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Graduate asked to work in PCA position?

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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.

Sour Lemon

Has 9 years experience.

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.

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.

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

Specializes in school nurse. Has 29 years experience.

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

Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych. Has 28 years experience.

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.

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

Has 2 years experience.

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

Specializes in Psychiatry, Pediatrics, Public Health.

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.

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

Has 33 years experience.

" 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.

Nurse Beth, MSN

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience.

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.

MiladyMalarkey, ASN, BSN

Specializes in Neuro. Has 2 years experience.

Did you do CNA work prior to this job? I ask this for a reason, because I did not and just as often as my RN preceptor taught me something, so did the CNA's I work with. In my opinion, as long as you get your 3 months of RN orientation complete with a preceptor and bonus if you are getting RN pay doing CNA work, why not? You may not think it, but doing CNA/PCT/PCA work will teach you a lot. And you will still be able to observe, learn and ask questions from the other RN's. I respect the PCT's I work with, they taught me tons and I always remember to treat them well and never look at them as "my tech"...no, we are partners in care. They work incredibly hard.

With that said, I understand wanting to jump right into your RN role. You are right, you worked hard for this for awhile and being asked to do something else can be a bummer. I would start feeling upset maybe if this last longer than a month or 2 because like I said, I understand wanting to start learning what it is to be a RN. But if this is going to be for just a small amount of time, I would look at this as opportunity to gain valuable experience.

I disagree with many of the opinions here. I am a new nurse just starting orientation as well and I would never compromise - if I was hired as an RN, I want to work as an RN...Period. Contrary to what people are saying, many places I applied to are pushing hard to find new nurses. I would not settle. And I would definitely not take a reduced pay and a shortened orientation. As I said I am new, but I worked as a nurse intern on a MS floor for 2 years and have 4 nurses in my immediate family, and I never heard of this scenario occurring.

At the end of the day, if you don't mind the proposition, go along with it. It is your choice. However, know that this is not normal and there are plenty of opportunities for a proper nurse residency out there, so do not feel like your scenario is happening everywhere or choices are limited.

londonflo

Specializes in oncology. Has 44 years experience.

On 7/26/2020 at 11:53 AM, ACNH_PRN said:

do you not think that preparing for boards while under quarantine during a pandemic is a bit stressful?

What about the quarantine made your studying for NCLEX harder than usual? You couldn't go to movies, restaurants, or bars?  Studying for NCLEX is Inherently stressful for everyone. Everyone stays home and studies.(Actually, with online clinicals as case studies, you and your peer group probably had more time to study than graduating classes previously). 

On 7/26/2020 at 11:53 AM, ACNH_PRN said:

And yes, my unit is 100% COVID so I am trying to transition into this new role while being exposed to a deadly virus.

You accepted the position, I believe with it's risks. (At least you are aware that you are dealing with a known virus present and  with adequate supplies of PPE.)

On 7/26/2020 at 11:53 AM, ACNH_PRN said:

 It's okay to be nice to new nurses sometimes, I promise. We're really struggling right now.

You are probably thinking I am a mean old nurse. Hopefully that is not true (except for the 'old' part) but I have seen 45 years of nursing graduates feel their experiences are tougher than anyone else. 

Your "new nurse" experience is not any different or more difficult than any other new nurse at any other time. Playing the victim or feeling your are under undue hardship will alienate those who endured the same educational track as you. Every new graduate feels their schooling and first post-graduation job is much harder than any nurse before them. 

I, too, took the NCLEX during COVID and honestly I think we got a good deal on that.  Ample time to study, lots of accomodations, fewer questions - I saw all that as positives.

I took an NA job before I passed boards (and by happenstance got a MUCH earlier testing date and started the job already RN (by a few days). AT first I kinda felt like you, that I was "wasting" my RN by being an NA but a month in I have to say that I have learned SO MUCH.  Some of the RNs know I have my RN and some don't.  Yesterday I "helped" with a blood transfusion.  I've also "helped" with NG placement.  My hospital is very restrictive, even for students, on what be performed in terms of tasks.  

However, yesterday I also had an RN (different one) thank me heartily because I caught a patient who was declining - solely because I'd been taking care of him for a week and I knew that even though his labs were good something wasn't right. 

I get lots of education, simply by being present, on how to prioritize your day, things to look for and techniques.  If you do your job well and first, you'll have many opportunities to "help" your RN and get a great education on being an RN and structuring your day.  Plus you'll know where all the secret stashes are located.  🙂

We just DXd our last COVID pax (on our floor/section) yesterday but I suspect we're looking at a mountain looming in the distance and we'll be in the thick of it again.  I have learned more in the past month than I did in all of nursing school (clinicals included).  I'm really glad I was able to work as an NA.

londonflo

Specializes in oncology. Has 44 years experience.

10 minutes ago, harvestmoon said:

I, too, took the NCLEX during COVID and honestly I think we got a good deal on that.  Ample time to study, lots of accomodations, fewer questions - I saw all that as positives.

Great positive attitude. Congratulations!

10 minutes ago, harvestmoon said:

Some of the RNs know I have my RN and some don't.  Yesterday I "helped" with a blood transfusion.  I've also "helped" with NG placement. 

 

13 minutes ago, harvestmoon said:

I get lots of education, simply by being present, on how to prioritize your day, things to look for and techniques.  If you do your job well and first, you'll have many opportunities to "help" your RN and get a great education on being an RN and structuring your day

Great rewards for being positive and receptive to sharing experiences with the RNs!

13 minutes ago, harvestmoon said:

Plus you'll know where all the secret stashes are located.  🙂

A secret we all want to learn!

Nunya, BSN

Specializes in NICU/Mother-Baby/Peds/Mgmt. Has 39 years experience.

I hope you update us and tell us if you really got that promised 3 month RN orientation....cuz I'm not going to bet any money that you will.  Call me cynical...