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LPNs called to come in and work as Aides? Is this common?

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catshowlady

Specializes in ICU.

The hospital I used to work at would float a nurse to other floors and have them fill the role of PCA/PCT. I never saw a nurse officially in primary care at that hospital. The one I work at now does not float nurses to be PCA's, but they have primary care assignments. (Primary care means the nurse is responsible for everything for that pt the entire shift - VS, toileting, feeding, etc. plus meds and assessments.) So I have seen this practice.

As far as your resident-to-CNA ratio, I'd say 2 CNA's to 15 residents is darn good compared to other LTC ratios I've seen posted here, and you may be being taken advantage of if they are pushing you to do CNA duties on a regular basis. I worked as a PCT during NS on a busy stepdown unit, and I was responsible for Q2H VS, accuchecks, bathing, turning, getting pts OOB, feeding, toileting, and stocking, plus I had to travel off the floor to monitor telemetry for pts that were going for testing. So I had additional duties to your CNAs' duties, and I did this for 9 pts, not 7.5. My nurses would help when they could, but they were busy too. Not saying your situation is all wrong, as I've never worked LTC, just be careful not to neglect your LPN duties for CNA duties unless it truly can't be helped.

:paw:

NurseLoveJoy88, ASN, RN

Specializes in LTC. Has 6 years experience.

I'm a LPN in assisted living and this is not normal. I'm responsible for meds, and my nursing duties. I do toilet and help with care when necessary but its not in mandatory that I help with meals, showers and etc. For example If I'm doing a treatment and my resident is soiled I don't call for an aide I'll do it myself. Now if I'm swamped with work or have an emergency then yes I will delegate. I'll never be above toileting a resident or assisting with ADLs however its hard to do my job and theirs to. When we have been short I was the nurse, med tech, and nurse's aide all at once. Its all about team work.

Thank you so much for taking the time to share your perspectives. I plan on doing my best for the residents at all times. Have a great day.

Sierralee

Specializes in family practice, pediatric, LTC/AL/PC.

WOW!! Are we as LPNs getting used or what LOL so great remarks. Don't wish to hard for the union thing. At my facility the nurses are not union, but the CNAS are. Let me tell you I have aides who have worked there from 16 to 30 years. You want attitude. I have one who thinks she is a wound nurse. I have one who has been trained to trained other CNAs to pass meds. She thinks she has the education of a nurse. It was a three days course. Now don't get me wrong. I have great aides, there are days they are my eyes, ears, hands. But I would like some of these others to remember to respect others of their peers and the nurses and to remember their parameters! But that union protects them and they know it. I totally agree with the nurse about those mds, i cannot tell you how many times either i can't get a resident more help (sending them to nursing) or i get them back, and they cannot perform their adls or fight their way out of a brown paper bags. GOD Love those smiley face social workers that go around saying, "you'll going to love this resident, they are sooooo cute". There are times I have to wait till they fall and break something before I can get them off my floors. God are the hospitals like this?

Hello Everyone,

I am a brand new LPN grad, a brand new LPN in LTC, and brand new to allnurses. I love this site! It has been so comforting to me as a student and now as a new nurse. I have a few questions and would really appreciate any feedback.

Does your LTC facililty expect you to work as an aide to cover a shift when an aide calls out? I am brand new on my job (3 weeks) but I hear the aides on the phone when an aide has called out for a shift trying to get someone to cover. They first call all the aides, who usually say they can not come in to cover. And then the aide starts calling the nurses to see if they can come in to cover the aide's shift. They do pay the nurses their LPN salary to work the shift as an aide. This is on an Assisted Living floor and the aides are not certified. I was really surprised when I heard the aide, not my administrator, calling nurses to come in to cover. I think the aides burn out because they don't have enough help and they rely on the nurses to help them, rather than the nurses being able to delegate some responsibilities to the aides. P.S.- the nurses' are overwhelmed and overworked as well, but try to take on as much as they can because there just don't seem to be enough aides for all the resident's many needs.

Also, when I work my shift on the work on the Dementia floor, I am expected to give my early morning meds, shower and dress 3 people and get them to breakfast. In the afternoon, I am to "toilet" 3 or 4 residents and either help with making beds and replacing towels in the rooms, or help clean the tables off after lunch. My first day was rough. I did my meds, and got my first resident showered and dressed and I heard a resident screaming, he had fallen. Of course, I immediately went to him. In between helping the aides, I had meds, assessments, calls to the MD, dressing changes, speaking with families, incident report, 24-hr report, my shift report and nursing notes. I have to say they have 2 aides on for 15 dementia residents. These aides must shower, serve food, clean up, do activities, toilet...all of it. So, I dont' believe the aides are lazy, just overwhelmed and need and expect help from the nurse on duty.

Being completely new to this field, I am asking...is this a normal practice?? Thanks so much in advance for any feedback!!!!

I've heard that it happens at heritage woods of chicago, from someone who lived there once. Don't know for sure though.

deleern

Specializes in LTC, MDS Cordnator, Mental Health. Has 9 years experience.

I Have been following this thread. You know the one thing that must be kept in mind. It is about the residents... Not about you... As the charge nurse I work in any position I am needed. Yes it is customary that LPN can be bumped to the floor if an RN takes a cart. and LPN can do patient care. My daughter will come in for 4 or 5 hours to help and chooses Not to do the cart, so she can leave. at the end the the time frame.

When licence staff does some pt care they may see thing that may not be reported to them. When I did MDS I usully tried to at least toilet the residents that were in the assessment Period.

DeeLee99,

I couldn't agree with you more...it truly is about the resident. Ironically, I was supposed to be the charge nurse on the dementia unit yesterday and one of the two aides called out. So, I was told by my Administrator that I would work as the aide for the shift and she would have the Assisted Living nurse do my meds. Well, I worked right along side the aide and did all the bathing, feeding, toileting...heck we even painted nails and baked a cake. And I managed to get the meds done as well and didn't have to take the Assisted Living nurse away from her hectic word load. I will say this...we DO need more help to provide quality and safe care for the dementia residents. And I talked to my Adminstrator about that yesterday.

And you are right, I was able to assess things I would not have otherwise seen if I hadn't toileted and bathed the residents. I, in no way, think I am above it. As a new nurse, I have to learn to do both. And I am sincerely working on it. It will take time.

Thanks for you advice!! Hope you have a great day. And in my opinion, I can tell your residents and staff are lucky to have you.

I've worked as an aide since becoming a LPN, and I did get paid the same LPN wages when I did it. However, I was never expected to be an aide, and perform nursing (LPN) duties at the same time. I ran around the whole shift when I did my CNA duties, so there wouldn't have been any time to do a med pass. I figure that if a facility wants a nurse to be an aide for a shift, then the nurse should only perform CNA duties during that time.

CapeCodMermaid, RN

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience.

We've had LPNs and RNs be aides if we were short. We had a few days where there were too many licensed people and not enough CNAs so I asked who wants to be an aide today?? The RN jumped at the chance to do something other than the med pass. Whoever said it's about the residents was right.

There is not a snowballs chance in Yuma, Az that myself or any nurses I know would come in and pull a shift as a CNA. My SNF wouldn't dare ask that. CNAa looking for work are a dime a dozen(like nurses) and there is no time they can't get someone. We always have CNAs wanting to pull a double. There are times while working that we do wind up toileting a resident or other CNA stuff just because we all have to work together to get it done.

Legally an employer and your licensing board can expect you to do anything that you have been licensed/trained to do.

Since nursing is such a diverse field and nurses have such an array of capabilities it is up to a nurse to make sure that their duties are described to them in detail before agreeing to accept a position. For example some nurses can only handle private duty patients that are bed ridden and others can take on the responsibliites of running an 800 bed acute care facility.

From what you are saying this doesnt sound like it is for you. It wouldnt be for me either. Most LTC facilities utilize licensed nurses to admin. Medications, treatments, charting, etc. things that unlicensed nurses cant do. If asking a licensed nurse to perform unlicensed duties interferes with their ability to perform licensed nurse functions then it is a problem.

You can do a time study and document how you spend your time and how much of it when you come to work everyday. If you can prove that providing personal care to the residents interferes with your med pass, charting, etc. then maybe the employer would understand that it is an unreasonable request. If others are able to do it and have no complaints then the employer might think you are not organized or working efficiently.

CoffeeRTC, BSN, RN

Has 25 years experience.

We've had LPNs and RNs be aides if we were short. We had a few days where there were too many licensed people and not enough CNAs so I asked who wants to be an aide today?? The RN jumped at the chance to do something other than the med pass. Whoever said it's about the residents was right.

As an RN and normally the one with the most senority, I would be able to bump the other nurse and have her work and an aid....not a chance! I wouln't say it is "fun", but I enjoy mixing it up and seeing things differently.

Thank you ALL so very, very much for your insight and wisdom. It means more to this new nurse than you could possibly know. I can honestly say that while on the Dementia Care floor, the aides are so over-burdened, that functioning as one of them, while also performing all of my nursing duties, IS interfering with my nursing abilities. And the other nurses who work on this unit, who have much more experience then me, have the exact same complaints and worries. It is not a matter of "helping out" with the residents. That is absolutely no problem. But my Administrator has made this "her baby", as she quoted to me the other day, and is bound and determined to make this work. The nurse on the Dementia Unit of 17 residents has 2 aides and 1 LPN who must be LPN and aide on the 7-3 shift. I have found one nurse is out on permanent disability and like I said the others have fled. I feel this is unsafe for the residents. I will inevitably miss something important by being so caught up in making beds and serving lunch, while giving out morning and afternoon meds. I plan on looking for other employment. I don't feel this is safe and I am not comfortable with it. I've got to go with my gut.

Thank you ALL so very, very much for your insight and wisdom. It means more to this new nurse than you could possibly know. I can honestly say that while on the Dementia Care floor, the aides are so over-burdened, that functioning as one of them, while also performing all of my nursing duties, IS interfering with my nursing abilities. And the other nurses who work on this unit, who have much more experience then me, have the exact same complaints and worries. It is not a matter of "helping out" with the residents. That is absolutely no problem. But my Administrator has made this "her baby", as she quoted to me the other day, and is bound and determined to make this work. The nurse on the Dementia Unit of 17 residents has 2 aides and 1 LPN who must be LPN and aide on the 7-3 shift. I have found one nurse is out on permanent disability and like I said the others have fled. I feel this is unsafe for the residents. I will inevitably miss something important by being so caught up in making beds and serving lunch, while giving out morning and afternoon meds. I plan on looking for other employment. I don't feel this is safe and I am not comfortable with it. I've got to go with my gut.

I think you said the ratio is an RN and an LPN plus two aids for 17 patients? I wonder if I am missing somthing because if that is the ratio it doesn't get any better than that. Most facilities have up to 35 patients, one nurse, and three aids per floor. I am in a SNF and consider myself very lucky to have 22 patients and two good aids on my floor.

I work as a nurse on the "memory care" unit. On the am shift there is 1 TMA, 1 nurse, and 4 aides. On the pm, 1 nurse, 1TMA, 3aides. Noc, 1nurse, 2 aides. There are 36 residents. The nurses are LPNs or RNs. I help the aides as much as I can, I feed residents at dinner (have to be in the dining room for safety reasons anyway). Seriously, I couldn't do the aide's job. It is hard physically, and the residents are hard to deal with. It takes a very special person to redirect over and over, sometimes agressive and combative people. It can be exhausting to care for these people and keep them safe. Still, we maintain a sense of humor and love on my unit. I love my job and consistent staffing is key to trust and routine on a dementia unit. Its not for everyone.