Critical question, please advise ASAP

I would chart the caregivers are uncertified, if you know that is a fact.

I'm not worried about ever reapplying there and I'm frankly not worried about what she might say about me. My work history prior to her is rock solid. The bottom line is that I feel my license is in undue jeopardy under current conditions and that is my reason for leaving immediately. Any employer worth their salt will understand that. In fact, I do already have another job lined up. My references have already been called and background check started today. But I think I will do as you suggest and just keep the letter generic and brief.

First thing, I doubt anyone could find fault with you leaving this place. Second, stop worrying about your license! Your license is in not in jeopardy because your employer decided to use non-trained staff for patient care.

Oddly enough your employer is probably not even doing anything wrong as far as State is concerned. Of course every state is different, but at least in WI certified nursing assistants are not required for any LTC setting except traditional nursing homes or skilled nursing facilities that accept medicare patients, which is most if not all of them. In assisted livings, group homes and home health all that is required are PCA's [personal care attendants] that have no state oversight or required training.

From my work as a legal nurse consultant, I can say it's not your license that's most at risk here, it's your liability exposure that's the big potential problem. They are two very different things that are often confused on allnurses and elsewhere.

Let's say the housekeeper is transferring someone and they fall, and the patient dies from complications of the fall. The family could sue, claiming if the person transferring had been trained, the fall and death wouldn't have happened and therefore negligence (in providing appropriate staffing) caused the loss. If you as an RN specifically delegated the task to a person not competent to safely perform the task, you're at risk. It matters very little that the owner said the housekeeper was to assist. BUT when these cases go to court, the lawyers look to place the blame on someone or something with deep pockets so they can recover big damages. That would most likely be the corporation or individuals that are keeping the place open without safe staffing. However, you could also be named in the suit.

The way around this is to NOT be the one delegating, and only do it for one shift. Say, "I'm sorry but I can't delegate that to the housekeeper as it would be unsafe to delegate to an untrained caregiver, but you're free to." Then write an email to your supervisor and whoever up the ladder you feel should be copied. Say that you're working under protest that shift so as not to abandon your patients, and print a copy and keep it in a safe place. Though you will be supervising the housekeeper, you have already lodged a protest. And don't work another shift. If you walk back into a situation like this knowing there is unsafe care being given, you are HUGELY at risk of being successfully sued if there's a bad outcome. Not having given a two week notice would be the least of your problems.

I know you've already quit, but this kind of thing will happen more and more often in the future. People need to know how to protect themselves from losing not their license but homes, retirement accounts, etc. in judgements against them. By the way, the housekeeper isn't at risk. She can't be expected to understand the potential consequences of working as a CNA without training.

I'm not worried about ever reapplying there and I'm frankly not worried about what she might say about me. My work history prior to her is rock solid. The bottom line is that I feel my license is in undue jeopardy under current conditions and that is my reason for leaving immediately. Any employer worth their salt will understand that. In fact, I do already have another job lined up. My references have already been called and background check started today. But I think I will do as you suggest and just keep the letter generic and brief.

Whether or not you intend to apply to be rehired at your current place of employment, quitting without notice can follow you around. Your current boss may become the new manager at someplace you DO want to work. Or worse, at someplace you're already working.

Your employer may buy, be bought by or merge with one of the larger employers in your area. This happened to a former colleague of mine. The small community hospital where she was working was acquired by a larger hospital system, a system which had already acquired the nursing home she had left without notice. She already was working for the hospital, but found that due to her previous job that she quit without notice, she wasn't eligible for promotion. Or the black mark with the system's HR department was not overcome by her good work history in her second job. She needed to leave that system in order to be promoted, and they controlled nearly every facility in the area.

You may find that your "license at risk" reason for leaving is not as understandable as you think. Licenses don't usually get yanked for mistakes, accidents or anything short of willful malfeasance, drug diversion or "fraudulent charting" which usually means taking the patient's narcotics and charting that you gave them to the patient. Take a look at your state BON's newsletter. Few nurses actually lose their licenses and those that do usually lose them for reasons associated with narcotics.

Best of luck to you.