Held to highest license?

[kaliRN]

I have been informed, that when employed in healthcare, one is held to their highest licensure. That is, an RN is legally held to the standards of that license, even if employed as an LVN ... A risk management nightmare (and a huge liability for the nurse). How do these rules apply to roles without a license - such as CNAs or HHAs/caregivers? Are the standards different in the hospital versus the home environment? I see the LOGIC behind this from a risk management standpoint, I just wonder about the legal basis.

Would someone be kind enough to direct me to information on these legalities? This is something I would like to verify and understand. Is this something from the BRN/BON in each state? I have been unable to extract it from the Nurse Practice Act in mine.

I have posted this on my state board with no response. Any insight would be greatly appreciated.

[caliotter3]

It is the same. If you are working as a CNA, you are held to the standards of your RN license for legal purposes. This concept applies moreso in this instance, because most RNs work as CNAs rather than as LVN/LPNs. I asked this question in my BSN program many years ago and was given this answer. I believe it is covered on the website of my state's Board but have not checked over the site lately. If you want the official opinion of the Board, one way to find out, is to write them a letter and use their letter back to you as your written guideline.

[caliotter3]

I also would hazard a guess that this policy came about as a result of legal precedent in lawsuits. I do not have the expertise to do legal research, but see that this would be a very interesting topic for such.

[Crocuta, RN]

Here's your answer from the California Board of Nursing:

http://www.rn.ca.gov/pdfs/regulations/npr-i-02.pdf

DUAL LICENSURE

THE RN AS LICENSED VOCATIONAL NURSE OR NURSING ASSISTANT

RN AS LVN:

The Board has been asked whether a person holding both current registered nursing (RN) and licensed vocational nursing (LVN) licenses may legally accept a position as an LVN. It is legal for the holder of both licenses to practice as an LVN. However, we caution the RN accepting such a position that although the LVN job description may limit the scope of practice of the dual licensee while functioning in a particular position, it is the position of this Board that, regardless of employment status, the RN is required to act as a patient advocate and to provide care that is in the best interest of the patient.

THE ABOVE IS REPRINTED FROM THE BRN REPORT -- WINTER 1994

RN AS NURSING ASSISTANT OR HOME HEALTH AIDE:

In a statement issued January 2, 1996 by the Department of Health Services, it was stated that: "It is the policy of Aide and Technician Certification Section (ATCS) to permit WITHOUT CERTIFICATION, the LVN, RN, or LPT to work as a Nurse Assistant (NA) or Home Health Aide (HHA). These individuals, for purposes of this policy, are person holding a California license as an RN, LVN, or LPT in active and good standing.

"An LVN, RN, or LPT receive more training and education, has higher skills level and scope of practice than an NA or HHA so it follows that certification for less is unnecessary and redundant. THEREFORE, ATCS WILL NOT ISSUE CERTIFICATES TO THESE INDIVIDUALS."

Just remember, should something happen, you cannot claim "I was only the CNA." While your scope of practice will be limited by your job description, if you ever have to stand in front of the Board and defend your actions, they will hold you to the standards of your RN licensure, and that is what you can lose if you are found to have not acted appropriately.

Hope you find an RN job soon.

[caliotter3]

I found the above link again, but distinctly remember my nursing instructor using much stronger language many years ago. I would be very interested to see how this has played out in any lawsuits.

[kaliRN]

Thanks for the reply Crocuta, I do appreciate the liability, and know of no hospital that employees RNs as UAP. I am taking under consideration working as a HHA, but have thus far given myself nightmares of not acting when necessary. It is a difficult position to be in and I would never want to risk my license, but at some point, my family needs me to make sure we are fed and housed and that's becoming increasingly difficult every month. I can't thank you enough for your reply and well wishes!

[caliotter3]

Home health agencies would be more likely to hire you as an RN than as a HHA, at least from what I've seen.

[kaliRN]

Calilotter, our Dean used the same strong language. It was nauseating, in our last few weeks before graduation, to have this whirlwind discussion of "We lied about the nursing shortage, there are no jobs, but DON'T do this." The entire tone was disgusting, as though we were addled children having the wool pulled from our eyes. It is easy for me to hypothesize scenarios that would be the basis for litigation. I am doing a fair amount of soul searching on this one and appreciate your feedback.

ETA: Home health does not go wanting for RNs the way they have in years past. I have just started actively applying in this area, but a hiring manager did tell me they would be glad to take me on as a "caregiver" if I would be willing to take the pay. I got a thumbs down as a new grad RN.

[Bubbles]

Sounds like all nurses need to obtain Liability Insurance and remember they are nurses even if forced to accept employment as CNAs or HHA. Since NSO professional liability insurance will not put one's insurance on hold if you are unemployed I have let mine lapse. NSO was supposed to send me info on a 'retired policy' which costs $54.20 rather than the usual $107.25 per year for the $1,000,000.00 / $6,000,000.00 I was paying. But when I get an job or even am just doing volunteer work I will need to reinstate it 'stat.' It is just not worth the risk in this suit happy society in which we live. At least it is a tax deductible expense.

[caliotter3]

Lately employers have been requesting copies of my Liability Insurance. While I do not agree with providing them the information upon hire, I give it to them in order to be cooperative to get the job. So, I just keep the insurance up to date, job or no job.

[klone, MSN, RN]

Are you sure one is held to their "highest licensure" and what exactly does that mean?

I work with several advanced practice nurses (CNMs, WHNPs, ANPs) who work as RNs on the unit upon which I work. It has never been a problem.

I also know of a hospital network that will hire new grad RNs to work as CNAs until an RN position opens up.

I imagine it depends entirely on each state.

[caliotter3]

Holding a nurse to her RN licensure is the surest way to get an RN for CNA pay. The employer knows very well that the RN is likely not going to sit on her butt while the patient is neglected. Most RNs and LPNs are very cognizant of the gravity of holding a license.