Scheduling nurses to work as CNAs?

RNtoACGNP · Jan 19, 2016

That is absolutely unacceptable. Are you being paid at a nurses rate or CNA's? I have never heard of this actually happening. I've never worked LTC but at an acute care hospital we would staff extra nurses in place of being short a CNA, so ultimately we would be doing what the CNA does but we would be the nurse as well (with less patients). Your facility needs to do some major changes in the staffing department if they are that short on CNA's

chare · Jan 19, 2016

I've done a couple shifts - it's pretty terrible, mainly because I was never trained as an aide at this facility (I did work as a CNA for 2 years about 10 years ago). I basically follow another CNA around and we do every single person together.

What training do you need? Are you being asked to do anything outside of the realm of routine nursing care?

Another nurse I work with ran right out to her doc when this scheduling started and he happily wrote her a note getting her out of itâ€¦

She needs to be careful doing this. As all of the duties performed by the CNA are all routine nursing care, she inadvertently obtained a statement from her physician that she is not physically able to do her job.

â€¦I know of one other nurse that flat out refuses to do it and has said she will walk off the job if she's ever scheduled to be a CNA.

And if she does, hopefully your DON will accept this as her resignation.

I don't want to come off as a snob, like I'm better than doing this sort of workâ€¦

Unfortunately, this is how this sounds.

â€¦I don't feel like it's safe at timesâ€¦

Uncomfortable, absolutely, but unsafe? I don't think so.

â€¦and I don't think it's fair that some nurses have to do it, while others just throw a fit and get out of it.

I view this much the same as floating. It's something that no one likes to do, but occasionally needs to be done. I agree, if your DON is going to require this of any of the RNs, then he or she needs to require this of all the RNs.

â€¦I've never worked LTC but at an acute care hospital we would staff extra nurses in place of being short a CNA, so ultimately we would be doing what the CNA does but we would be the nurse as well (with less patients)â€¦

Yes, this is another option. However, depending upon the staffing ratio, adding one additional nurse and, requiring each nurse to perform total patient care, without the assistance of the CNA, might be a much worse situation.

Eleven011 · Jan 19, 2016

When I was working LTC and they were really short of CNA's they had nurses cover the shifts. But it was a volunteer kinda thing, extra hours/overtime for whatever nurse wanted it. And we were paid at our nursing rate. We actually had quite a few taking advantage of it. I never did, simply because with 4 kids at home, I was busy enough without extra shifts.

Editorial Team / Admin · Jan 19, 2016

It's one thing to use nurses to cover as CNAs as a temporary measure. To do so with no effort at bringing on more CNA staff speaks of management not wanting to fix the status quo.

However, CNA duties are within the scope of practice as a nurse; they are simply activities that may be delegated if there is someone to delegate to. The nurse who got the note may find herself with unwanted consequences.

If this is going to continue, it needs to be fair- each nurse takes a turn. No pitching a fit and getting out of it.

RNfromMN, BSN, RN · Jan 19, 2016

What training do you need? Are you being asked to do anything outside of the realm of routine nursing care?

Where supplies are found in each room. How they transfer. Dentures? Depends or pads? How much assistance is needed in dressing. There are 25-30 residents on my floor with new admissions throughout the week - I know these things about some of them, but no, honestly, not all of them. And they are things I can go find out, but that puts us all behind.

She needs to be careful doing this. As all of the duties performed by the CNA are all routine nursing care, she inadvertently obtained a statement from her physician that she is not physically able to do her job.

And if she does, hopefully your DON will accept this as her resignation.

Staffing shortage :). I'm not exaggerating when I tell you that the many CNAs & nurses who have put their notice in over the past year or so have been strongly (& always unsuccessfully) persuaded to stay. I'm not really sure at this point what one would have to do to actually lose their job where I work.

I view this much the same as floating. It's something that no one likes to do, but occasionally needs to be done. I agree, if your DON is going to require this of any of the RNs, then he or she needs to require this of all the RNs.

It's not occasional. It's looking like every shift for me. For an indefinite period, as explained to me by the gal doing the schedule. No one's applying and float agencies only respond about half the time they're called (I'm told). The full time nurses I talk to tell me it's the far majority of their shifts that they are scheduled as CNAs. I sympathize with my employer, but kinda feeling like it's more of a "not my problem" situation. Particularly when it's not a shared problem - the work is only required/expected of certain nurses.

RNfromMN, BSN, RN · Jan 19, 2016

That is absolutely unacceptable. Are you being paid at a nurses rate or CNA's? I have never heard of this actually happening. I've never worked LTC but at an acute care hospital we would staff extra nurses in place of being short a CNA, so ultimately we would be doing what the CNA does but we would be the nurse as well (with less patients). Your facility needs to do some major changes in the staffing department if they are that short on CNA's

That's totally how I feel. The doc that wrote my coworkers note didn't believe her that she was being scheduled involuntarily for CNA shifts. I guess he was like, "I don't understand - did you get in trouble for something over there? Are you being reprimanded? Or put back on probation?" We are being paid our normal wages, so that's nice.

RNfromMN, BSN, RN · Jan 19, 2016

When I was working LTC and they were really short of CNA's they had nurses cover the shifts. But it was a volunteer kinda thing, extra hours/overtime for whatever nurse wanted it. And we were paid at our nursing rate. We actually had quite a few taking advantage of it. I never did, simply because with 4 kids at home, I was busy enough without extra shifts.

Yeah, definitely not a volunteer thing. Don't get me wrong - some of the nurses (that started where I work as CNAs) love the change. But even they're getting tired of never being scheduled to work as nurses over and over and over again.

CapeCodMermaid, RN · Jan 20, 2016

Have any of you actually tried to hire CNAs? Depending on where you live, it is NOT an easy task. Do you think the management team likes to pay a nurse to do a CNA's job? Of course not. Instead of so much complaining, why don't y'all try to recruit some CNAs?

RNfromMN, BSN, RN · Jan 20, 2016

As a staff nurse that only works weekends & takes care of her 3 small children during the week, I really don't feel it's my place to try & hire nursing staff. And if I knew anyone qualified for a CNA position, I wouldn't exactly feel comfortable recruiting them to a place where I've seen other CNAs mandated for 16 hour shifts on their first day.

I don't think management enjoys paying through the nose for their nursing staff, but I definitely think this is their hens coming home to roost - there's definitely a reason everyone's quitting & no one's coming in to apply.

amoLucia · Jan 20, 2016

Have any of you actually tried to hire CNAs? Depending on where you live, it is NOT an easy task. Do you think the management team likes to pay a nurse to do a CNA's job? Of course not. Instead of so much complaining, why don't y'all try to recruit some CNAs?

The CNA pool loses many of its CNAs to agency staffing for much the same reasons that nurses go agency. The opp'ty for increased wages, preferred assignments, and scheduling draw them away from becoming routine staff. Not a unique problem for many other LTC facilities.

If your management is as bad as you feel it is and you are THAT dissatisfied about the job responsibilities, then maybe it's time for you to seriously look elsewhere. But comments by other posters are all true. Nothing you are being asked to do is beyond your scope of practice and it falls well within that last job description entry "other duties as assigned".

You could be hard pressed if your facility is an 'at will' employer and they exercise that privilege. You run the risk of 'insubordination' which could negate your ability to collect unemployment & COBRA and it could hamper your job search chances.

Unless you are unionized, you don't have much leverage.

Be careful about protesting too much.

RNfromMN, BSN, RN · Jan 20, 2016

Just before I had found out about this pregnancy, I was on the verge of accepting a nursing position with another facility. I don't get any benefits through this job, but at least I would still qualify for my 12 weeks unpaid FMLA time once the baby comes. I wouldn't be able to receive that starting a new job at this time (which only means I wouldn't be guaranteed a job after 12 weeks).

I agree with parts of what you're saying (& for the record, I have not complained once about my schedule), but it's more than a bit frustrating when I can barely walk into my front door without assistance after a shift, while other non-pregnant nurses with no existing health conditions are just saying, "No, I won't do that," and no one thinks anything of it. Which leads me to believe that the nurses *do* have some leverage in this situation.

If I thought it was just helping out for a little while, that would change my feelings on the subject, as well. However the staffing coordinator has shared with me that she doesn't see this ending anytime soon because no one is applying and the aides we have are dropping like flies because they're so tired of the mandatory overtime.

We do have a new administrator starting next month, so I'm a bit hopeful things might change.