Nurses forced to work as aides

Nurses Professionalism

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I am frustrated with my hospital. We have a shortage of aides, and no wonder because they have a hard, backbreaking job for measly pay. As a result, sometimes when we nurses show up to work, we're made to work as aides. No notice, just here: you're an aide today.

This seems really unprofessional to me. I signed up to be a nurse. I never worked as an aide because I know how difficult that job is, and I don't want it. It's confusing to the patients to have two RN's running around. Thankfully, the other nurses haven't asked me to medicate a patient, because I'd have to say no since I didn't get a nursing report, nor did I look up the patients to a sufficient level to be able to take full-on nursing care for them nor did I assess them, but I can see how this could set up a problem in the future for a med error.

It just seems wrong on several levels. I guess this is what happens when you work in a hospital with no union. At least I still get my nursing pay, but I still feel that this is inappropriate.

Thoughts? Have you ever heard of this before?

Here's what I still don't understand, though: why not just assign more nurses to the shift, give them each a smaller assignment, and have them do total care? Then they aren't paying nurse wages to someone acting as a CNA and all the work is still getting done. Can a nurse manager please explain this?

Sorry I should have explained that I work in LTC. I have 30 residents to pass meds to, so while I assist with Adls, it would be near impossible for me to take on a list for total care as well as doing Meds and treatments.

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Specializes in Registered Nurse.

Interesting topic. I guess it has a lot to do with what you are use to. In the hospital where I spent my first very nearly 10 years, we had no Nurse's Aides or Nurses Assts to speak of. There was rarely what they called a SNAP aka Student Nursing Assistant or a student to help. So, we were use to doing it all including what a Nurse's Aide does. Actually, none of the hospitals I have worked in had aides or assistants! We probably had a lighter patient load because of that.

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You have an opportunity to learn several things.

1.) When your facility is experienced a problem, it's time to be part of the solution.

2.) You will gain insight into the nurse aid role and your working relationship with them will be stronger.

3.) You have the opportunity to improve basic nursing skills, such as skin assessment, behavioral assessment.. because you have more time at the bedside.

Assure the rotation to the nurse assistant assignment is evenly distributed, and make it work.

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Yes, I've seen the website. I spoke with someone at the NYSED about this issue and they stated what I posted before, which is in direct contradiction to their website. I suppose the question is whether or not a RN would ever take a job as a LPN or an aide? I know I wouldn't, but I can imagine that there are some that might.

I'm almost embarrassed to admit this, but I found it so hard to believe that the NY BON's position on this would be significantly different from the position of every other state BON that I emailed them and asked the question (which is the official position of the Board on practicing below your level of licensure, the info on the FAQ page of the website, or what you were told over the phone?) This is the written (emailed) response I got from the NY BON (in its entirety):

"The website is correct."

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I'm almost embarrassed to admit this, but I found it so hard to believe that the NY BON's position on this would be significantly different from the position of every other state BON that I emailed them and asked the question (which is the official position of the Board on practicing below your level of licensure, the info on the FAQ page of the website, or what you were told over the phone?) This is the written (emailed) response I got from the NY BON (in its entirety):

"The website is correct."

It really makes me wonder who exactly is staffing the email address for the NYS BON and if their understanding of the issue is adequate. My guess is no since we've both gotten different answers in response to separate emails sent to them (as well as my phone call).

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It really makes me wonder who exactly is staffing the email address for the NYS BON and if their understanding of the issue is adequate. My guess is no since we've both gotten different answers in response to separate emails sent to them (as well as my phone call).

Perhaps not, but the statement on the FAQs page of the website and the written response I got is congruent with the position of most (all?) other state BONs on the subject, as opposed to your verbal response, which directly contradicts what the BON website and most (all?) other state BONs say. Why would the BON have a statement contradicting their official position on this this posted on the website?

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Why would the BON have a statement contradicting their official position on this this posted on the website?

Because this is the NYS BoN we're talking about, NOT a pinnacle of efficiency OR sound judgment.

This is the same BoN that allows umpteen trillion attempts at the NCLEX, when other States recognize that a candidate needs a remediation, or review classes, or something before trying again. Just my two cents.

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Because this is the NYS BoN we're talking about, NOT a pinnacle of efficiency OR sound judgment.

This is the same BoN that allows umpteen trillion attempts at the NCLEX, when other States recognize that a candidate needs a remediation, or review classes, or something before trying again. Just my two cents.

(Okay, good point. :))

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Listen people, the alternative is to have ZERO CNAs and less patients. Would that still be working beneath your licence? Honestly, I wish all nursing was primary care.

I used to work at a state ran LTC facility where the CNAs who had been there forever (in other words all of them) made wages WAY above the regional average. As in well over $20 an hour. There was a much higher turnover for the LPNs there, resulting in a situation where most of the CNAs made nearly as much as most of the LPNs. When the government budget was cut a few years back, one idea that was considered was to fire all the CNAs, hire more LPNs, and run on a model of primary LPN care where each LPN would be given 6-7 residents a shift and provide total care. ADLs, meds, treatments, everything for that relatively small group of residents..... with a smattering of RNs here and there to supervise.

Given that the CNAs they'd be firing were at the pinnacle of their payscale, and the new LPNs would be coming in at the bottom of theirs, this LPN-only model would actually have been cheaper than the traditional "one nurse and a bunch of CNAs" model typical of LTC.

TPTB, of course, chickened out and instead opted for firing the state-CNAs and bringing in agency aides at minimum wage. Pity. I would've really liked to see how a primary-nursing model would've worked in LTC.

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Specializes in CCRN.
Here's what I still don't understand, though: why not just assign more nurses to the shift, give them each a smaller assignment, and have them do total care? Then they aren't paying nurse wages to someone acting as a CNA and all the work is still getting done. Can a nurse manager please explain this?

I will explain this from my previous nurse manager experience.

When we tried to keep extra RNs working as RNs and have them provide primary care (which they were not use to), we had a lot of problems with complaints and things being missed. Upon investigating why this wasn't working for us, we found several things:

1. Patients and their family were use to having 2 designated staff members assigned to them and they understood the difference between the two roles. When they only had their RN (even though the RN had fewer patients), they felt that their needs were not being met in the same way they were with the designated CNA.

2. Although the RNs had fewer patients and were told to provide primary care, many of them did not realize exactly what they would be responsible for, especially since our CNAs have additional duties as well (cleaning the break room, equipment room, restocking, trash, linens, etc.) We do have an assignment sheet with this information on it, but the RNs were still focused on their nursing responsibilities more than the "CNA" responsibilities.

3. When we instead left the RNs with their normal assignments and pulled one to work as a CNA (and provided them with the CNA assignment sheet and expectations of additional duties), the staff and the patients were happier.

This would vary from place to place and really depend on the team on each unit. For our unit, at the time we had staffing issues with CNAs, it worked best to have RNs work as CNAs.

Now, in regards to paying a RN to do it rather than a CNA or agency, obviously we would prefer not to pay the extra, but we wanted the shifts covered and we would rather give the shifts to our staff than bring in agency CNAs. Our facility is very strict about agency usage and we try to avoid at all costs. That's not to say we didn't bring in agency when we needed to, but we allowed our staff to bump the agency staff any time they wanted to (unless they were contracted).

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Specializes in Transitional Nursing.

I'm not going to reply to anyone by name, because this comment can apply to more than one of you, so, like I always do when I don't quote someone directly, I am just going to leave a general response that may or may not apply to some of you.

Some CNA's suck, I get that. I'm sorry for that, but I can't change it. What I can do is offer insight for those who want it, and try to defend the role of a good CNA when I get the opportunity. It is upsetting as someone who has done this job and also loves it, to stumble across a thread that makes me feel like there is something wrong with being a CNA or doing the work associated with that role.

Especially because it is common to work alongside a nurse who truly does delegate every single aspect of his or her job to the CNA, not out of necessity but out of convenience. (Could that be why some CNAs suck?)

Not all CNAs have low IQ's or poor work ethic. Not all CNAs need direction 24/7 and not all CNAs view their job as being lowly or beneath the nurse. Just like not all nurses think that CNAs are beneath them and some nurses understand that a good CNA is worth their weight in gold.

If you don't want to take an assignment as a CNA for a shift, then ask to be called off or split the assignment among the nurses that are scheduled. Most of the time, I am sure there is a lowly CNA at home who would love to come in and work.

My comment about doctors, for those of you who took issue with it, was not to insinuate there is something wrong with being a doctor, but to point out that Doctors are notorious for "getting someone else" do do things that they are perfectly capable of doing. Some that they have time for and some that they don't. It is that mentality that shouldn't be in nursing and I take issue with anyone who has it.

You can get your panties/boxers in a wad and get all huffy if you want to, but if all you're going to do is quote me and argue how none of this applies to you, then it wasn't meant for you.

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Especially because it is common to work alongside a nurse who truly does delegate every single aspect of his or her job to the CNA, not out of necessity but out of convenience. (Could that be why some CNAs suck?)

"Common"? I find it hard to believe it is "common" for you to work with nurses who "truly do(es) delegate every single aspect of his or her job to the CNA," since there are only a few, very limited elements of the RN's responsibilities that can legally be delegated to CNAs.

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