RN's and LPN's working as Nursing Assistants?

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If you came into your facility and they asked you to work as a nursing assistant for the day for your regular nursing pay, would you agree to it? Why or why not? If you would, or if someone else would, do you feel they are still accountable to their patients as a nurse?

Yes and Yes.

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The joke in our facility is "How do you tell the difference between an LPN and a BSN?" "If the diaper is on sideways, the nurse has a BSN."**

**I love you, BSN nurses, don't come at me with the fury of a thousand suns

I love this joke. ADN nurse here. The sad basics of patient care I am deficient in are embarrassing. Getting a diaper on straight, getting a patient on and off a bedpan, bed baths, etc.

I'm a mother, grandmother, with a 10 year old special needs grandson who will always be in diapers. I could never even get diapers on babies that wouldn't fall off as soon as they stood up.

Once a year I babysit my 10 year old for a week. It takes 5 days for me to get the hang of getting his diaper on so it doesn't fall off, look crooked, leak, etc.

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I love this joke. ADN nurse here. The sad basics of patient care I am deficient in are embarrassing. Getting a diaper on straight, getting a patient on and off a bedpan, bed baths, etc.

I'm a mother, grandmother, with a 10 year old special needs grandson who will always be in diapers. I could never even get diapers on babies that wouldn't fall off as soon as they stood up.

Once a year I babysit my 10 year old for a week. It takes 5 days for me to get the hang of getting his diaper on so it doesn't fall off, look crooked, leak, etc.

Sounds to me like just a personal deficiency rather than as a result of your education. Practice makes perfect, and the joke to me is saying that the BSN has less practice at ADLS (presumably because she is performing tasks unique to the scope of the RN) than the LPN. It's not clear to me why you have so much exposure to the task but admit that you are not proficient at it, but I'm pretty sure having the RN title on your badge is not responsible for your difficulties, or that being an LPN would magically confer expertise.

I've been changing diapers since the age of 10, when my mother had the first of three younger children. I was a diaper expert before I set foot into my BSN program. I'll put my diapering abilities right up there with any nurse, LPN or otherwise. I will even finish with my hands up in the air, just like the calf ropers do in competition. :)

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Sounds to me like just a personal deficiency rather than as a result of your education. Practice makes perfect, and the joke to me is saying that the BSN has less practice at ADLS (presumably because she is performing tasks unique to the scope of the RN) than the LPN. It's not clear to me why you have so much exposure to the task but admit that you are not proficient at it, but I'm pretty sure having the RN title on your badge is not responsible for your difficulties.

I think you and I are over thinking this issue. It is a joke/exaggeration. Most of my bedside acute care nursing was with CNA's. Whom I loved, and helped as much as I could.

Hopefully if my title was CNA I would be proficient in ADL's. Probably not!!! I probably couldn't have made it through CNA classes When I give a bed bath the patient, bed, floor, and I, end up soaked.:roflmao:

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It's always weird to me that some nurses think that the reason some other nurses don't want wiping butts, as you so elegantly put it, to be the main feature of their work day, is because they think it's "beneath them". Beneath them sounds emotional and implies that someone thinks they're better than someone else. My personal interpretation of the division of labor is based solely on efficiency and the best utilization of available resources.

EXACTLY!

Okay, so this is not the same thing you have been complaining about. Asserting that because RNs have a scope way beyond that of a CNA, so much so that it is not cost effective for the RN to spend too much time doing something that can be delegated to unlicensed personnel, is not the same as objecting to CNA duty on the basis of increased liability, which is what you have spent pages arguing.

Expecting RNs to take a full load of patients (and often more than should be assigned) AND do total care instead of providing them with ancillary help is something many of us have struggled with and have objections to. Count me as one! Assigning a RN for one shift in order to do nursing care that any CNA could also do is a different thing altogether. From the employer's viewpoint, this is not cost effective, but from the RN viewpoint, compensation remains the same.

Also at issue (for me at least) would be how often this assignment is made. Once in a blue moon? That's one thing. So often that the RN doesn't get to engage in the work she has spent years of her life getting the education to practice is another thing altogether. Your OP made it sound as if this is not something that is inflicted on a regular basis to a single individual; rather, it sounds as if this is something that is spread out over the unit on an occasional basis. That would certainly affect my opinion of this whole issue, and I bet I'm not alone.

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Specializes in CrItical Care, Street Medicine/PHM, School nurse.

In my ICU stepdown unit we sometimes assign RN's to be a "task nurse" when we're short a CNA/PCT. The task nurse basically does all the tech work plus pass meds, start IV's, Foley's, etc. if the patients main nurse is busy and needs a little help. It's a lot of work but it's a good way to keep your basic nursing skills sharp. I haven't done it yet but I would like to do it. The task nurse does not have an assignment persay but he/she does assist the main nurse.

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Specializes in Psych, Addictions, SOL (Student of Life).

Weighing in late here but IMHO this whole argument is somewhat ridiculous. First of all there is nothing a CNY does that is not within the scope of practice of a RN. Even if a RN is working as a CNA and said nurse felt they were only responsible for CNA duties and something happened. Their license would not be in danger even if they only acted to the highest standard of a CNA.

Scenario in point a CNA or RN acting as a CNA come in on a patient who is struggling to breath. The correct action would depend on facility protocol but would essentially be to stay with the patient and call for help and stay with the patient until a higher level of care arrived and be prepared to airway support and CPR if necessary. Even if the patient coded and expired it is unlikely that either caregiver would have action against their license or certification.

Now if your facility has CNA who would leave a patient struggling while "I go find your nurse!" and an RN working as a CNA does the same then the actions of both persons could be seen as negligent and reportable to the licensing agency.

When I am precepting a new nurse and he/she starts talking about fear of losing their license I advise them to go to the discipline section of the on-line BON report and see the kind of things nurses actually lose their license for.

I am never too good to anything on my unit. Yes I am an RN and I worked hard to get that but at the end of the day - My best days as a nurse are those where everyone works together as a team without complaining about assignments or throwing job titles around.

Hppy

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When I am precepting a new nurse and he/she starts talking about fear of losing their license I advise them to go to the discipline section of the on-line BON report and see the kind of things nurses actually lose their license for.

Hppy

That fact has been pointed out to the OP, but apparently is not enough to calm her worries that working an occasional shift taking over the duties normally assigned to a CNA puts her license at risk.

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I've been changing diapers since the age of 10, when my mother had the first of three younger children. I was a diaper expert before I set foot into my BSN program. I'll put my diapering abilities right up there with any nurse, LPN or otherwise. I will even finish with my hands up in the air, just like the calf ropers do in competition. :)

Same here. I was a mom, aide, and LPN before I became an RN. And as a mom of four and grandmother of five, whom I'm blessed to see regularly, I am definitely well trained in changing diapers and adult briefs.:)

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Okay, so this is not the same thing you have been complaining about. Asserting that because RNs have a scope way beyond that of a CNA, so much so that it is not cost effective for the RN to spend too much time doing something that can be delegated to unlicensed personnel, is not the same as objecting to CNA duty on the basis of increased liability, which is what you have spent pages arguing.

Expecting RNs to take a full load of patients (and often more than should be assigned) AND do total care instead of providing them with ancillary help is something many of us have struggled with and have objections to. Count me as one! Assigning a RN for one shift in order to do nursing care that any CNA could also do is a different thing altogether. From the employer's viewpoint, this is not cost effective, but from the RN viewpoint, compensation remains the same.

Also at issue (for me at least) would be how often this assignment is made. Once in a blue moon? That's one thing. So often that the RN doesn't get to engage in the work she has spent years of her life getting the education to practice is another thing altogether. Your OP made it sound as if this is not something that is inflicted on a regular basis to a single individual; rather, it sounds as if this is something that is spread out over the unit on an occasional basis. That would certainly affect my opinion of this whole issue, and I bet I'm not alone.

No, it's not what my original post was about. As opinions have been given, I've been responding to some of them, and the topics deviated from the original post, as they often do.

But my position/opinion remains the same. I don't agree with Nurses working as CNA's with a CNA assignment EVER. My reasoning is for more than increased liability, but I have emphasized that. I also feel that facilities need to stop dumping this on us. Staff properly so that all can do their role. Have a solid backup plan for when call offs occur. You see, I am, and always will be a woman's advocate. These are still predominantly female roles. And we continue to be taken advantage of in far too many ways. That goes for CNA's, LPN's, RN's with every degree, and advanced practice nurses. This is one of them.

I see I will have to agree to disagree with some of you. As I tend to be an opinionated person, it won't be the first or last time.

Let me clarify something though. My frustration is with the facility for asking us to act as a CNA ever. That's not the job description we signed...etc. My frustration is also with nurses who agree to do this. The more we agree to do this, the more it will be asked of us to do so, and the less likely staffing issues, an ever constant nemesis, will be taken seriously.

One last thing. I believe it was you who discussed discipline from the board and how you haven't seen discipline related to a nurse working as a CNA. Correct me if I'm wrong, but if criminal charges were involved the board wouldn't even deal with that until after the fact, and who knows what the verbiage would be. I seem to recall seeing licenses being permanently revoked without reasons listed.

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One last thing. I believe it was you who discussed discipline from the board and how you haven't seen discipline related to a nurse working as a CNA. Correct me if I'm wrong, but if criminal charges were involved the board wouldn't even deal with that until after the fact, and who knows what the verbiage would be. I seem to recall seeing licenses being permanently revoked without reasons listed.

What would be the odds that you would face CRIMINAL charges for actions relating to a CNA assignment? That sounds incredibly far fetched.

I can understand your other comments related to why RNs should not be asked to take on CNA-only assignments. I personally am more passionate about being asked to take heavy RN assignments with no CNA. That's why I left my last job (endoscopy center). Our RN assignments were kept at their same incredibly stressful and challenging level, then they quit hiring aides. So in addition to the constant influx of new patients, we were required to wash down and re-make our beds and take them around the building back to the pre-op area. We had no help with patient care at all. Insufficient staffing is a huge problem these day, and that's where my attention has been drawn to. We all have our particular areas of concern, clearly.

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As promised, I spoke with a nurse attorney, who is also a nurse practitioner in my home state, Ohio. My exact question was "If I may ask you, what are your thoughts about someone who is an RN working as a CNA for a day?" Her first response was, "If they're an RN, why are they working as a CNA?" I said, the facility is short a CNA and has asked them to do so. Her response, "That is idiotic and I wouldn't play around with an RN license like that. It benefits the facility, puts you at risk, and you're not even certified to do that position. How much are they being payed?" My response "their regular RN wage." She said "that doesn't make sense to me at all, it won't make sense to the board of nursing, and good luck with explaining to the board that you were working as a CNA for that day, let alone a judge. Does that sound like it makes sense to you?" I said, "to me, not at all."

I'm still waiting to hear from the board of nursing. I will post their response when they send it. Hopefully it will be this century.

My point in calling an attorney and posting her response...to make you think about what you're doing. Push aside that crap about being above patient care (which is pure bologna), about doing whatever the team or facility needs (more Oscar Meyers), or about validating what you've done or are willing to do, and really think. At the very least, call an attorney or the board in your state and let them weigh in on it.

And on that note, I digress, until I hear from the board. (I hope I used digress properly. I've always wanted to use that word in a sentence) :happy:

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