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.
When I was in nursing school oh so many years ago I remember a student was asked to change a bed and she replied "Isn't that what the CNAs are for?" The instructor came down on her like a ton of bricks. Stating there is no patient care task that is beneath an RN to do. In my years as an RN I have mopped floors, unplugged toilets and down every dirty code brown type job there is.
The following reflection isn't just a response to the quoted post but a response in general to many other similar post I've previously read on this topic. I get the feeling that some nurses think that standing elbow deep in fecal matter is somehow the ultimate sign of excellence in nursing and something to be worn like a badge of honor.
Personally I think that having an RN make beds and unclog toilets is a gross misallocation of resources and a manager would in my opinion have to be incompetent to assign someone who they pay more than twice as much as another person to perform these tasks. Not to mention that I would be disgusted as a patient if my nurse came straight from her/his poo plumber duties to hook something up to my epidural. The fact that they washed/sanitized their hands in between wouldn't make me feel a whole lot better. I just find mixing these tasks rather eeeewww.
I really hate nurses who shove all the dirty work onto the CNA's as if it's beneath them. If I'm getting paid my full wages they can make me an aid if they want.
It's not that I think that the tasks are beneath me. I think that having me make beds etc. is a waste of my competence. If I wanted to make beds for a living, which I did as a teenager working extra as a hotel maid, I would have stayed in that job or something similar. Instead I've chosen to spend six years (specifically for nursing, I have another degree previously) at university, forsaking a lot of income during those years that I would have made if I'd worked full-time or overtime in my previous job.
I did this because I thought I'd enjoy nursing, be good at it and be challenged intellectually. So far the job hasn't disappointed me and I've chosen specialties and managers/work environments who seem to regard how my time is best spent in a similar fashion as I do. Of course I've done ADL's and some cleaning but it's been a very small part of my duties. It goes without saying that I'd never leave a patient in distress, but I'll never seek a job that focuses heavily on ADL's. If my employer was to change my job description other than for short periods of time after I accepted the job, I'd look elsewhere.
I think the OP got the message. Anyone who been a nurse for any length of time has been asked to fill in for CNA duty. I started as a CNA, grew up to RN, and finally nurse practitioner. I have worked on units that had strong CNA's, and units that had none at all. I never minded walking in to be the CNA for the day. It took me back to my roots.
Now, I still jump in and help CNA's and RN's alike when they need help doing basic care for a patient. I will frequently help a patient to the bathroom or BSC when I am seeing them. Usually, I wake them up, and of course they have to go to the bathroom.
Specializes in Management, Med/Surg, Clinical Trainer.
The courts have repeatedly found (there's no question about this) that licensed professionals are obligated to function at their highest level of education and licensure, regardless of what your job title or job description from your employer might be. That doesn't mean that you have to also give meds while you're toileting people and changing beds because you're working as a CNA on a particular shift, but it does mean that, if you observe something that you know is dangerous and that you, within your scope of practice as an RN or LPN, would ordinarily be expected to address, you are obligated to respond as any other safe, prudent person with your same level of education and licensure would. You don't get to say it's not your responsibility because you're working as a CNA that day. So, basically, employers that hire individuals to work "below" their level of licensure (permanently, I mean; I'm not talking about occasionally filling in because of staffing needs) are intentionally exploiting those people; the employers realize that they're basically getting an LPN for a tech's salary because, whatever title they give the LPNs, they can't stop being LPNs.
Totally agree nurses must work to their highest license. However, even working as a nurse we are NOT responsible to make sure other nurses on the floor do their job. Whether someone is working as an RN or a RN acting like a CNA that day...the process would be the same.
An RN working the floor typically does not assume the care of her fellow nurses patients.
That said, any nurse working as a CNA or RN would intervene when they noted a problem. However, if I was doing vitals for that nurse and found a high BP i would not dash out to the cart and get the BP meds and dose the patient. If I noted a low BG...I would offer a snack, if allowed, but again would not dash to the cart and grab a bolus....especially not before looping in that nurse. If the numbers were very low or high yes an RN working as an CNA would intervene, but in both of those scenarios I would not go any further with out that RN in the loop whether physically or at least verbally, as it is her patient and she is the one who is responsible...and she is the one who took report.
I have walked by rooms in the unit, and noticed a patient crashing. Do i intervene, yes, but at the same time I am getting that patient's nurse in the room.
Totally agree nurses must work to their highest license. However, even working as a nurse we are NOT responsible to make sure other nurses on the floor do their job. Whether someone is working as an RN or a RN acting like a CNA that day...the process would be the same.
An RN working the floor typically does not assume the care of her fellow nurses patients.
That said, any nurse working as a CNA or RN would intervene when they noted a problem. However, if I was doing vitals for that nurse and found a high BP i would not dash out to the cart and get the BP meds and dose the patient. If I noted a low BG...I would offer a snack, if allowed, but again would not dash to the cart and grab a bolus....especially not before looping in that nurse. If the numbers were very low or high yes an RN working as an CNA would intervene, but in both of those scenarios I would not go any further with out that RN in the loop whether physically or at least verbally, as it is her patient and she is the one who is responsible...and she is the one who took report.
I have walked by rooms in the unit, and noticed a patient crashing. Do i intervene, yes, but at the same time I am getting that patient's nurse in the room.
Of course you would include the other nurse "in the loop." My point wasn't that you (functioning as a CNA for the shift) shouldn't report the problem to the other, assigned RN, but just deal with it yourself, or that you as an RN are responsible for making sure that every other nurse on the floor is doing her/his job. My point was that, as a licensed RN or LPN, your duty doesn't simply end with reporting the problem to another nurse (as it would if you actually were a CNA). You have the same "duty to rescue" that you do any other day at work, by virtue of your license. If the other nurse doesn't respond and deal with the problem appropriately, you are both equally responsible (legally) because you both failed to respond as a safe, prudent RN would in that situation.
The following reflection isn't just a response to the quoted post but a response in general to many other similar post I've previously read on this topic. I get the feeling that some nurses think that standing elbow deep in fecal matter is somehow the ultimate sign of excellence in nursing and something to be worn like a badge of honor.
Personally I think that having an RN make beds and unclog toilets is a gross misallocation of resources and a manager would in my opinion have to be incompetent to assign someone who they pay more than twice as much as another person to perform these tasks. Not to mention that I would be disgusted as a patient if my nurse came straight from her/his poo plumber duties to hook something up to my epidural. The fact that they washed/sanitized their hands in between wouldn't make me feel a whole lot better. I just find mixing these tasks rather eeeewww.
It's not that I think that the tasks are beneath me. I think that having me make beds etc. is a waste of my competence. If I wanted to make beds for a living, which I did as a teenager working extra as a hotel maid, I would have stayed in that job or something similar. Instead I've chosen to spend six years (specifically for nursing, I have another degree previously) at university, forsaking a lot of income during those years that I would have made if I'd worked full-time or overtime in my previous job.
I did this because I thought I'd enjoy nursing, be good at it and be challenged intellectually. So far the job hasn't disappointed me and I've chosen specialties and managers/work environments who seem to regard how my time is best spent in a similar fashion as I do. Of course I've done ADL's and some cleaning but it's been a very small part of my duties. It goes without saying that I'd never leave a patient in distress, but I'll never seek a job that focuses heavily on ADL's. If my employer was to change my job description other than for short periods of time after I accepted the job, I'd look elsewhere.
This.
Having nurses stand in for aides and get their regular nurse pay is bad management. It's a waste of resources and demonstrates poor staffing ability. I'm guessing the overall RN staffing becomes short when management pulls a nurse from staffing and assigns them as aides. But who cares if RN staffing becomes short because it's a nurse's ultimate civic duty to function as an aide. Smh, whatever.
I work with nurses like the OP. As a PCA, they were my least favorite nurses to work with because I knew I would be responsible for 100% of every "icky" aspect of patient care. No one likes that nurse, and everyone on the unit knows who those people are. I find it funny that the nurses I disliked during my PCA days are the same ones that my current PCAs don't like working with lol
As far as the RNs working as PCAs legality issue, I did it for 6 months while I was waiting for a position to open up on my unit. This rule varies by state; in Ohio, you can do this. I only functioned as a PCA. I don't understand the logic behind the RN licensed PCA being held accountable for patient status, either. If I fail to check on my patient and assess charted vitals, that's on me.....not the PCA, regardless of their licensure status.
Hi, I see how frustrating it is for you, I am assuming they keep your pay same. I agree that as nurses we should be able to do that job as well. As ICU nurses we do it all for our patients.
What I know is going on in hospitals is that they are like farmer, (the farmer with bachelor degree in business) who bought the cow which milked 20 galons per day. Hmmm let increase production and save on costs as great business manager the farmer decide - so now the farmer expect cow to milk 30 galons a day and stopped feeding her...
In hospitals this means that management gives almost nursing homes ratios per nurse, then sent home the CNA or nurses aid or patient technicians, (if CNA even shows up and do not call off, since she knows she would face 28 heavy patients on the floor all by herself. So the nurses ends up with unrealistic number of patients and with no help, no CNA, but patient still expecting spectacular customer service. And management deaf to common sense has as well the expectations of five star hotel service.
So for me, if there are no CNA, fine, give the nurses less patients and let them accommodate all the needs, urine outputs, vitals, wash the patient, take them to bathroom, etc... but GIVE THE NURSE DOABLE assignment.
I think there should be law demanding how many patients nurse can have, and how many patients the CNA can have, also, I think the salaries are pure joke as for nurse so for CNA. CNA goes though same abuse from some patients as nurse does. CNA works hard physically, and should be paid accordingly, there are floors where CNA has easy job, and fine the salary is appropriate, but there are hell floors and that CNA should get paid double! I asked management and I went to HR because there were two great CNA and I was told that there is no way to increase their pay or give them bonus. Well one left already. Don't have to tell you how long the nurses last. It all comes to management and it's decision.
I sometimes entertain myself, imagine the management working three days on the floor :) just to stand up to their own expectations :), not talking about reality, being pooped on, scratched, possibly exposed to all sort of infections, and being called names (and for same salary as we all get) :)
Wow, there are so many comments here!!! The funny thing is that I can relate to almost every single one except that CNA work is "beneath" an RN.
I'm a brand new nurse -- just passed my NCLEX THIS week and have been working as a GN. I have been trained in both the Tech's job and my own job as an RN. I will also be training as the Unit Secretary as well as being floated to several other floors to learned various other jobs and roles.
I have no problem with any of this-- I HAVE a scope of practice, which I accepted when I filled out the application for licensure. . The CNA does NOT have a scope of practice. We would all do well to remember this. We, as the RN, no matter what, have the responsibility when we clock in for the day to the scope of our practice, including reporting to the Charge nurse and supervision of unlicensed staff..
It is a huge responsibility -- so earning your $25/ hr (or whatever your RN wage is) and doing CNA/Tech work -- is really the financial duty (mistake?) of your nurse manager, and your sole responsibility is to either accept or not accept the assignment for the shift.
Wow, I laughed out loud a little when reading the OP.
I was just talking to a fellow nurse last night about how nurses that think any job is below them are usually crappy nurses. I don't know you and so I'm not saying that is true, but the nurses I have worked with over the years who whine about having to do jobs "below their pay grade" or skill level are usually crappy, lazy nurses and the whole floor knows it.
Aide responsibilities are the foundation of nursing. As a nurse your job is to take care of your patients, not to just do a neat little list of "RN only" tasks and dump all the dirty work on your aides.
I usually try to be a little more polite and diplomatic........but get over it. Do your job, which involves aide work when necessary. Take care of your patients and quit worrying about your make believe pedestal.
I work with nurses like the OP. As a PCA, they were my least favorite nurses to work with because I knew I would be responsible for 100% of every "icky" aspect of patient care. No one likes that nurse, and everyone on the unit knows who those people are. I find it funny that the nurses I disliked during my PCA days are the same ones that my current PCAs don't like working with lol
I was just talking to a fellow nurse last night about how nurses that think any job is below them are usually crappy nurses. I don't know you and so I'm not saying that is true, but the nurses I have worked with over the years who whine about having to do jobs "below their pay grade" or skill level are usually crappy, lazy nurses and the whole floor knows it.
LOL I love it when other people post my exact thoughts.
Aide responsibilities are the foundation of nursing. As a nurse your job is to take care of your patients, not to just do a neat little list of "RN only" tasks and dump all the dirty work on your aides.
While this may not be true for OP, luckily enough for me my employer is the author of "the little list", not me. I haven't worked med-surg for years but when I did there was an official job description posted for RNs and CNAs. The RN list was quite a bit longer than the CNA list but ADL's was only listed on the CNA list. That didn't mean that a nurse wouldn't help out if the CNAs were swamped but that seldom happened. It was usually the RNs who'd have to try to squeeze in a half hour meal break whereas the CNA's would take a morning coffee break, lunch and an afternoon break.
It's a fact that nurses are legally allowed to do more interventions than CNA's. If CNA's can do tasks A,B and C while nurses can perform A,B,C,D,E,F and G it makes perfect sense that CNA's do the majority of A-C and nurses focus on D-G. That has nothing to do with anything being beneath someone. I swear, some of you folks in this thread are more Scandinavian than you realize...
Checking vitals and diagnosing is well within a physician's scope of practice. Does anyone think that a good way to utilize a cardiologist's competence would be to have him or her take all routine blood pressures and routine assessments on the floors? Or are we okay with having that responsibility carried out by nurses without pointing fingers at physicians for dumping their dirty (menial?) tasks on us?
I was just talking to a fellow nurse last night about how nurses that think any job is below them are usually crappy nurses. I don't know you and so I'm not saying that is true, but the nurses I have worked with over the years who whine about having to do jobs "below their pay grade" or skill level are usually crappy, lazy nurses and the whole floor knows it.
macawake, MSN
2,141 Posts
The following reflection isn't just a response to the quoted post but a response in general to many other similar post I've previously read on this topic. I get the feeling that some nurses think that standing elbow deep in fecal matter is somehow the ultimate sign of excellence in nursing and something to be worn like a badge of honor.
Personally I think that having an RN make beds and unclog toilets is a gross misallocation of resources and a manager would in my opinion have to be incompetent to assign someone who they pay more than twice as much as another person to perform these tasks. Not to mention that I would be disgusted as a patient if my nurse came straight from her/his poo plumber duties to hook something up to my epidural. The fact that they washed/sanitized their hands in between wouldn't make me feel a whole lot better. I just find mixing these tasks rather eeeewww.
It's not that I think that the tasks are beneath me. I think that having me make beds etc. is a waste of my competence. If I wanted to make beds for a living, which I did as a teenager working extra as a hotel maid, I would have stayed in that job or something similar. Instead I've chosen to spend six years (specifically for nursing, I have another degree previously) at university, forsaking a lot of income during those years that I would have made if I'd worked full-time or overtime in my previous job.
I did this because I thought I'd enjoy nursing, be good at it and be challenged intellectually. So far the job hasn't disappointed me and I've chosen specialties and managers/work environments who seem to regard how my time is best spent in a similar fashion as I do. Of course I've done ADL's and some cleaning but it's been a very small part of my duties. It goes without saying that I'd never leave a patient in distress, but I'll never seek a job that focuses heavily on ADL's. If my employer was to change my job description other than for short periods of time after I accepted the job, I'd look elsewhere.