Has anyone heard CNA IIs may replace LPNs in NC??

Cari · Aug 29, 2004

I went to my first CNA class yesterday (I get points for nursing school for being a CNA) and the instructor told us that NC is considering doing away with LPNs and replacing them with CNA IIs. She didn't have any further info but, I thought I would share this just incase any one here knows more.

I have been hearing that for 20 years in one form or another....not in our lifetime!

RNPATL, DNP, RN · Aug 29, 2004

I went to my first CNA class yesterday (I get points for nursing school for being a CNA) and the instructor told us that NC is considering doing away with LPNs and replacing them with CNA IIs. She didn't have any further info but, I thought I would share this just incase any one here knows more.

Not sure that NC could actually afford to do away with LPNs. They are a very valuable part of the nursing team. I am also very sure that many of the local nursing organizations (both RN and LPN) would fight such an action.

Marie_LPN, RN, LPN, RN · Aug 30, 2004

NC has areas that have a hard enough time maintaining adequate nursing staff. Creating jobs with a lower pay and the same amount of work to do? Won't happen.

VickyRN, MSN, DNP, RN · Aug 30, 2004

Probably NOT true (even though the Educational Committee of the NCBON is coming out with some pretty controversial proposals lately and I wouldn't put it past them.) Have not heard even a whiff of that rumor and we have a thriving LPN program at our cc.

RNPATL, DNP, RN · Sep 4, 2004

Probably NOT true (even though the Educational Committee of the NCBON is coming out with some pretty controversial proposals lately and I wouldn't put it past them.) Have not heard even a whiff of that rumor and we have a thriving LPN program at our cc.

Being new to North Carolina, I am sometimes shocked and amazed at what CNA II's can actually do. Today, one of the nurses handed a CNA II a bag of NS and told her to hang it on one of her patients. I stopped the CNA and the nurse and asked if CNA II's were permitted to hang IV fluids. I was told they were.

It seems that we restrict LPN practice in this State, but let people with less training hang IV fluids. DO you have an opinion on this as an educator?

I am very confused right now and plan to visit the NCBON website to get clarification on the scope of practice for a CNA II. Sometimes, I really wonder what the difference is between a CNA II and an LPN .... although, I have been told that CNA II's can not pass medications.

As an RN in this State, it concerns me that we allow unlicensed assistive personnel (UAP) do so much stuff that should really be carried out by licensed staff. Am I alone in this feeling or is this nothing new in NC? Hopefully there are some opinions and answers out there.

Maggie in NC · Sep 4, 2004

Hey everyone, Just wanted to share what was said in my CNA class today. It was rather shocking. I don't know where to go to get more information or check this out but, they are telling us this at an accredited community college...

My instructor told us that, "Yes, NC is doing away with LPN's". She said from what she was told the change will not take place until Jan. 05. Any LPN's in a current nursing program will be allowed to finish but anyone on waiting lists for a program will be removed. She said that technically LPN's are CNA-II's combined with MedTech. They cannot start IV's or give injections, but they can pass meds. She said that when this change takes place, CNA-II's and LPN's will be considered the same thing CNA-II's, which will force LPN's to transition to RNs or they risk being classified as CNA-II's. I asked her about the LPN's that are currently working and how they would affected. She said they may take a drop in pay. She said more than likely CNA-II's will be given LPN pay. Thus, CNA-I's should expect some sort of small pay raise as well. In order to be LPN's they would have to stay at their current position at the current facility to be recognized. She also said that RN's and LPN's before taking the state exam for nursing can be listed on the Nursing Board registry as CNA-II's until they take the exam.

Please don't shoot the messenger. I'm not trying to spread gossip. I posted this because I am very concerned. I welcome ANY information to the contrary or otherwise. I just want to be informed to make the best choice, like every other nursing student about to hit the cross roads and decide on a path.

Marie_LPN, RN, LPN, RN · Sep 4, 2004

What a crock.

VickyRN, MSN, DNP, RN · Sep 4, 2004

Thanks for the heads-up, Maggie. I will definitely look into this. Considering the current political climate at the NCBON, I would not put it past them.

Here are current draft recommendations. (These are creating a firestorm reaction within ADN programs--The Education Committee in the NCBON is obviously anti-ADN. If they are successful in implementing these, many ADN programs across the state will close. I am not an alarmist-type person--I am just stating facts. I will address these in a separate thread when I have the time):

http://www.ncbon.com/forms/SummaryAndDraftRules.pdf

I did not see anything listed there concerning LPN's.

Here is the person to contact in the NCBON directly about the LPN-CNAII question (get it straight from "the horse's mouth":

Practice Consultant at the NCBON: 1-919-782-3211

Of course, they are off this weekend and Labor Day, so will have to wait until Tuesday.

VickyRN, MSN, DNP, RN · Sep 8, 2004

OK, I had a very pleasant telephone conversation with one of the NCBON practice consultants today. She stated categorically that there are NO plans to get rid of LPN's and replace them with CNAII's, and that there never has been such a plan.

To clarify the CNAII's role (for Patrick)--they can spike an IV fluid bag and aseptically run the fluid through tubing as long as it is under the delegation of a licensed nurse and NOT CONNECTED TO A PATIENT. They cannot attach the IV tubing to the patient, and initiate an intravenous infusion. They can help monitor IV fluid flow rate. And, they can discontinue existing peripheral intravenous infusions (under supervision of a licensed nurse).

http://www.ncbon.com/prac-naiitasks.asp

http://www.ncbon.com/prac-naiimod7.asp

RNPATL, DNP, RN · Sep 8, 2004

OK, I had a very pleasant telephone conversation with one of the NCBON practice consultants today. She stated categorically that there are NO plans to get rid of LPN's and replace them with CNAII's, and that there never has been such a plan.
To clarify the CNAII's role (for Patrick)--they can spike an IV fluid bag and aseptically run the fluid through tubing as long as it is under the delegation of a licensed nurse and NOT CONNECTED TO A PATIENT. They cannot attach the IV tubing to the patient, and initiate an intravenous infusion. They can help monitor IV fluid flow rate. And, they can discontinue existing peripheral intravenous infusions (under supervision of a licensed nurse).
http://www.ncbon.com/prac-naiitasks.asp
http://www.ncbon.com/prac-naiimod7.asp

Joy - thank you so much for this research. I have been appointed to head the LPN practice committee at my hospital (given that my unit has the most LPNs) and this information is very helpful. Currently, our LPN's are not permitted to do anything with the patient assessment, despite the fact that the nurse practice act allows for the LPN to "participate in the assessment process." In addition, LPN's are not allowed to update and implement the plan of care. I agree that the initial assessment and the plan of care development is an RN responsibility, but I see no reason why the LPN can not update the plan of care as well as be actively involved with implementing the plan of care. Interesting point to note - our LPN's can do IV push meds, take off their own orders, but can not update a care plan ... seems pretty crazy to me!

Anyway, the information you have provided on the CNA II is wonderful. This is another area that I am addressing on my unit. Some of the CNA II's function to their scope and some do not. Some tend to go over their scope of practice, which in my opinion, boarders on practicing nursing without a license. Anyway, I appreciate the information you gathered and it will be very helpful for me as I endeavor to correct and better define the scope of practice for both LPN's and CNA II's at my hospital.

barefootlady, ADN, RN · Sep 9, 2004

For several years now I have beening hearing that the NCBON is very nurse unfriendly. Is this true? If it is true, then why are the nurses there putting up with that kind of treatment from the board that is supposed to be representing your interest? Promoting nursing. Being an advocate for the profession.

Pat, why would a nurse ask a CNAII to skipe a bag of IV fluids? That seems like the time to assess the site, change tubing if it is needed, and generally to a quick assessment to see if fluid intake and output is WNL.

LPN's can do certain parts of an assessment at some facilities here, some do write orders, most do not in the hospital setting because most of the hospitals do not allow an LPN to do it. In the nursing homes they do this and more. Updating a care plan should be a duty that all assigned to the care of the patient has access to doing, but the RN may retain the ultimate responsibility in assuring the update is within the goal of the care plan. The example I am quoting is this, POC states, patient will take more active role in ADL's. CNA has encouraged patient and patient is now helping with own bath, combing hair, feeding self after cartons are opened, etc. then goal could be met and new goal set. ie. patient will get oob for all meals. do own bath except back, walk in room as tolerated with minimal assist. This should be a collaberated effort, but anyone should be able to initial and date when a goal is met is RN cosigns. I hope this is clear as mud, but I do think a manager should always press for ways to involve all of the team in the care of the patient as long as a policy is in place to do so, or do a study so a new policy that is involving all members in the care of patient.

I cannot believe that a CNA is given meds to give to patient there. I an signing that I know the patient has taken the med ordered as ordered and on time. WHY would any nurse allow this responsibility she/he has signed for be done by someone else? Very different to me. Here we give only what we pour, drawup in syringe, or open from unit dose. NEVER have given another nurse's meds in over 25 years of nursing.

Sorry, if I am rambling, but these are some questions I have about nursing down there. I just guess I would have a hard time adjusting to the way it is done there. Thanks for the ear and I look forward to the answers to my questions.