I am trying to transition into this new role while being exposed to a deadly virus. It's okay to be nice to new nurses sometimes, I promise. We're really struggling right now.

Been there,done that, ASN, RN · Jul 26, 2020

" I didn’t study for 4 years and take NCLEX during a pandemic to miss out on having a proper residency experience". See the many threads here from new grads that cannot find employment or get a one week orientation.

We are in a health care crisis.. conditions will not be ideal. Time spent learning the basics of nursing care.. will be highly valuable.

Career Columnist / Author · Jul 27, 2020

There's a good chance this will be a temporary move. CNOs right now are allocating resources in any way they can and this is the plan of the month.

Soon they'll realize they need to get you up and running as an RN. beekee gave you good advice on maximizing your opportunities to practice your skills. Just try and go with the flow.