Is it legal to work as an aid while you are an RN

elkpark · Jun 30, 2016

It makes sense that after licensure you're held to the RN level of responsibility, BUT, if you are working as a tech, you do really have the same responsibility as the nurse who has been assigned the care of that patient? If someone, as an experienced nurse working the floor, notices something wrong with another nurse's patient, it's not that person's responsibility to notify doctors or give meds, it's their responsibility to notify the assigned nurse and let them follow through. Wouldn't it be the same if you were working as a tech? Aside from critical situations where every moment matters, it seems to me that the assigned nurse would still be ultimately responsible for the patient's nursing care. If something is wrong, you notify the nurse and add a note to that effect. If something is really, terribly wrong, you also notify the charge nurse and add a note to that effect. Wouldn't that cover your backside?

In the example you give, the other RN (the one who just walks by) isn't directly responsible because s/he isn't assigned to that client. However, an RN working as a tech is assigned to a set of clients, and is therefore equally as responsible, professionally, legally, as the assigned RN, even though s/he is working in a tech role on that particular day. It's not as if someone just happened to be walking by and noticed something; the individual is assigned to those clients, the same as the (other) RN. If the person working as a tech is a licensed RN, sees something amiss and brings it to the attention of the person assigned as the RN for the shift but does nothing further, and the other RN doesn't appropriately deal with the situation and the client suffers an injury as a result, why on earth wouldn't both RNs be equally responsible? They're both licensed RNs ... They're both assigned to the client ... I'll bet you my next several paychecks that a jury and/or BON would certainly see it that way.

That's the sticky thing about working "below" your level of licensure; employers restrict you to the scope of practice for the position in which you're working, but, if something happens to go pear-shaped enough to end up in court, the courts will hold you to the standards of your highest level of education and licensure, regardless of what your job title may have been on that particular day.

Some employers like doing this (having employees working below their level of licensure) because they're essentially getting an RN for CNA wages. Other, more responsible and ethical employers just won't allow people to work below their level of licensure. (There have been a number of people who have posted here over the years that they were v. surprised to discover that they were laid off from their CNA positions as soon as they passed boards; they hadn't realized that their employers weren't going to allow them to continue working as a CNA while they looked for RN jobs. I always feel bad for the people who have that happen, but I respect those employers.)

NotAllWhoWandeRN, ASN, RN · Jun 30, 2016

In the example you give, the other RN (the one who just walks by) isn't directly responsible because s/he isn't assigned to that client. However, an RN working as a tech is assigned to a set of clients, and is therefore equally as responsible, professionally, legally, as the assigned RN, even though s/he is working in a tech role on that particular day. It's not as if someone just happened to be walking by and noticed something; the individual is assigned to those clients, the same as the (other) RN. If the person working as a tech is a licensed RN, sees something amiss and brings it to the attention of the person assigned as the RN for the shift but does nothing further, and the other RN doesn't appropriately deal with the situation and the client suffers an injury as a result, why on earth wouldn't both RNs be equally responsible? They're both licensed RNs ... They're both assigned to the client ... I'll bet you my next several paychecks that a jury and/or BON would certainly see it that way.
That's the sticky thing about working "below" your level of licensure; employers restrict you to the scope of practice for the position in which you're working, but, if something happens to go pear-shaped enough to end up in court, the courts will hold you to the standards of your highest level of education and licensure, regardless of what your job title may have been on that particular day.
Some employers like doing this (having employees working below their level of licensure) because they're essentially getting an RN for CNA wages. Other, more responsible and ethical employers just won't allow people to work below their level of licensure. (There have been a number of people who have posted here over the years that they were v. surprised to discover that they were laid off from their CNA positions as soon as they passed boards; they hadn't realized that their employers weren't going to allow them to continue working as a CNA while they looked for RN jobs. I always feel bad for the people who have that happen, but I respect those employers.)

Thanks for sharing. That is very, very interesting. When my last unit was overstaffed we'd float to other units, but we were only allowed to do tech work if it was a unit substantially outside our training. So if I, floating from a med-surg unit, don't remember the specifics of contraction monitoring, but think something on the tracing isn't right, I'm still liable if something goes down after I notified the assigned (and OB-trained) RN and they thought everything was hunky dory? That's... scary.

rzyzzy · Jun 30, 2016

Thanks for sharing. That is very, very interesting. When my last unit was overstaffed we'd float to other units, but we were only allowed to do tech work if it was a unit substantially outside our training. So if I, floating from a med-surg unit, don't remember the specifics of contraction monitoring, but think something on the tracing isn't right, I'm still liable if something goes down after I notified the assigned (and OB-trained) RN and they thought everything was hunky dory? That's... scary.

In my state, you can "inactivate" your higher-level license by notifying the BON if it's a situation where you might lose a good job by being "overqualified".. If your license isn't "active" you can't be held to the higher standard of care.

VTsquach · Jun 30, 2016

Just call the board of nursing and ask or call human resources as your facility likely has a policy in place. I have never worked anywhere where a CNA was allowed o continue in that roll after passing NCLEX. I am licensed in 27 states and know of multiple occasions where CNAs had to leave their job because they achieved their RN, but did not have employment as an RN. My gut says it isn't legal, but I don't know for sure.

Salisburysteak, BSN, RN · Jun 30, 2016

Well here's my story. I passed my NCLEX RN yesterday and I'm officially RN now. During my school I worked as nursing assistant in the MICU and I got hired as an RN in the same unit before my graduation and my manger was waiting for me to take my board to officially start working as an RN. My manger in vacation right now and he wont come back till July 14th which is like 2 weeks from now and I wont be able to start as an RN till he come back to work. I'm still on the schedule for the next two weeks as a nursing assistant and I mostly work every day. Is it normal to stay in my job as an aid while waiting to my manger to come back? I have no problem to stay aid for couple of weeks but is it legal or it will cause me troubles?

Do you have your license yet? If you do not have a license you are not an RN yet. You are still technically an aide. Work as an aide until your manager gets back, and then when he gets back find out from there what to do.

bgxyrnf, MSN, RN · Jul 1, 2016

For the last 7 years I've been seeing people state that if one has a nursing license but is working as an aide or tech that they are ethically and legally bound to act as a nurse.

I remain skeptical of this assertion and I'm wondering if anybody can offer anything than their opinions or anecdotes. Specifically, I'm interested in links to BRN sites, statutes, or settled cases that support this claim.

The reason for my skepticism is that, even as a nurse, I am not required to act as a nurse unless I have entered into the nurse-patient relationship in the course of my employment.

elkpark · Jul 1, 2016

For the last 7 years I've been seeing people state that if one has a nursing license but is working as an aide or tech that they are ethically and legally bound to act as a nurse.
I remain skeptical of this assertion and I'm wondering if anybody can offer anything than their opinions or anecdotes. Specifically, I'm interested in links to BRN sites, statutes, or settled cases that support this claim.
The reason for my skepticism is that, even as a nurse, I am not required to act as a nurse unless I have entered into the nurse-patient relationship in the course of my employment.

Here are some sample statements from various BONs on this topic, that I was able to find in a quick Google search (not a comprehensive survey) and have posted here in the past.

New York:

Can a Registered Professional Nurse (RN) or Licensed Practical Nurse (LPN) work in a position that is below his/her level of licensure?

Answer: Yes. A licensed nurse may work in a position that he/she has the training to do and that is within his/her scope of practice. RNs have the training to perform LPN, Certified Nurses Aid and Home Care Aid functions and therefore could accept a work identified for these levels. An LPN has the training to perform Certified Nurses Aid and Home Care Aid functions, and could accept work identified for either of these positions. However, the nurse that does so would still be required to act prudently based on his/her educational preparation and would be held to that standard.

http://www.op.nysed.gov/prof/nurse/nursepracticefaq.htm

Wisconsin:

IF I HAVE AN RN LICENSE, BUT CAN ONLY FIND WORK AS AN LPN OR CNA, IS IT ACCEPTABLE FOR ME TO WORK IN A POSITION BELOW MY LEVEL OF LICENSURE UNTIL I CAN FIND OTHER WORK? THE SAME WITH AN LPN WORKING AS A CNA?

The Board of Nursing does not regulate CNAs, so questions regarding the practice of CNAs should be addressed to the Wisconsin Department of Health Services. It is important to note that while working at a lower level, you may be held to a higher standard of care due to advanced education, training and experience. Also, you must hold the credential for the profession in which you work.

404 - File or directory not found.

ã€€

North Carolina:

Can a LPN or RN work in a position that is below his/her level of licensure?

A licensed nurse may accept and work in a position that he/she has the training to do and that is within his/her scope of practice. A RN has the training to perform LPN and NA functions and therefore could accept a position identified for either of these levels. However, the nurse that does so would still be required to act prudently based on his/her educational preparation and would be held to that standard.

FAQ - Nursing Practice | North Carolina Board of Nursing

Iowa:

Q. Can a LPN or RN work in a position that is below the level of his/her licensure?

A. There are no laws or Iowa Board of Nursing rules that prohibit a licensed nurse from working in a position that is below the level of his or her licensure. However, the board has previously determined that the nurse who does so is held to the highest level of his or her education. If a nurse is working in a position lower than the nurse's licensure and fails to act prudently based on education preparation, the nurse's license would be subject to sanction by the board.

Practice - Frequently Asked Questions | Iowa Board of Nursing

ã€€

Maine:

Practice Below Level of Licensure

A licensed person who agrees to be employed in a position which requires less knowledge and skill than that for which s/he is prepared may find several problems:

1. S/he may be expected to perform at the level for which s/he has been prepared even though classified at a lesser level; and

2. S/he will be held to the standard expected of the higher licensure level should legal problems occur in that health care facility, no matter what the job classification.

The practice of employing licensed individuals to work below their level of preparation, as defined in the LAW REGULATING THE PRACTICE OF NURSING, places that licensed nurse in potential legal jeopardy and is of serious concern to the Board. (1985)

Maine State Board of Nursing Website - General Practice Questions

wanna_be · Jul 1, 2016

You're asking a thoughtful question, OP--I just passed the NCLEX and may be in the same boat depending on when the BON gives me a license. One thing to consider (and another poster pointed out): you said you passed your NCLEX yesterday. You likely already know this, but just to clarify, you must actually have an active license with your BON to be considered an RN--even after you pass the NCLEX, you are not licensed to practice as an RN until your license shows up as active. Good luck!

Rn 1979 · Jul 1, 2016

Thank you everyone for your replays. I still don't have an active license on the BON, so I will keep working as an aid till see my license on active status.

Helloeverybody · Jul 2, 2016

Thank you everyone for your replays. I still don't have an active license on the BON, so I will keep working as an aid till see my license on active status.

Your manager comes back on my Birthday! I am also a CNA and waiting to take my boards. The BON in NJ is extremely slow. No one in my school received a date yet. Just doing questions, questions, questions. What did you use that helped you with the NCLEX? Kaplan? Uworld?

smartnurse1982 · Jul 2, 2016

In my state, you can "inactivate" your higher-level license by notifying the BON if it's a situation where you might lose a good job by being "overqualified".. If your license isn't "active" you can't be held to the higher standard of care.

That does not make sense,because you cannot just "forget" what you've learned.

How would that work?

NotAllWhoWandeRN, ASN, RN · Jul 2, 2016

[/b][/u]
That does not make sense,because you cannot just "forget" what you've learned.
How would that work?

If you don't have an active RN license, you're not an RN anymore, period. Without the state license you're not qualified to work a nursing position, knowledge or no.

Having a certain level of knowledge is required to become an RN, but it doesn't make you one.