RN as CNA

londonflo · Jul 7, 2021

My understanding of an RN being in a CNA role, is if the RN is not attending to something that may cause harm or be indicative of a significant change in condition, the RN in the CNA role needs to identify the problem and take it higher. Not be the primary person responsible. I don't think it was intended that for the 10 patients you had as a CNA, that you were responsible for interpretations of labs, giving medications and evaluating the effects of those medication unless the RN was disregarding important signs....for example, BP 210/140 and no BP medications given and no contact with the MD. Another example, patient having frequent grossly bloody stools but nothing being done in terms of assessment.

Since it sounds like you worked in a unit that used CNAs how did you evaluate if they were doing their jobs correctly? Did you ever assist a new CNA with an unusual transfer and give a helpful hint or turn your back and head out of the room.

OK, I really do not understand your frustration with your role assignment but I agree it was best to part ways and seek a job without any CNAs or delegation. In the 1970's I worked primary care nursing which meant an RN had no CNAs and did all the care themselves....like running 7ups down the hall when another patient was crashing. If you want that world, it is yours for the taking. I so appreciate the CNA role and appreciate them as essential in the whole of patient care.

26 minutes ago, 512Runner4lf said:

Patient ratios.

Have you objected to a CNA have a 1:10 ratio?

Best wishes on your new ventures.

512Runner4lf, ADN, BSN, MSN · Jul 7, 2021

My earlier comment didn’t post. You almost understood what I saying. If I was working as as a CNA and reported to the nurse that had the pt in their care for that shift that let’s say the bp was really seriously high. Let’s say the nurse did nothing about it. Also…let’s say the family was there and saw the whole thing. Nothing gets done and the pt ends up worse off and they all sue. I can be held liable! This is what I am worried about. I love my CNAs. But hey thanks for misconstruing my words. Thank you all for your unhelpful comments. I really hope you don’t end up in a situation like this and get screwed. I’ve been in it before and was looking here for help but obviously just found some old nurse ratchets with nothing better to do than keep the bullying going. You all are the ones who ruin nursing for the new ones. I honestly feel bad for the ones who work around you.

londonflo · Jul 8, 2021

23 hours ago, 512Runner4lf said:

If I was working as as a CNA and reported to the nurse that had the pt in their care for that shift that let’s say the bp was really seriously high. Let’s say the nurse did nothing about it.

If this hypothetical situation happens, you need to document your communication to the RN responsible. Even working as a CNA you are able to document RN findings. If a lawsuit happens as a RN working as a CNA you are so down the totem pole you are eating dirt. Suing you would be the least $$ avenue.

For example, I am a nursing instructor and with my 10 students assigned I do find some assessment data that needs attention. Do I quit? No I meet with the RN and we share thoughts. I am an RN and would also be responsible for ignoring significant assessment data. I do my part and chart communications! Believe me I have had instances of this....a new mother on a medical surgical floor (history of preeclampsia) with high, high blood pressure and headache. I did go over the "traveling RNs" head. Document all communications at all times. Is your ICU full of patients crashing? that is a better reason to leave.

23 hours ago, 512Runner4lf said:

let’s say the family was there and saw the whole thing. Nothing gets done and the pt ends up worse off and they all sue. I can be held liable!

No, it would be exceptional stressful if the family saw nothing was done.....Documentation and moving it up to a higher decision making level with subsequent documentation will show a malpractice lawyer your followed protocol. THIS IS THE SAME IF YOU WERE THE PRIMARY NURSE...document!

23 hours ago, 512Runner4lf said:

But hey thanks for misconstruing my words. Thank you all for your unhelpful comments. I really hope you don’t end up in a situation like this and get screwed

I did NOT misconstrue your words...I quoted them. But hey, thanks for the good hopes.

23 hours ago, 512Runner4lf said:

I’ve been in it before and was looking here for help

Repetitive patterns in your work history that your cannot be happy with may need to be something you need to explore before accepting your next position.

23 hours ago, 512Runner4lf said:

I honestly feel bad for the ones who work around you.

Ditto, but I really do wish you the best in your future....

ThursdayNight, CNA · Jul 9, 2021

On 7/7/2021 at 2:48 PM, 512Runner4lf said:

Quote

If I was working as as a CNA and reported to the nurse that had the pt in their care for that shift that let’s say the bp was really seriously high.

I'm a CNA so this is how I operate. I do my assignments. Report to the assigned nurse verbally and hand a note. Note the time and date. Follow up with the nurse. The nurse is almost constantly doing different things at the same time.

Quote

Nothing gets done and the pt ends up worse off and they all sue.

Are you also passing medications while working as a CNA?

I'm a CNA so this is how I operate. I do my assignments. If I'm unfamiliar with what parameters to report immediately, I ask when I would have to interrupt a nurse. Report to the assigned nurse verbally and hand a note if there's anything out of expected values. On my V/S sheet, I circle the abnormal findings. I'd draw an arrow to them if there's no highlighter. Note the time and date. The nurse is almost constantly doing different things at the same time so I follow up later...like 30 minutes or ASAP when I'm done with the next patient after I reported. I sound like a nagger. I'm a human Alexa. ?... I don't remember placing a nurse in trouble. I'd ask the nurse if I retake the V/S. Most of the time, the nurse trusts me to do it. And I chart it right away and give a note to the nurse. I like to keep it that way. So far, everything is good. It takes less than 2 minutes to get V/S if the devices aren't malfunctioning.

ThursdayNight, CNA · Jul 9, 2021

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DesiDani · Jul 9, 2021

In my state the CNA is required by the board to report any findings to the RN. Just like for RNs if it isn't charted it never happened. That still does not absolve the RN for doing a CNA job. The CNA is to assist the RN. A CNAs job is directly tied to the RNs, not the other way around. A CNA to a RN is an added benefit, that the hospital does not have to provide to RNs. Some units do not have the benefit of any CNAs.

Remember it is Certified Nurse Assistant NOT Certified Patient Assistant. If a CNA was there to only assist the patient they would not have to do vitals signs, I/O documentation, accucheck (in some states), transport for tests, drop off lab, pick up blood , and a host of other things. A CNA would just feed, dress, bath, and provide incontinence care.

sleepwalker, MSN, NP · Jul 10, 2021

On 7/7/2021 at 5:48 PM, 512Runner4lf said:

My earlier comment didn’t post. You almost understood what I saying. If I was working as as a CNA and reported to the nurse that had the pt in their care for that shift that let’s say the bp was really seriously high. Let’s say the nurse did nothing about it. Also…let’s say the family was there and saw the whole thing. Nothing gets done and the pt ends up worse off and they all sue. I can be held liable! This is what I am worried about. I love my CNAs. But hey thanks for misconstruing my words. Thank you all for your unhelpful comments. I really hope you don’t end up in a situation like this and get screwed. I’ve been in it before and was looking here for help but obviously just found some old nurse ratchets with nothing better to do than keep the bullying going. You all are the ones who ruin nursing for the new ones. I honestly feel bad for the ones who work around you.

Every comment/response provided to you seems to be on the same page. The only person not understanding the answer is you because you're not being provided the answer you want to hear as well as the preconceived answer you've already decided is correct.

I think moving on from this position and finding one that doesn't require teamwork, delegation, or performing duties you're not familiar with is your best option...but you already knew that?. Best of luck!

vintagegal, BSN, DNP, RN, NP · Jul 10, 2021

One day we were down a CNA. Working hospice, all us nurses spilt up the assignments. Went out to homes, did showers, bed changes, peri care, light cleaning, etc. We kept good attitudes. I got a refreshed sense of pride for our CNA counterparts. We often forget how hard they work. I can tell you for certain those CNAs are a lot more thorough as nurses can be rusty with certain skills if not practiced often. It is our core value to be caring, and to care for the patient means to be gentle, understanding, and able to tolerate “less than desirable” situations. If you’re not comfortable with certain skills because you forgot them, turn back to an old nursing book, phone a friend, ask your CNA. All of these skills are under your scope. To be a team player, remain optimistic, rise to the occasion, and be versatile. During the height of Covid I played beauty salon and did my best to curl and fluff hair for some of the elderly ladies who were bored to death with the lockdowns. They had a blast, we chit chatted, swapped stories, laughed. Some of the most cherished memories of my career.

PollywogNP, ADN, BSN, MSN, LPN, NP · Jul 10, 2021

On 7/7/2021 at 3:48 PM, 512Runner4lf said:

My earlier comment didn’t post. You almost understood what I saying. If I was working as as a CNA and reported to the nurse that had the pt in their care for that shift that let’s say the bp was really seriously high. Let’s say the nurse did nothing about it. Also…let’s say the family was there and saw the whole thing. Nothing gets done and the pt ends up worse off and they all sue. I can be held liable! This is what I am worried about. I love my CNAs. But hey thanks for misconstruing my words. Thank you all for your unhelpful comments. I really hope you don’t end up in a situation like this and get screwed. I’ve been in it before and was looking here for help but obviously just found some old nurse ratchets with nothing better to do than keep the bullying going. You all are the ones who ruin nursing for the new ones. I honestly feel bad for the ones who work around you.

On 7/7/2021 at 3:48 PM, 512Runner4lf said:

. But hey thanks for misconstruing my words. Thank you all for your unhelpful comments. I really hope you don’t end up in a situation like this and get screwed. I’ve been in it before and was looking here for help but obviously just found some old nurse ratchets with nothing better to do than keep the bullying going.

Gee here we go with the NETY! You didn’t like our answers so you resort to this childish behavior. I don’t believe you contacted your BON over this. I think you are misinterpreting verbiage in nurse practice act to suit your self. .

Those of us with decades of experience have worked without CNAs many times.

Editorial Team / Moderator · Jul 10, 2021

If I understand correctly, the OP is concerned about being held to an RN standard of care for a CNA load of patients (10). I don't think that is realistic - yes, you are held to the level of your license, but I think that would only come into play if you made some kind of error that injured a patient while acting as a CNA. If something went south with a patient in the course of CNA duties, you wouldn't be expected to deal with it - you get the primary or call a rapid, whatever is necessary. When you are functioning as a float or CNA or in any role that is not the primary nurse, you are NOT the primary nurse, period.

DesiDani · Jul 10, 2021

2 hours ago, Pixie.RN said:

If something went south with a patient in the course of CNA duties, you wouldn't be expected to deal with it - you get the primary or call a rapid, whatever is necessary.

You are expected to deal with it within your scope of practice. The CNA is not ACLS trained you are. If a pt codes that is when you drop the CNA duties and go into RN mode. The now lone CNA on the floor has to deal with it. You are helping them out, but your main priority is to be a RN. So if you must go to a code as a RN, go. They may say they don't need you, then you can continue to help out as a CNA.

Editorial Team / Moderator · Jul 11, 2021

17 hours ago, DesiDani said:

You are expected to deal with it within your scope of practice. The CNA is not ACLS trained you are. If a pt codes that is when you drop the CNA duties and go into RN mode. The now lone CNA on the floor has to deal with it. You are helping them out, but your main priority is to be a RN. So if you must go to a code as a RN, go. They may say they don't need you, then you can continue to help out as a CNA.

Yes, sorry - I meant you wouldn't be expected to deal with it alone. You call the team.