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When do you say no.

jmcd84 jmcd84 (New) New

I have a question for LPNs out there. I work at a facility that is constantly short staffed. The other night we had more nurses that we needed, so I went home. I got called and asked to come back in as a CNA. Unlike a lot of us in the profession I have never been a CNA. I went straight to nursing school cause I had no desire to become a CNA. I refused to come back in for this assignment. I didnt do it because I feel I am better than a CNA, or simply because I didnt want to do that work. I feel that if I take the shift and don't say anything or protest that they'll simply keep doing it rather than fixing the problem with staffing.

What is your take on this?

I agree with your decision for not going in. I myself have stayed for part or all of the next shift because the cna's at my facility call out on the regular. I have felt bad at times because it always seems to hurt our good cna's and the last thing I want is to loose them, so I have done this. It won't fix the problem though and often times it could have been prevented if the supervisors did their jobs and called to get someone in to replace them. Often they just pass it on to the next supervisor, clock out and wash their hands of the situation. I recently started telling my cna's that they can't leave the floor until their replacements are in the building, mandating them to stay. It's not nice to do, but it solves the problem of not adhering to ratios. They all freaked out but in reality if your next shift just didn't show up, you wouldn't abandon your residents and punch out leaving them without a nurse.

You have a license to protect! It's almost illegal for a lpn to do certain things that a CNA has been trained to do. For example; suppose that Mrs. Smith needs to be transfered from the wheelchair into bed. She falls on the floor. Later you learn that she's a two person assist and you didn't follow proper procedure.

Then you're asked to help feed Mrs. Jones but you didn't realize that she is to have thickened liquids.

A CNA is responsible for the tasks he or she has been trained in...and it may be outside the scope of your practice as a LPN.

MunoRN, RN

Specializes in Critical Care.

You have a license to protect! It's almost illegal for a lpn to do certain things that a CNA has been trained to do. For example; suppose that Mrs. Smith needs to be transfered from the wheelchair into bed. She falls on the floor. Later you learn that she's a two person assist and you didn't follow proper procedure.

Then you're asked to help feed Mrs. Jones but you didn't realize that she is to have thickened liquids.

A CNA is responsible for the tasks he or she has been trained in...and it may be outside the scope of your practice as a LPN.

This is quite possibly one of the most absurd posts I have ever read on this site.

It's not in any way illegal for a n RN or LPN to perform the tasks of a CNA. If a nurse isn't familiar with what a 2 person assist is or what swallow precautions are, then they shouldn't be a nurse, it's not an issue of just avoiding working in the capacity of a CNA.

I was describing two true situations I know of, but I'm not revealing whether it was a LPN, RN, or CNA. "Mrs. Smith" (name changed) received a comminuted break of the femur. "Mrs. Jones" was sent to the ER for aspiration but died.

Absurd post? Perhaps.

hppygr8ful, ASN, RN, EMT-I

Specializes in Psych, Addictions, Elder Care, L&D.

You have a license to protect! It's almost illegal for a lpn to do certain things that a CNA has been trained to do. For example; suppose that Mrs. Smith needs to be transfered from the wheelchair into bed. She falls on the floor. Later you learn that she's a two person assist and you didn't follow proper procedure.

Then you're asked to help feed Mrs. Jones but you didn't realize that she is to have thickened liquids.

A CNA is responsible for the tasks he or she has been trained in...and it may be outside the scope of your practice as a LPN.

While I agree with OP about going back in I would like to point out that the tasks you are specifically noting are well within the scope of practice of both LVNs and RNs. Both disciplines learn how to transfer patients and feed them while in school.

Hppy

CNA duties are LPN/RN duties. What CNA's do is within your scope of practice. My job has been short on CNA's before. I was scheduled as a CNA. I still held the title of LPN. I still received LPN pay, I just did CNA tasks. If I didn't know a patient well, I looked at the care plan. The care plan tells you how to transfer or if their liquids are thickened. I was happy to do it. No assessments, no med pass, but because I'm a Nurse I was able to assist the Nurse working the floor. It was only for one shift. As long as I get my LPN pay, I'm cool.

Learning how to say no is one of the hardest tasks in nursing. There are several factors to consider in a decision to come in for a CNA shift or not, notwithstanding are you really rested, emotionally in the mood, just plain willing to work an extra shift, in any capacity? As stated before, once you agree to this sort of thing, it starts to become a habit for management to call on you. You have to set limits on who and what can impinge upon your free time.

Again I have no issues doing a shiftas a CNA. My big complaint is that its never just one shift. Management seems to believe the idea that "If you're scheduled to work, we can plug you into whatever role we need." There is a RN in my facilty that made the jump from CNA to RN. He was a CNA a year ago. Thus he is always being asked to step into that role. He's comfortable with this because hes uncomfortable with his ability to critically think on the fly in emergencies. Hes been doing this alreadt for months. Because of this management has not made it a priority to hire more CNAs. We've brought in more nurses, and this the push is to have nurses drop into more CNA roles now. Its just something that at this point in my career I don't want to do. Maybe that makes me a bad nurse.

Again I have no issues doing a shiftas a CNA. My big complaint is that its never just one shift. Management seems to believe the idea that "If you're scheduled to work, we can plug you into whatever role we need." There is a RN in my facilty that made the jump from CNA to RN. He was a CNA a year ago. Thus he is always being asked to step into that role. He's comfortable with this because hes uncomfortable with his ability to critically think on the fly in emergencies. Hes been doing this alreadt for months. Because of this management has not made it a priority to hire more CNAs. We've brought in more nurses, and this the push is to have nurses drop into more CNA roles now. Its just something that at this point in my career I don't want to do. Maybe that makes me a bad nurse.

You work at a terrible facility! I understand your pain!!

No, I would not come in as a CNA.

Your facility needs to stop being cheap! And just call for the agency staffing! That is why they exist!

I feel sorry for ya! I wish I can hug you! Don't let them take advantage of you!

There's a bigger issue presented in the OP's post and that's the legal ramifications of an LPN accepting a CNA shift.

This is simply evidence of an increasingly flawed and crooked system trying to undervalue regulated health professionals. Diploma nurses are NOT equivalent to unregulated care providers. Where I live, in a circumstance like this, if the LPN accepted the shift as a CNA that wouldn't exempt him/her from their legal responsibilities as an LPN. So, if anything happened to their patients' acuity to change their health status or require nursing interventions/ care, the LPN would still be responsible and held accountable to provide nursing care and liable for that care.

The OP was correct to refuse!

You have a license to protect! It's almost illegal for a lpn to do certain things that a CNA has been trained to do. For example; suppose that Mrs. Smith needs to be transfered from the wheelchair into bed. She falls on the floor. Later you learn that she's a two person assist and you didn't follow proper procedure.

Then you're asked to help feed Mrs. Jones but you didn't realize that she is to have thickened liquids.

A CNA is responsible for the tasks he or she has been trained in...and it may be outside the scope of your practice as a LPN.

Is this a joke!? CNA duties are NOT outside the scope of practice of a LPN, they're ADL tasks delegated to CNAs by nurses to help lighten a nurses' workload so he/she can focus on providing clinical nursing care. Things like bathing, feeding and toileting are not above a nurse's knowledge, skills, and/or judgement; and not illegal for a nurse to perform. To even suggest such a thing is completely unintelligible and absurd. The considerations you mentioned as an example are all things that a nurse would already know because it's in the care plan because considerations like these extremely basic examples you mentioned impact all of a patient's care from medication administration (ex PO, crushed or vs other route like IM/IV/SC), to wound care, for example. Even the most green nurse knows those things. Nursing students learn this in their first semester. But if you were actually a nurse you'd know that. Are you even a nurse? I smell an imposter.

Edited by CaffeinePOQ4HPRN

Depends. Not sure I'd move down to take the CNA job again if it were in LTC.

But I'd jump for joy if they needed me to do CNA work again in the hospital. I mean, are you kidding? CNA work for RN pay? Oh yeah. Nearly zero responsibility and the easiest tasks. I did it once for about two hours on MedSurg when we were overstaffed and they thought they'd need me later. Absolute cake and I could do extra things to help out my compadres.

Well, last evening I worked as a med nurse (LPN, in my facility), but when necessary during any shift I toilet or dress patients, feed them, supervise baths, do dressing changes or other treatments (LPN duties, usually), pass snacks, brush teeth, clip nails, hand out tissue, or hold hands. In other words, I do it all.

I get the idea of not wanting to work extra in something other than your usual role. It's uncomfortable. But if you're a nurse, CNA duties are within your scope of practice. And you can't be too good to do it. Too tired, though, I get. I've had many days when I'm too tired to haul another patient on and off the toilet--I'll ask one of the aides for help. I'm not Supernurse. But I will participate. I'm not proud--I'm a nurse; pride is pretty much out the window at this point--fart, vomit, drop a BM on the floor, sneeze a wad of snot on my face, it's all good, no problem. Nurse life.

Short-staffing sucks. We are chronically short-staffed. But again, nothing new. I've worked in badly-staffed situations for decades. You get used to it. I walk in to work and automatically go into hyperactive mode; I move fast, I talk fast, I have little time to talk to anybody, including patients; and when you work in psych, that's a problem. But that's modern nursing. I do the best I can. It's all anyone can do.

Nonetheless, don't feel bad that you didn't want to work extra in a role not your own. Feel bad that society values healthcare so little that it won't prioritize nursing--the backbone of modern healthcare--enough to esteem and pay nurses and nurses' aides what they are really worth. That is the real problem.

Again I have no issues doing a shiftas a CNA. My big complaint is that its never just one shift. Management seems to believe the idea that "If you're scheduled to work, we can plug you into whatever role we need." There is a RN in my facilty that made the jump from CNA to RN. He was a CNA a year ago. Thus he is always being asked to step into that role. He's comfortable with this because hes uncomfortable with his ability to critically think on the fly in emergencies. Hes been doing this alreadt for months. Because of this management has not made it a priority to hire more CNAs. We've brought in more nurses, and this the push is to have nurses drop into more CNA roles now. Its just something that at this point in my career I don't want to do. Maybe that makes me a bad nurse.

If they schedule you for a regular shift and ask you to work as a CNA for that shift, then do it. However, stop saying yes when asked to come in for an extra shift to do so. It is too bad that your one colleague has brought this situation to exist. If you spoke to him about it he would probably take a stance that he can do as he pleases in order to appease his employer. Meanwhile, you might consider starting to look for a new place to work. Not all places hire nurses to work in place of CNAs.

I was describing two true situations I know of, but I'm not revealing whether it was a LPN, RN, or CNA. "Mrs. Smith" (name changed) received a comminuted break of the femur. "Mrs. Jones" was sent to the ER for aspiration but died.

This person is wrong. LPNs and RNs can do EVERYTHING a CNA can do. It is in your scope of practice. I understand you weren't talking about this, but if you as a nurse don't know if YOUR patient youuu are RESPONSIBLE for is a two - person assist or needs thickened liquids, you shouldn't be working as a nurse. It's your job to make sure the CNA knows these things, not the other way around.

You have a license to protect! It's almost illegal for a lpn to do certain things that a CNA has been trained to do. For example; suppose that Mrs. Smith needs to be transfered from the wheelchair into bed. She falls on the floor. Later you learn that she's a two person assist and you didn't follow proper procedure.

Then you're asked to help feed Mrs. Jones but you didn't realize that she is to have thickened liquids.

A CNA is responsible for the tasks he or she has been trained in...and it may be outside the scope of your practice as a LPN.

This person is wrong. LPNs and RNs can do EVERYTHING a CNA can do. It is in your scope of practice. I understand you weren't talking about this, but if you as a nurse don't know if YOUR patient youuu are RESPONSIBLE for is a two - person assist or needs thickened liquids, you shouldn't be working as a nurse. It's your job to make sure the CNA knows these things, not the other way around.

I don't understand your post Floor_nurse

Nothing is ever "almost" illegal, especially in healthcare... and it's always the responsibility of the nurse on the floor to know how each and every one of their residents ambulate and their diet. The nurse should know that because it's part of their job, seriously. Picking up the next shift as a CNA doesn't excuse anyone from using their nursing common sense!

Edited by Cream and sugar LPN
forgot to address poster

I hope that what that commenter was getting at was that if you are a nurse working as a CNA and something goes wrong, legally you are held to the higher standard of a Nurse.

You have a license to protect! It's almost illegal for a lpn to do certain things that a CNA has been trained to do. For example; suppose that Mrs. Smith needs to be transfered from the wheelchair into bed. She falls on the floor. Later you learn that she's a two person assist and you didn't follow proper procedure.

Then you're asked to help feed Mrs. Jones but you didn't realize that she is to have thickened liquids.

A CNA is responsible for the tasks he or she has been trained in...and it may be outside the scope of your practice as a LPN.

Wait, what? An LPN can do everything that a CNA can do. I expect my CNAs to get report on their patients. I also give them a rundown on my patients so that nothing was missed from the CNA to CNA handoff. I also expect that if you don't know something, ASK...or if your an LON working as a CNA-ask or check the orders.

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