RN as CNA

Nurses Safety

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Please help if you can. My job (ICU) tried to make me work as a CNA one day. I refused as I see this a legal liability.  They think otherwise. I live in NJ and our board NPA is nonspecific in this regard. I have been written up and will get fired if this happens again.  What do I do??!! It’s would have looked like I had ten patients!

Never fear, RNs, if there is a horrific Code Brown, I believe that most CNAs know that they are better trained and prepared to deal with such a disaster. Best to let the RN move aside and mumble with shock and horror "OMG it was EVERYWHERE!" at a safe distance while the experts deal with it. That does mean that a CNA may not get to that VS or drop off a lab.

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I do understand your license and staffing concerns, as this is an ICU not a medical floor. An ICU by me gives total patient care to the RNs with only TWO patients. You are doing the right thing by going with your gut and finding a new position. 

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19 hours ago, 2BS Nurse said:

An ICU by me gives total patient care to the RNs with only TWO patients.

They get 2 patients because the acuity of the patients in an ICU floor is much higher then a med/surg floor. I don't think you should equate total patient care in ICU, with total patient care in med/surg two different things. An ICU nurse especially one in SICU shouldn't delegate any patient care solely to a CNA, primarily  because of their high acuity. Yet in the context of this thread if a RN is brought in to an ICU unit to help out and act as a CNA, that would be great because that RN-temp CNA would be more capable of helping out if needed.  Much better than if a CNA was brought in to help on an ICU unit.

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On 7/10/2021 at 9:49 AM, 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.

Responding to a code is not dependent on your job assignment, it is dependent on training, scope of practice, and skills. In the event of a code everyone has a role or job. Even if you are an RN acting as a CNA, your role in the event of a code will always be as a RN.  A CNAs role in the event of code can never be a RN. You deal with it as an RN because you are an RN, just because they ask you to pass out lunch trays or place a few bedpans for a few hours doesn't change that.

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Specializes in Community health.
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.

Wow. Girl. Nobody here bullied you. I read the thread and it seemed like you explained what was going on, and your concerns, and some nurses disagreed.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
15 hours ago, DesiDani said:

Responding to a code is not dependent on your job assignment, it is dependent on training, scope of practice, and skills. In the event of a code everyone has a role or job. Even if you are an RN acting as a CNA, your role in the event of a code will always be as a RN.  A CNAs role in the event of code can never be a RN. You deal with it as an RN because you are an RN, just because they ask you to pass out lunch trays or place a few bedpans for a few hours doesn't change that.

Yes, I clarified that - no one is expected to deal with the emergency alone, you would take the usual steps per unit protocol. 

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Specializes in LTC & Rehab Supervision.

I don't understand the whole "I am liable even though I'm working as a CNA!" thing.

I worked as a CNA in my nursing home, and had no nursing duties. Thus, I had no nursing assignment. I only had the CNA assignment.

In this case, why would you be liable for not doing nursing duties? Your job would be to take care of the patients, and report findings, abnormal or not, to the ASSIGNED nurse. Then it's off your shoulders, because they're not on YOUR (nursing) assignment.

Maybe I'm misunderstanding something?

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14 hours ago, Lynker said:

Your job would be to take care of the patients, and report findings, abnormal or not, to the ASSIGNED nurse. Then it's off your shoulders, because they're not on YOUR (nursing) assignment.

True. Yet the OP also implied in the event of a code that they are STILL acting as a CNA, therefore the duties and responsibility in the event of the code is that of a CNA. That RN-CNA should always ask if they are needed as a RN, since they are RNs. In the event of a code other RNs from other assignments will help, so why shouldn't a RN acting as a CNA in the assignment that the patient codes help with that code?

 

There is nothing that says an RN cannot act as a CNA, yet a CNA cannot act as an RN. 

 

 

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14 hours ago, Lynker said:

Then it's off your shoulders, because they're not on YOUR (nursing) assignment.

That's not point. It is what you can do to HELP the patient within your scope a practice, not to get things "off your shoulder". Of course you can't pass a med because you are not assigned to that patient, but you can help evaluate/access   the patient with that assigned RN.

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Specializes in Hospice.

It happens sometimes. I've had to do that and all you can really do is suck it up. If you cant find a job where that doesn't happen. 

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Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.

You will be held to the standard of care for your licensure no matter what they call you. That means for physical assessment, analysis, planning what nursing care the pt gets, and evaluating its results, not to mention emergency responses. CNAs cannot do those things.

They can’t say, “You’re a CNA today” because your licensure is what it is. They could theoretically tell you not to exceed scope of CNA practice, but were anything untoward to occur and you didn’t meet RN standard to deal c it, that wouldn’t mean a thing. 

Otherwise, there is nothing in a CNA scope of practice for pt care that is outside RN scope of practice, nothing at all. If you mean you weren’t oriented to some other tasks, like, oh, getting ice for the water pitchers or pushing a stretcher to the morgue, those aren’t tasks that would be outside the scope of RN practice. Wasteful? Sure. But not a threat to your license. 

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Specializes in Home Health Care.
On 7/12/2021 at 6:38 AM, 2BS Nurse said:

I do understand your license and staffing concerns, as this is an ICU not a medical floor. An ICU by me gives total patient care to the RNs with only TWO patients. You are doing the right thing by going with your gut and finding a new position. 

Same here, I've never worked in ICU before but I recently applied to 2 ICU positions and 1 Step Down as a CNA.

From my understanding Nurses in these units do far more than other units except maybe ER because the patients are not always stable and need far more care that is why most Nurses in these units have about 1-3 patients.

 

I recently quit my job working in a Nursing Home where I as a CNA had 9 patients to deal with as a standard minimum. The LVNS had the whole hall with 1 LVN and Wound Care Nurse per hall.

The RNs were the Managers that liked to stay in their offices.

Now that I think about it we could have used at least 1 more LVN per hallway as they mostly just passed of medication but of course that isn't without Documentation and it takes time while patients are asking for more pain pills or laxatives.

Still I've read that 9 Patients a CNA is low in Nusting Home and the legal limit in California is 20.

My capability of good patient care is a maximum of 3 at this time.

In Hospitals it seems Nurses have far fewer patients as they are sicker needing treatment CNAs can't give them and CNAs have less or about the same as a Nursimg Home depending on the Acuity of the patients in the units.

 

Generally it seems ICU is 1-3 Pat to RN, Step Down is 1-4, and Med-Surg is 1-5.

For CNAs it seems Med-Surg is about 9-15 Pat to CNA, I'm praying to God in Jesus's name it is fewer in Step Down and ICU.

 

I honestly think it seems CNAs have it easier than RNs in ICU as the RNs have to do far more and complicated things than CNAs do.

This is the main reason I am applying to ICU, even though the pace and prospect of imminent death of the patient is intimidating I am still an drawn to the idea of being able to focus on a few patients as opposed to 9 or more I simply don't have the time for.

 

I can take care of many things quickly, but when 5 patients all need their diapers changed while 4 others need my attention to, 8 hours and 1 me is simply not enough. Thank God I had 5 other staff members help me! I quit that same day. I don't promise people something I can't give them. That would make me a liar.

 

If the original poster of this thread had to do all the things I would do as a CNA and do all the things that an RN has to do in an ICU to, I'd quit that job to.

 

Even though they would be technically employed as a CNA, because of their training capability and license they would be REQUIRED to intervene whenever something should happen suddenly like a Code which is much more common in the ICU than in other units.

 

Don't push our duties as a CNA as less important to the side during these times, yes you could be saving a life that is coding right now but us CNAs are the ones that take care of all the other patients that are left without care in that time of the code response and if we don't keep monitoring them and maintaining them as best we could they could code to and then you would have multiple codes maybe even at the same time if not one after another.

 

Because guess what could happen: a patient codes and another is left on the bedpan, they fall off the bedpan and their tube pops out, now they're suffocating to death and they need immediate help to at the same time as this other patient who is coding.

 

You see how a simple thing as pooping on the bedpan could quickly turn into an emergency?

 

So yeah I don't blame the original poster for quitting. 

 

10 Patients is way too much for a CNA in an ICU in my honest opinion, and as an RN you're also responsible for them in emergencies to which is common in ICU, that's death waiting to happen. Nope. Quit and report this homicidal manager ASAP.

 

5 patients max for a CNA in ICU and 1-2 for RNs I think seems far more possible.

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