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

Yes, I would do it. No, I would not hold myself accountable for the same things I would if I were the nurse assigned to that patient. I work sub-acute/skilled and granted, it's different. That being said I don't see how it would be an issue to function as a CNA for any nurse. If anything, being a nurse makes the role of a "CNA" much easier because you don't have to go find the nurse for every little thing and you can handle things yourself that come up, such as dressing changes, answering questions, etc. Only one nurse should be medicating the patient or handling things such as labs and contacting the MD. Provided whoever the main nurse for the patient is has a good communication line open I wouldn't think anything of it. IMHO most nurses don't want to work as a CNA because its hard work and honestly, many don't really feel comfortable.

Also, I feel like I have to echo the others who have said THERE IS NO SUCH THING AS CNA WORK. It is ALL nursing work. You are responsible for your patients hygiene, mobility, hygiene and ADLs. You simply have helpers that do much of that for you, but when push comes to shove they are NURSING duties.

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.

I'm sorry, but that is the most absurd thing I have ever heard. A RN needs no such "certification" to spend the day giving bed baths, getting patients up to the bathroom, taking and recording vital signs, and doing any other task that is already within her scope. Really, really think about what you (and your "expert") are expecting us to swallow. If you had no CNAs (and many here have related how they do not), you would be doing total care for your patients. You would not be legally "exposed" because you do not have a CNA certification. Every single thing a CNA is legally qualified to do is already covered by your nursing license.

I was completely ready to hear any number of potentially valid reasons to back up your position, but your nurse attorney really *&^& the bed on that one. Sorry, but your expert sounds like an idiot. And that is not something I would say lightly as I usually try to be really respectful. But telling a registered nurse that she cannot do ADLs and other tasks CNAs do without additional certification is simply idiotic; there is just no other word for it.

Just read through all of this and would like to join the discussion, blackmamba.

I wonder if you are overlooking the idea that, although professional surveillance of a group of patients is indeed an RN role and you are an RN, being responsible for larger and larger groups of patient surveillance is by assignment, so that ultimately, a staff RN becomes "liable" for 5 or 6 patients, or a charge nurse may be expected to coordinate or oversee the surveillance of the group as whole. But every RN on a floor is not wholly liable for every matter involving every patient including those s/he may not be aware of because s/he is not assigned to a particular patient. If working as an NA, you are not assigned the role of professional surveillance for the whole floor of patients collectively - just as you aren't when you show up to do your staff RN role.

Let's say you are an RN performing the NA role for a shift and you enter the room of a patient (A) to obtain vital signs and find the patient in some sort of extremis and you need to perform an immediate intervention. At that very moment, how is your liability more than if you were the RN assigned to that patient? It isn't, and what you are charged with doing/liable for is performing immediate and prudent RN actions that you are licensed to do, while notifying patient A's nurse. Which is exactly what you would do if you were working as an RN who is not assigned to patient A and happened to walk past the room and notice a problem.

Now let's say that, at that same time, another patient (B) on that unit has....any other problem. You are not the RN assigned to patient B, and therefore you are not the primary licensed individual responsible for patient B. Patient B's problem is not required to be reported to you; you may not even become aware of it. Some other RN is responsible for patient B. In fact, it might even be the same RN who is assigned to patient A. But either way, patient B and his/her problem does not involve you.

So now, you aren't the primary individual who is legally responsible for patient A, and you aren't legally responsible for patient B's problem at all.

Now let's say that you are providing personal care to a patient © while, unbeknownst to you, patient A is having the life-threatening problem. You are not patient A's nurse. The responsibility for basic surveillance of patient A falls to patient A's nurse, and the primary responsibility for responding to patient A's crisis falls to patient A's nurse. At that point, you have no more liability related to patient A than any other nurse on the shift who is not assigned to patient A.

So let's move on to the matter of the fact that on a 20 bed unit, various patients might have issues of varying acuity/severity during the shift. You are to perform the usual NA duties on behalf of all of these patients, although you are licensed as an RN. Right off the bat, you are not assigned to the role of worrying about each of their individual crises; some one else is assigned to that role for each and every one of these patients. This means that for every one of those separate and individual 20 patients, you are no more responsible for each one's crisis than you would be if you were performing the RN role on that unit that day but were not assigned to the patient having the crisis. If you are the one who discovers the crisis you must handle it as a prudent RN would - which is also true if you are assigned to the RN role and discover another RN's patient having a crisis, as already discussed above.

This basic situation in the preceding paragraph is also mitigated by some of the same things that apply to an individual who is an NA, such as the fact that one person is not expected to know everything and provide all aspects of care to all patients. Meaning, when an NA has two tasks that must be completed urgently, one of them must be reassigned to someone else. That same truth is in effect for an RN performing an NA role as well - the only difference is that the RN would be liable to make independent and prudent decisions about prioritizing the tasks.

The fact that there are 20 patients on the unit and you will have occasion to be responsible for a singular portion of each of those 20 patients' care at singular points in time during your shift does not equate to you being responsible for the continual professional surveillance and total care of each of those 20 patients when you are not the RN assigned to those patients. If that were true, you would have that very same liability every day that you come to work as an RN with regard to the continual surveillance and total care of the patients not assigned to you.

That's all there is to it.

Caveat: I do see one major potential problem with the RN-as-NA, and that is documentation. NAs' documentation requirements vary widely and are always facility-specific. That is not true for RNs. So...going back to my original patient A scenario, I could see where the RN-NA might be expected to more thoroughly document his/her involvement in the situation, including RN-appropriate assessments and interventions and indicate that appropriate care hand-off was made.

Due to the high number of tasks an NA may become involved in during a shift, this could become very problematic when the RN-NA makes a significant assessment or discovery or must use RN skills on the patient's behalf, since - now you have to have time and be allowed to chart accordingly while everyone wants you to move on to the next task. This is why the utilization of NAs can be helpful to begin with - - they can move on while we attend to detail (legal and otherwise).

I would think that, in scenario A, it could become a liability if the RN-NA simply (appropriately) bagged the patient a few times while activating a code and then (as might be expected) moved on to the next task when the code team and primary RN showed up and the proper care of the patient was being continued.

I guess this concern could be mitigated by stopping to documented accordingly as one would do as an RN not assigned to the patient, all other demands be damned for the moment.

A nurse practitioner and attorney who says that an RN is not "certified" to perform a CNA role is...representative of so much that could be said to be wrong in our profession.

Come on, that comment reflects either a serious lack of either intelligence or a serious lack of integrity. One of the two.

That person gave you their emotionally-tainted two-bit opinion.

I'm sorry, but that is the most absurd thing I have ever heard. A RN needs no such "certification" to spend the day giving bed baths, getting patients up to the bathroom, taking and recording vital signs, and doing any other task that is already within her scope. Really, really think about what you (and your "expert") are expecting us to swallow. If you had no CNAs (and many here have related how they do not), you would be doing total care for your patients. You would not be legally "exposed" because you do not have a CNA certification. Every single thing a CNA is legally qualified to do is already covered by your nursing license.

I was completely ready to hear any number of potentially valid reasons to back up your position, but your nurse attorney really *&^& the bed on that one. Sorry, but your expert sounds like an idiot. And that is not something I would say lightly as I usually try to be really respectful. But telling a registered nurse that she cannot do ADLs and other tasks CNAs do without additional certification is simply idiotic; there is just no other word for it.

Agreed. That one statement discredits everything else your "expert" has to say. I wouldn't like being assigned as the CNA, and I may struggle a bit with time management due to the change in routine, but I'm not unqualified.

I cannot believe that a nurse working as a CNA would think that she was not responsible as a nurse that day? Did you not read the fine print when you were taking the Ethics class? Did you not read the fine print on your license? Tag! You're it any day of the week, no matter the shoes you fill!

One of the first things we did in nursing school lab was learn CNA skills (I was already an SRNA so had a little head start there). The other program I applied to required you to be an SRNA as a prerequisite for admission.

I get not wanting to enable management to short staff aides/techs - but if they can use CNAs it doesn't make sense long term not to for fiscal reasons if nothing else (though I know CNAs who make $50K between raises and overtime). OTOH, as an aide, I appreciate when a nurse will work as an aide for a shift if my load is high. A few weeks ago I was the only aide with 19 (eventually 20) patients (low acuity adult psych, mixed men and women). As it was I ended up walking 7 miles during my shift just doing safety checks, and that was splitting them with one of the RNs. Plus vitals, meals, manning the station/phone. Not that I couldn't have covered it all myself, but it was really nice that I didn't need to.

As a nurse, used to sign up for OT knowing I was going to be working it as a cna. I would many times work days as a CNA and then afternoons as the nurse. I made thousands of dollars in OT by doing this. I also signed up for sitter work, same results, lots of money, even easier work. When I knew I would be leaving the facility, I poured on the OT even more. Another even bigger plus was that by working OT, it would help keep one off the mandation list. One time I went six months without being mandated. Some of our nurses were being hit three times a week.

The benefits:

The cna's were very appreciative, as they were getting beat-up with mandation.

I got to know the residents, their families and other staff even better.

I made a lot more overall money. I wanted a good cushion for when I eventually left.

The nurses benefitted from having another nurse as a cna.

I think I asked something like this, but my question was more voluntarily involved as in "I would want to work as a CNA on the side" rather than "Do I really ******* have to?".