RN assigned as a CNA

[myree72]

I am an RN at a Rehabilitation hospital and occasionally when I get to work I am assigned as a CNA on a team. Most recently when I worked as a CNA, which I have never trained to be, I suffered a back injury and missed 3 days of work, which in my state I won't get paid for. Also in this instance after receiving my assignment & report from the previous CNA over the phone while she was driving and listening to music, I told the charge nurse that I was uncomfortable with the assignment, to which she just said "what do you want me to do about it?" Furthermore, the assigned nurse for that team that shift was an LPN. I have been a nurse for 13 years and this is the only place I have ever seen RNs used as CNAs so I am just wondering how common the practice is. I am certainly not trying to start any kind of RN vs. LPN or nurse vs. CNA debate, because I have a lot of respect for everyone in the medical profession. I am just curious if others have been in the same position and how other hospitals use staff. Thanks!!

[steelydanfan]

I understand. I just think that RN's have multiple times more training than CNA's do. If an RN isn't comfortable with a CNA assignment, I imagine the CNA's would be even more uncomfortable with the assignment considering they have much less training.

I think the OP was not referring to the scope of CNA work, just the breadth of it. She knows I/O, basic hygiene and lifting proceedure, she just has never had to care for 7-12 pts. The logistics can be daunting for a new grad that never worked as a CNA.

New grads just don't have the time management skills if they never did CNA work, mores the pity. It REALLY helps when you get on the floor. Not to say you can't do well without it, but it HELPS.

[klone, MSN, RN]

I wouldn't do it even if paid as a RN which they are required to do. I've always felt this was a liability issue and wouldn't put myself in that kind of predicament.

Can you give a practical example of a situation where this would be a liability concern?

[Orange Tree]

I'm guessing the only assigned nurse for the shift was an LPN because the LPN would have refused the assignment that you accepted. I would have refused it, too.

Your injury is a completely different issue, though. Transferring patients is a task that you have been trained to do, and if you felt you were unable to safely transfer the patient in question, it should have been addressed at the time of the transfer. Compensation for your time off also has nothing to do with the staffing situation. Any paid time off that you deserve, a CNA would deserve as well.

[ZippyGBR, BSN, RN]

some hospitals only employ rns to do all nursing care, no cnas. It makes me mad when nurses refuse to do cna work.

it makers me madder when HCAs expect me to do an 'equal' share of the delegatable/ any member of the nursing team tasks as well as all my RN only work , rather than just a 'fair' share of the any member stuff.

[ZippyGBR, BSN, RN]

Can you give a practical example of a situation where this would be a liability concern?

i can't think of one you are still held to the standards of an RN and your employer should support you in acting i nthe scope of an RN

not sure of the position with leftpondian Nursing regulators but the NMC is pretty clear

Registered nurses or midwives working as Healthcare Assistants (HCAs) or other non-registered support roles | Nursing and Midwifery Council

"Accountability

If a nurse or midwife is employed to fulfil the role of an HCA, they should only undertake the roles and duties outlined within their job description. However, by virtue of their registration, they would remain accountable for their practice. This means that they would be bound by the code regardless of their HCA status and their fitness to practise could be called into question if they were found to be in breach of any of the terms. The code states that nurses and midwives are required to "provide a high standard of practice and care at all times"

The code states:

"you are personally accountable for actions and omissions in your practice and must always be able to justify your decisions"

"you must be able to demonstrate that you have acted in someone's best interests if you have provided care in an emergency"

Therefore, in an emergency situation, there may be occasions, where a nurse or midwife could be required to work outside the scope of the HCA role parameters. As a registered nurse or midwife they would be expected to use their professional knowledge, judgement and skills to determine occasions where it would be appropriate to work outside their HCA role parameters and should be prepared to account for their actions should they make the decision to do so. ...

Vicarious liability

Vicarious liability means that the employer is accountable for the standard of care delivered and is responsible for employees working within agreed limits of competence appropriate to the abilities of that employee. To remain covered by an employer's vicarious liability clause, an employee must only work within this area of assessed competence and within the responsibilities of their role and job description.

Nurses or midwives who undertake HCA roles should therefore, inform their employer that they are on the NMC register as a nurse or midwife and that in exercising their professional accountability, they may be required to step outside their contract of employment as an HCA. They should also seek to ensure that their contract recognises the extent of their role and that the job description is clear as to what would be expected of them in this role. "

[heelhook80]

I think the OP was not referring to the scope of CNA work, just the breadth of it. She knows I/O, basic hygiene and lifting proceedure, she just has never had to care for 7-12 pts. The logistics can be daunting for a new grad that never worked as a CNA.

New grads just don't have the time management skills if they never did CNA work, mores the pity. It REALLY helps when you get on the floor. Not to say you can't do well without it, but it HELPS.

It says right under her name 13 years experience, where is this new grad talk coming from?

[myree72]

Yes I have 13 years experience, yes I know how to do CNA duties, yet I was still uncomfortable with the assignment as I am not familiar with the CNA routine on evening shift which involves meals and bedtime, and as I mentioned before all of these patients are OOB for meals and exhausted after 3 hours of therapy a day, and someone who might be a one person assist in the morning gets tired by then. My problem was the acuity of the team, the charge nurse should not give the "heaviest" team to someone working outside of their comfort zone. There were 5 teams due to a higher census than we normally have, extra nurses are scheduled extra CNAs are not. Each of the other 4 CNAs could have taken 2 extra patients and I could have helped with bells trays and baths. What my concern is, is that I was not given a choice about accepting the assignment, I received report over the phone from the previous CNA who had left because nurse and CNA shifts are staggered, and no management to go to with my concerns since it was a weekend. I love how everyone is eager to bash me without reading all of my posts. :)

[Ackeem, BSN, MSN, RN, APRN]

I don't see why she should not question the fact that she is an RN and is doing patient care at a CNA's level, doesn't matter if she stills has the title if a RN , bottom line Rn's are entitled to do different patient care from the CNA's and vice versa . FYI I have yet to see an hospital short of CNA's, I don't know maybe its just me.

[SrnD]

everyone has missed the fact that the lpn was the team leader while the rn (like it or not, a higher license) was put to do the cna's work. and as the OP stated NUMEROUS times, she had no problem taking the cna role for the shift, but under the particular circumstances, had an issue (that the supervisor disregarded).

everyone in healthcare can complain except for the nurse, right? when the secretary is swamped, the nurse has to pick up some slack. when the cna is swamped, again the nurse picks up slack. but when the nurse is swamped with RN only duties, well, no one picks up his or her slack - do they?

[SweetBabyLPN]

everyone has missed the fact that the lpn was the team leader while the rn (like it or not, a higher license) was put to do the cna's work.

I didn't miss it. Just didn't see the point in adressing it since if that LPN was anything like this LPN, she refused the assignment. They try to get over on who they think will let them get away with it and in this case, the OP was their sucker. Sorry OP, but they did play you. Like I said, as long as you haven't accepted an assignment (i.e. get report, count narcs, etc.) you are not OBLIGATED to take it, and can refuse. How your facility handles that however is up to them.

I know where I work, they would never try to pull that on me and if they did, I would refuse. I'm pretty sure that after standing my ground, they would run scrambling to find someone else to ask. But that's me.

[klone, MSN, RN]

i can't think of one you are still held to the standards of an RN and your employer should support you in acting i nthe scope of an RN

Yes, I understand all that. But I would like someone to give me a real world example of a situation where this would cause an RN to get in trouble.

Would an RN go into a pt's room who's blue and unresponsive and say "Oh, I'm not going to call a code; I'm just a CNA today." Of course not.

Just because you're workign the role of the CNA does not mean suddenly all of your nursing training and knowledge is going to fly out your ear.

[myree72]

I'm pretty sure had I refused the assignment I would risk getting fired, since as it has been stated on these boards numerous times, you can get fired for any reason. Either way, not a chance I was willing to take. So, I went back to work Sunday night and they had me doing paperwork all night. I asked the 7p-7a charge nurse if that had anything to do with my doctor's note, which states that I can return to "full RN duty", she knew nothing about my dr's note but must have mentioned it to our scheduling secretary who seems to be running things in the absence of nursing management (not a nurse). I get a call first thing Monday morning from her telling me there is some confusion about my note and "full RN duty" and that maybe I need to take a copy of my job description to the doc. I read through the policy that states I should be able to lift, push, pull 30lbs and am comfortable with that so I called the HR director to whom I originally gave the note to see if there was a problem with the wording of my note and so far no reply. I think that they want to be able to use me for whatever they want whenever they want since I work 3-11 and all but 2 other nurse do 7a-7p or 7p-7a, which means the evening shift nurse is easy to plug into whatever empty slot they have on their assignment sheet. I totally agree with the poster who said that RNs can pick up the slack for every other position, we are expected to do those jobs plus our own and no one else can do ours!!