Hired As A Nurse Extern Now Being Used As A Cna ???

oramar · Feb 19, 2008

I think the last paragraph of your post contains the solution to your problem. I think you already figured out for yourself what to do.

bethin · Feb 19, 2008

Do you have a job description? If so, I would look at that. It will outline your duties and responsibilities. Have you spoken to your manager? Bring your concerns to him or her. They will assume you're not having any problems unless you speak up.

Where I work, nurse externs and CNA's are equal, except in pay. Scratch that, nurse externs can do admissions and insert foley's. And yes, nurses will drag them away from something so they can do an admission for them.

If you truly hate it, you're not doing yourself or your coworkers any favors by staying.

hospitalstaph · Feb 19, 2008

I had this happen to me too. I interviewed at a major trauma center for a nurse extern position and was hired. I was told that I would get "lots of practice with nursing skills" and would have endless opportunities to learn. Whatever! Unless stocking sheets and taking patients to the floor was a learning experience, I felt totally lied to. In the entire 6 months I was there, I drew blood twice and inserted one foley. So I started looking around and found a much, much smaller hospital that did not have an official nurse extern program. I applied for just a regular ER tech position but explained to the manager my desire to learn. Best choice I ever made. Yes I did "tech stuff", but I also had opportunities to practice skills. On graduation I was offered a job and the rest is history:nuke:

N51308 · Feb 19, 2008

Thanks for all your responses. I'd feel different if I felt appreciated and part of the "team." But the majority of the nurses don't appreciate the CNAs or myself. More than anything I was really just curious if anyone had this experience happen to them specifically. Thanks again for the replies. :tku:

llg, PhD, RN · Feb 19, 2008

I agree with the general opinion that you are being taken advantage. Now, to turn this into a positive learning experience ...

While you did a nice job of explaining the initial problem in your OP, you never told us what steps you have taken to resolve the situation. Before you simply leave the unit (by transfer or resignation) and put a little "red flag" in your employment history ... you should try to resolve the problem. After all, you are less than a year away from becoming an RN. You will want to be able to present yourself in the best possible light as you look for your first RN job.

Have you spoken with your supervisor? Is your relationship with at least a few of the nurses positive enough to ask them for some guidance in dealing with the politics of the situation? etc.

Every job has its politics. The interpersonal skills of working as a team are just as important to your career success as any technical nursing skill. In fact, those interpersonal skills are usually more likely to cause problems for a new grad than the technical skills. (Technical skills are easier to teach and learn.) Don't just run away from this imperfect situation. Work on resolving it before giving up. Resolving it will help you learn valuable interpersonal skills that will come in very handy later. Giving up and moving to a new job only 4 months before graduation may raise a "red flag" for your next couple of job searches. And when you are asked to explain it, you might make yourself look like someone who can't navigate the reality of the workplace and get along with her colleagues.

It might not work out ... but it is worth a try to give resolution a shot.

JustJen, BSN, RN · Feb 19, 2008

Before I finished school this COULD HAVE happened to me. I was hired in a position that sounds a lot like yours. The single most reason that it didn't happen to me was the RN that I shadowed would not allow it to happen.

I am not saying that I didn't help with vitals and ADL's occasionally. I did, and often. I will say that my RN many times would say "Why don't you assess patient XYZ and let me know what you think about such-and-such, I am going to help and get vitals for the floor. Our CNA is sick tonight so we are working short." This experience taught me two things. #1: I got better at assessing such-and-such, but #2 and perhaps the most important lesson, was my RN taught me how to be a member of the team. I am a preceptor now, and one of the things I stress the most with my new orienees is TEAMWORK. We all need to help each other out. Thats the key to sucess on the floor.

My RN would not let me be taken from things that I would learn from so I could answer call bells all night. Now, if we were all caught up, and bells started to ring, we would all do our part to get things done.

I think to a lot of people, once your name has RN after it, you don't have to do the typical "CNA duties" but I am here to say that I do as much bathing, and toileting, and vitals now as I did as an aide. Maybe not every night, and shoot, lots of times the majority of the patients are not mine, I just happened to hear their call bell and tried to help.

Talk to your manager and ask to be assigned to an RN who will watch out for learning opportunities for you.

N51308 · Feb 19, 2008

Again, thanks to all who have responded. I agree that I am probably rushing my decision. Upon further insight I have decided to stick it out. I think my frustration lies in that my original preceptor did look out for me and provided multiple learning opportunities. Yes, I know we all most work as a team. And as I mentioned before I don't believe I'm above helping out with any duties. However, my main concern is lately I am not learning but filling in for the CNAs. I do have control of my schedule though and may alter that to work with the Nurses who I know will give me multiple opportunities to learn and participate. Again, thank you for all the advice. I especially appreciated your comment llg about remembering to resolve a problem before running away. And all who pointed out that this is still a learning opportunity regardless of the circumstances.

wonderbee, BSN, RN · Feb 19, 2008

You will probably not be reassigned to another nurse and this one has plans for keeping you busy as her aide.

I found that no matter what we called ourselves, we were nursing assistants first, students later (if there was time). The hospital gets good UAP and a steady pool of RNs to choose from upon graduation. Once in a while, they throw you a bone but make no mistake, they want an aide.

classicdame, MSN, EdD · Feb 19, 2008

My response will not make you happy. According to my nurse practice act the nurse extern is unlicensed assistive personnel. Others who fall in that description are CNA, PCT, techs, etc. You do not have a license so you cannot do what a licensed person can do. In my facility we pay the externs more than the CNA's for two reasons 1) we hope they will stay on with us after graduation and 2) we expect them to use their brain and grow a little while here. But they are not mini-nurses and cannot have patient assignments. If you learn how to be a good CNA you will be a good nurse. Remember the nurses in NO after Katrina? No resources. All they could provide was basic care. That is what saved lives at that point. Absorb all you can and don't get an attitude about working beneath your education. If you cannot wipe a hinney, then please, don't apply where I work because I want nurses who are willing to do what it takes to get the job done. Good luck. You have a good career ahead.

pagandeva2000, LPN · Feb 19, 2008

I guess that nurse externs do different things in different areas. In my end of the world, most nurse externs are actually telemetry monitors. They have training in interpeting EKGs and inform the nurses if there are any problems. In addition, some of them do fingersticks, dressings in addition to CNA duties when the time calls for it.

The answer would really be to obtain a job description, review it, and maybe transfer to another place/position that does not require too much direct care.

hypocaffeinemia, BSN, RN · Feb 20, 2008

My response will not make you happy. According to my nurse practice act the nurse extern is unlicensed assistive personnel. Others who fall in that description are CNA, PCT, techs, etc. You do not have a license so you cannot do what a licensed person can do. In my facility we pay the externs more than the CNA's for two reasons 1) we hope they will stay on with us after graduation and 2) we expect them to use their brain and grow a little while here. But they are not mini-nurses and cannot have patient assignments. If you learn how to be a good CNA you will be a good nurse. Remember the nurses in NO after Katrina? No resources. All they could provide was basic care. That is what saved lives at that point. Absorb all you can and don't get an attitude about working beneath your education. If you cannot wipe a hinney, then please, don't apply where I work because I want nurses who are willing to do what it takes to get the job done. Good luck. You have a good career ahead.

NPA's are, of course, different in every state. I know mine from back to front as a student (or else it's beat into me), so here's the relevant section from Texas's:

Sec. 224
(4) Unlicensed person--An individual, not licensed as a health care provider:
(A) who is monetarily compensated to provide certain health related tasks and functions in a complementary or assistive role to the RN in providing direct client care or carrying out common nursing functions; (B) including, but is not limited to, nurse aides, orderlies, assistants, attendants, technicians, home health aides, medication aides permitted by a state agency, and other individuals providing personal care/assistance of health related services; or
© who is a professional nursing student, not licensed as a RN or LVN, providing care for monetary compensation and not as part of their formal educational program shall be considered to be unlicensed persons and must provide that care in conformity with this chapter.
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The following standards must be met before the RN delegates nursing tasks to unlicensed persons. These criteria apply to all instances of RN delegation. Additional criteria, if appropriate to the particular task being delegated, may also be found in 224.8(b)(1) of this title (relating to Discretionary Delegation Tasks).
(1) The RN must make an assessment of the client's nursing care needs. The RN should, when the client's status allows, consult with the client, and when appropriate the client's family and/or significant other(s), to identify the client's nursing needs prior to delegating nursing tasks. (2) The nursing task must be one that a reasonable and prudent RN would find is within the scope of sound nursing judgment to delegate. The RN should consider the five rights of delegation: the right task, the right person to whom the delegation is made, the right circumstances, the right direction and communication by the RN, and the right supervision as determined by the RN. (3) The nursing task must be one that, in the opinion of the delegating RN, can be properly and safely performed by the unlicensed person involved without jeopardizing the client's welfare. (4) The nursing task must not require the unlicensed person to exercise professional nursing judgment; however, the unlicensed person may take any action that a reasonable, prudent non-health care professional would take in an emergency situation. (5) The unlicensed person to whom the nursing task is delegated must be adequately identified. The identification may be by individual or, if appropriate, by training, education, and/or certification/permit of the unlicensed person. (6) The RN shall have either instructed the unlicensed person in the delegated task, or verified the unlicensed person's competency to perform the nursing task. The verification of competence may be done by the RN making the decision to delegate or, if appropriate, by training, education, experience and/or certification/permit of the unlicensed person. (7) The RN shall adequately supervise the performance of the delegated nursing task in accordance with the requirements of 224.7 of this title (relating to Supervision). (8) If the delegation continues over time, the RN shall periodically evaluate the delegation of tasks. For example, the evaluation would be appropriate when the client's Nursing Care Plan is reviewed and revised. The RN's evaluation of a delegated task(s) will be incorporated into the client's Nursing Care Plan.
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The registered professional nurse shall provide supervision of all nursing tasks delegated to unlicensed persons in accordance with the following conditions. These supervision criteria apply to all instances of RN delegation for clients with acute conditions or in acute care environments.
(1) The degree of supervision required shall be determined by the RN after an evaluation of appropriate factors involved including, but not limited to, the following: (A) the stability of the client's status in relation to the task(s) to be delegated; (B) the training, experience, and capability of the unlicensed person to whom the nursing task is delegated; © the nature of the nursing task being delegated; and (D) the proximity and availability of the RN to the unlicensed person when the nursing task will be performed. (2) The RN or another equally qualified RN shall be available in person or by telecommunications, and shall make decisions about appropriate levels of supervision using the following examples as guidelines: (A) In situations where the RN's regularly scheduled presence is required to provide nursing services, including assessment, planning, intervention and evaluation of the client whose health status is changing and/or to evaluate the client's health status, the RN must be readily available to supervise the unlicensed person in the performance of delegated tasks. Settings include, but are not limited to acute care, long term care, rehabilitation centers, and/or clinics providing public health services. (B) In situations where nursing care is provided in the client's residence but the client's status is unstable and unpredictable and the RN is required to assess, plan, intervene, and evaluate the client's unstable and unpredictable status and need for skilled nursing services, the RN shall make supervisory visits at least every fourteen calendar days. The RN shall assess the relationship between the unlicensed person and the client to determine whether health care goals are being met. Settings include, but are not limited to group homes, foster homes and/or the client's residence.
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(a) Tasks Which are Most Commonly Delegated. By way of example, and not in limitation, the following nursing tasks are ones that are most commonly the type of tasks within the scope of sound professional nursing practice to be considered for delegation, regardless of the setting, provided the delegation is in compliance with 224.6 of this title (relating to General Criteria for Delegation) and the level of supervision required is determined by the RN in accordance with 224.7 of this title (relating to Supervision): (1) non-invasive and non-sterile treatments; (2) the collecting, reporting, and documentation of data including, but not limited to: (A) vital signs, height, weight, intake and output, capillary blood and urine test for sugar and hematest results, (B) environmental situations; © client or family comments relating to the client's care; and (D) behaviors related to the plan of care; (3) ambulation, positioning, and turning; (4) transportation of the client within a facility; (5) personal hygiene and elimination, including lady partsl irrigations and cleansing enemas; (6) feeding, cutting up of food, or placing of meal trays; (7) socialization activities; (8) activities of daily living; and (9) reinforcement of health teaching planned and/or provided by the registered nurse. (b) Discretionary Delegation Tasks. (1) In addition to General Criteria for Delegation outlined in 224.6 of this title, the nursing tasks which follow in paragraph (2) of this subsection may be delegated to an unlicensed person only: (A) if the RN delegating the task is directly responsible for the nursing care given to the client; (B) if the agency, facility, or institution employing unlicensed personnel follows a current protocol for the instruction and training of unlicensed personnel performing nursing tasks under this subsection and that the protocol is developed with input by registered nurses currently employed in the facility and includes: (i) the manner in which the instruction addresses the complexity of the delegated task; (ii) the manner in which the unlicensed person demonstrates competency of the delegated task; (iii) the mechanism for reevaluation of the competency; and (iv) an established mechanism for identifying those individuals to whom nursing tasks under this subsection may be delegated; and © if the protocol recognizes that the final decision as to what nursing tasks can be safely delegated in any specific situation is within the specific scope of the RN's professional judgment.
(2) the following are nursing tasks that are not usually within the scope of sound professional nursing judgment to delegate and may be delegated only in accordance with, 224.6 of this title and paragraph (1) of this subsection. These types of tasks include:
(A) sterile procedures--those procedures involving a wound or an anatomical site which could potentially become infected;
(B) non-sterile procedures, such as dressing or cleansing penetrating wounds and deep burns;
© invasive procedures--inserting tubes in a body cavity or instilling or inserting substances into an indwelling tube; and
(D) care of broken skin other than minor abrasions or cuts generally classified as requiring only first aid treatment.
© Nursing Tasks Prohibited from Delegation By way of example, and not in limitation, the following are nursing tasks that are not within the scope of sound professional nursing judgment to delegate:
(1) physical, psychological, and social assessment which requires professional nursing judgment, intervention, referral, or follow-up;
(2) formulation of the nursing care plan and evaluation of the client's response to the care rendered;
(3) specific tasks involved in the implementation of the care plan which require professional nursing judgment or intervention;
(4) the responsibility and accountability for client health teaching and health counseling which promotes client education and involves the client's significant others in accomplishing health goals; and
(5) administration of medications, including intravenous fluids, except by medication aides as permitted under 224.9 of this title (relating to The Medication Aide Permit Holder).

In reality, a nursing student working as an extern can help with all 5 of the explicitly forbidden tasks, we just can't be charting it. So at least in Texas, the RN preceptor is given significant leeway as far as what their externs can do. It's their license on the line, but they are given the ability to assess just what the extern can do and therefore what you can and can't do might fall more under nurse preference and/or hospital policy.