Transitioning from CNA to New Grad

[Nurse Beth, MSN]

Dear Nurse Beth,

I am about to start working as a new graduate nurse. I will be working where I currently work as a CNA. What advice do you have for a smooth transition?

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Dear CNA to New Grad,

Congratulations!! Clearly they like you and the work ethic you've demonstrated as a CNA. One of the best ways for a new grad to land a job is to do what you did- work as a CNA in the facility you want to work in as an RN.

At the same time, transitioning from a CNA to an RN can come with challenges, especially if it's on the same unit. Your main concern is your relationship with the CNAs, who were very recently your peers.

Many of them will be happy for you. But there can always be one or two who are passively resentful of your success and undermine you. In essence, you are moving from one social work group to another. Therefore you may need to expend a little extra energy to win them over.

Be sensitive to their reactions to you. Pick up subtle cues as to how they really feel, and keep lines of communication open. They are watching to see how you act. Show that you appreciate their help. When you communicate that you are willing to help when you are able, they will give you grace at times when you are swamped with RN duties and are not able to help them.

When you truly respect others, it is apparent and felt. In other words, out of the heart, the mouth speaks”.

As a new RN, you do have to learn to delegate. It is a challenge for most nurses, and most especially new nurses. We are not acculturated to asking for help, or worse yet, assigning tasks to subordinates. It can feel awkward. Take note of an RN on your unit who has the skill of easy delegation down. Watch and learn.

Good luck to you. I talked with a new grad recently who started on MedSurg where she had worked as a CNA. I was more concerned about the transition than she was, and she actually did fine. It's a tribute to both her and the wonderful CNAs we have at my work place.

Best,

Nurse Beth

[sherri64]

In my career I've seen a lot of people move up and try to work in the same unit. It usually doesn't work. The only place where I saw it work really well was in Hawaii, where you cannot even go to nursing school until you have worked as a CNA for a year. The mutual respect and willingness to work together between nurses and CNAs was great. I think it should be required everywhere.

[Elaken]

I was a float CNA during nursing school before becoming a float RN so I see a lot of different people and units. Most aides tend to work on their same unit after graduating if they are decent. It hasn't really been an issue. However there usually is a lot of griping if the aides feel the new nurse won't do "aide work" anymore. I get a lot of appreciative comments from aides on how I help out and I don't think I even do that much. I think the two important things are 1) answer call lights when you can even if sometimes it means putting your charting on hold and 2) don't delegate the bathroom duties. If your patient needs to be changed or cleaned up than do it. Don't hunt down the aide and ask them unless you have a truly priority situation happening elsewhere.

[sailornurse]

I think it is best to work on a different unit where you will be treated as a new grad that needs mentoring.

[Axgrinder]

Congratulations!

I had some difficulty transitioning from the student nurse float pool, to a new grad RN. One person only - an LPN - resented the change in my title and made some problems for me I never could have foreseen. It was actually pretty horrible, however any other rationale person would never have done the things she did.

Another RN from PACU refused to give me report because he wouldn't listen to me than I was no longer a PCT.

I believe most people working in a medical facility are used to seeing the type of changes from CNA to RN on a fairly regular basis. I think as long as everyone is on board with the change in your job title that you will have a smooth transition.

Good luck! We need all the new nurses - LPN and RN - we can get. And welcome!

[cjcsoon2bnp, MSN, RN, NP]

To the OP, I agree with Nurse Beth's advice on this issue and the advice of other users. It will present a unique (but not insurmountable) challenge to become a nurse (LPN or RN) where you were once a CNA, you will have to remember to always be professional and that initially, at some point, you will get some feedback/reactions you may not like. How you carry yourself and how you react to feedback (both positive and negative) will determine your success in this role.

As Nurse Beth said, you will need to learn how to delegate because you cannot do all of the work by yourself and many of the tasks that a nurse does cannot be delegated to a CNA and you will have to focus on those things in addition to the ADLs that can be delegated to a CNA. A benefit to having been a CNA previously is that you know how challenging it can be to help patients with ADLs and you appreciate it when a nurse helps you to complete these tasks and doesn't abuse their ability to delegate. Remember these things when you are in the nurse role, if you have time to help the CNA complete these tasks for your patients then please do and when you delegate take a minute to ensure that the delivery is polite and professional. I was a CNA prior to being an RN and most of the CNAs I work with at any job know it before I ever tell them because of the way that I ask for their help and readily offer to help with patients (mine and sometimes the patients of other nurses) when I'm available.

As I mentioned, you're likely to get some push-back because of this transition in your role. It could be from other CNAs who feel like you have "risen above them" and "think you're better than us" which may result in some passive-aggressive behavior such as avoiding helping you or trying to undermine you. It could also be from other nurses (LPN or RN) because they feel like you will suddenly "develop a know-it-all attitude because you are a nurse now when you were just a CNA before" or that you are now "on equal ground with them" which thus disrupts the "balance of power" and this may result in passive-aggressive or overtly aggressive behaviors such as undermining you or saying things to discredit your judgements or options.

Please note that I do not hold any of these beliefs, I am just explaining the mindset that others may have. The best thing to do in both of these situations is to (a) always carry yourself professionally, (b) do not engage in arguments or conflicts in public, and © when this kind of behavior occurs address the individuals promptly, privately and openly so that it can be addressed "the right way" and "right away". If addressing these issues yourself with an individual does not work only then should you include a manager in conflict resolution.

In my experience, any potential issues that happen when you transition from one role to another within your same unit (CNA -> Nurse, LPN -> RN, RN -> APRN, Staff Nurse -> Management etc.) are usually time limited and tend to blow over after a while.

!Chris

[CountryGirl619]

I think the two important things are 1) answer call lights when you can even if sometimes it means putting your charting on hold and 2) don't delegate the bathroom duties. If your patient needs to be changed or cleaned up than do it. Don't hunt down the aide and ask them unless you have a truly priority situation happening elsewhere.

LOVE this advice. As a current CNA who is transitioning into the RN position next month, I can truly appreciate the nurses who don't delegate call lights and bathroom duties. Even if it means you put them on the toilet and come tell me that they are there and ask that I go remain with them, it's still a huge help.

I have a wonderful unit and am hopeful that my transition will be fairly smooth. I realize road bumps will be in my future, to say the least, but I work with a wonderful group who do truly support each other. Or maybe it's just my attitude and the way I choose to look at it through my rose-colored glasses Either way, I win!