Over-hiring LPNs-forced to work as an aide?!

[luv_a_nurse]

I'm writing this to see if other LPNs can identify with my situation. I just graduated from nursing school in August, and became employed by a skilled nursing facility. I took my boards about a month later and gained licensure as a practical nurse. At first I really loved the job: decent starting wage (20.36/hr for 2nd shift,) good nurse-patient ratios, friendly staff, and a good orientation program, ect.

Lately though it's become quite unstable. The facility hired too many nurses, and now my full-time status is in jeopardy. I've been sent home 3 times in the past month. The facility refuses to call us if they're overstaffed, and many of us drive 30+ minutes one-way to be sent home!

Now the latest thing is they're going to have us do "primary nursing." At first I was okay with it, they told us we would be getting vitals, passing trays, getting ice for residents (all of which I have been doing all along when i'm working as a nurse on the unit.) In addition, we were promised we would be paired up with another aide to make it easier on us.

Well, now we're being forced to take our own assignment of 8-12 patients and work as an aide. The facility has given us very little in-service about mechanical lifts, how the CNA's do their charting, transfer techniques, ect. This is not "primary nursing." Primary nursing is when you do total patient care: ADL's, pass meds, treatments, T&R.

I am really not to keen on being forced to work as an aide without even being asked, and these were not the terms of my employment at all. Granted, I knew getting into nursing there would be a certain amount of this type of work to do--but it's happening quite frequently.

I feel as though myself (and the other LPNs) are being punished for the facility's inability to staff an appropriate amount of LPNs/CNAs. I love my residents and I love the people I work with but what would you guys do? Can I refuse this kind of work without worrying about losing my job?

[caliotter3]

If they are paying you as an LPN, then I would be happy to have a job. After all, they could lay off their "over staff". But if they change you to CNA pay, I would be gone with the first job offer. You should be looking for another job anyway. If you can see that the employment situation is unstable, then layoffs are a big possibility looming in the future and I would not wait around to be demoted to CNA pay or laid off.

[Plagueis]

I'm a LPN who's also worked as an aide, even after being licensed. (I was a CNA for years before becoming a LPN.) I was still paid my LPN wage, and all I did was aide work. This has happened to other LPNs where I work, too.

Sorry this has happened, but I hope you are still making your LPN salary. Honestly, I didn't mind working as an aide after I became a LPN. However, I don't know what the law or rule is on whether a LPN can refuse being a CNA for a shift. In your case, it seems like you are being led to aide work fulltime.

Plus, some facilities may assume that if someone is a LPN, she should know some basic aide training, such as transfers, and personal care. (In my LPN program, us students did aide work and passed meds during clinicals.) I would ask for orientation.

[heathert_kc]

Wow there are actually places that overstaff... I am a fairly new nurse graduated a year ago only been in ltc for about 4 months, I can't say that I have ever been forced to work as an aide but occassionally when they are short I will choose to fill in I get the same pay but with almost none of the responsibility, seems like a good deal to me, plus it reminds you how hard your CNAs work and gives you a renewed appreciation. Even when I am a nurse I do answer call lights and assist with ADLs more than most nurses. My facility has had some issues with staffing nurses, at present time there is too many of us in comparison to the number of hours now availible. This problem came about due to them changing pt ratios for the worse/using more med aids in our unit, change in DON and some staff changing their availibility and preffered number of hours. The "powers that be" has said that they are basicly wanting or hoping that a couple of us find hours elsewhere, for now most everyone is just unhappy with the schedule.

[SuesquatchRN, BSN, RN]

I think the OP's actual problem with this is having worked so hard for a license and now not getting to use it.

I would suck it up and do it. Remember, there is nothing that an aide does that is not a nursing duty.

As to charting, lifts, etc., nursing tends to throw you into the deep end and then say, "Whaddaya mean you can't swim?" Dog paddle, honey.

:)

[llg, PhD, RN]

I agree with SuesquatchRN. It sounds as if the facility miscalculatated and ended up with a few too many nurses on staff. In that situation, many (most?) places would have laid people off. Instead, this facility is trying to keep everyone working and earning a paycheck. That's better than laying people off ... or cutting your hours to a bare minimum.

If the place is otherwise a good place to work, I'd give it more time before making a big moves. As a couple of nurses leave and don't get replaced, the situation will correct itself in time -- and if that is the worst you have to endure in this horrible economy, you are extremely lucky.

As for the lack of training with some of the equipment and procedures... that should be something you can improve by taking the initiative and planning some education for yourself. Speak up in a positive way and say that you want to support the management and will happily pick up those tasks -- but that you have a few questions about how to do some of those things safely. Be sure to use words like "safety" and "safely" a lot as they are important buzz words right now. Find someone to show you the things you do not know how to do. If you have a positive attitude about it, you should be able to find someone who will give you a hand with that part of it.

Monitor the situation and keep your eyes open for other opportunities. But I wouldn't blow this situation up in this job market unless you have a better and sure thing already lined up. I'd keep the option open to stay where you are and try to help the situation resolve in a positive way for all involved.