RN working as CNA under an LPN?

[RNlove17]

Im a relatively new RN who works per diem at a hospital on a rehab unit but im usually floated to their eden centered nursing home (set up like cottages with 20 elders to a cottage) though. I only worka once a month here (i have a FT job elsewhere).Theres one nurse and 4 shabaz on each shift. Today I was assigned to the rehab unit but at the last minute the supervisor floated me over to the cottages. Well they put me on as a CNA working under an LPN whos on as the nurse. Im uncomfortable because im not sure i can legally do this. I live in NY, where can I go to find out??

[LadyFree28, BSN, LPN, RN]

I'm sure the overburdened CNAs reading this would wholeheartedly agree that adding cooking to their job descriptions will make the load so much easier....

At my place of work, the implication is starting to take place...

[Esme12, ASN, BSN, RN]

Here is this "new concept"...Reformers Seek to Reinvent Nursing Homes : NPR

[classicdame, MSN, EdD]

a lot of critical care areas do not have CNA's so the nurse does it all. Think of yourself in that role. My only issue would be with the supervision part. I believe you are still held to the highest level of licensure and must refuse any task that is not safe for the patient, just as if you were the primary RN for that patient.

PS - me and the CNO have worked together as CNA's when we were short. Both of us have MSN's. Kinda fun to do something different.

[sistrmoon, BSN, RN]

When we are sometimes overstaffed on my floor, an RN will work as a PCA. It sucks though because you essentially end up doing PCA work then helping nurses with all their nurse stuff too. The only good part is short report in the morning and less charting:)

[BrandonLPN, LPN]

Nurse aides to get new titles and duties at Loretto's Green House project | syracuse.com

A "shahbaz," which means the "King's Falcon" in Persian, will do the caregiving. That's the title for a new breed of certified nurse aide who will take on extra duties such as cooking, cleaning and seeing to the overall welfare of elderly residents. The plural version of the term is "shahbazim."

Feh.

The "Green House" sounds exactly like the "Eden Project" from a few years ago. The upshot seems to be that residents would benefit from a more home-like environment where they have private rooms and can choose their own meals and recieve one-on-one personalized care.

Well, thank you Captain Obvious.

You know who can afford facilities with all private rooms, short order cooks and numerous caregivers? Rich people. You know who CAN'T afford such facilities? Everybody else. Guess which group of people wind up in Medicaid funded nursing homes?

What the Greenhouse Project describes is NOT "reinventing the nursing home from scratch". What it describes is some sort of private-pay adult foster care home that can afford to function with 6-7 residents in a house staffed with nurse aides and licensed nurses. Such facilities do not exist outside of insanely expensive elite facilities for the grandmas of the super-rich. My facility doesn't put residents two to a room and staff with a 15:1 caregiver ratio because we hate old people. We do it because that's all that funding allows.

I agree there needs to be a culture change in LTC. Our facility is moving toward this, slowly. For starters, we need to let our residents sleep in and take their meals when they're good and ready instead of forcing a gaggle of 90-year-olds to be up and dressed and in a communal dinning room by 730am.

But saying the solution is private rooms and more staff and individualized restaurant-like meal service is absurd. Where is the money for that going to come from?

[RNlove17]

Thank you for responses! I don't mind the floating down to a CNA (although I will admit that don't want to do it all the time, because the main reason i work per diem is to keep up my nursing skills because my FT job is more of a desk job and less acute care. But here and there is okay...) I really just wanted to make sure I wouldn't get in trouble or was compromising my license.

Yea the shahbaz thing is new... it's basically a CNA who also has to prepare, server and clean up dinner in the LTC facility (that's NOT the job description, just observation). They are part of the Eden centered/green House care model. At our facility, there are 4 "cottages" with 20 elders in each, 10 on each side. there's 1 nurse per cottage, and 4 shabaz (2 on each side). Each side has private bedrooms around a common living room and dinning room area with the big kitchen in the middle between the 2 sides. It's more "homey" than a regular nursing home setting, I'll say that. The shahbazs make a little more money than the regular CNAs/PCTs. I honestly think their job though (at our facilities) is more relaxed than the CNAs/PCTs jobs

[Been there,done that, ASN, RN]

If your concern is legal... check with your malpractice insurance carrier.

You are smart to be concerned, as you carry your RN responsibility within the CNA role.

Enjoyed learning about the shabaz role, thanks.

[BeachsideRN, ASN]

Reformers Seek to Reinvent Nursing Homes : NPR From what I gather a shahbaz is an aide

[mclennan, BSN, RN]

Back in nursing school I worked as a "shabaz," at an LTC that had just converted over to a "neighborhood" model after the administrators traveled to Sweden and saw something similar in practice there. No more long dark hallways with shared rooms and a nursing station; it was converted to "pods" of 5 or 6 private rooms clustered around a small central kitchen/open lounge. They changed the CNA job description (& pay rate) to reflect additional duties of cooking a simple breakfast in the morning and each CNA ("shabaz") was assigned to ONLY that "pod" for an entire shift.

It worked well, in my opinion. I loved working there! I only took care of my little "pod" of residents, and was able to spend enough time with them to do thorough baths, oral care and careful transfers & toileting. I could also hang out with them, watching TV, playing cards or doing a puzzle. Plus I did all the inventory and stocking of supplies, med admin, (I had my CMA) and charting. Dietary stocked the fridge & food, housekeeping did the cleaning. As far as I remember, they had pretty conventional funding sources - my residents were garden variety Medicare folks, not rich or elite at all! The best part was, their families actually WANTED to come visit because it was so much more pleasant than the old nursing home model. We sometimes had staffing probs but it was never a crisis level, it was no big deal to cover another pod. Some pods that had total care residents were staffed with 2 of us.

[mclennan, BSN, RN]

And admin were very clear and adamant about their somewhat different expectations of CNAs at the point of hire. I didn't mind scrambling a few eggs or fixing oatmeal for 5 or 6 people. They paid a little more than other LTCs in town and the stress was WAY less. If CNAs didn't like it they could work somewhere else. The place didn't stink like C.diff, was quiet and mellow. Sure it had some issues but nothing even close to what I heard about conventional LTCs.