Working below your license

ruby_jane, BSN, RN · Jan 31, 2018

I would encourage you to keep looking on your BON site or attempting to find a human being. If you're not employed as an LPN you should not be doing LPN duties (at least that's how our BON looks at it here). You CAN be employed as an aide. But if the employer wants you to do LPN work, they need to employ you and pay you as such.

Flatline, BSN, RN · Jan 31, 2018

You can work below your license but you are always held accountable to the standard of your license. The reason you have been told not to work below your license is that it is a liability to you since you are not made aware of all the pertinent patient information but will still be held to the same level of expected care.

I worked at a place were we would routinely bring in RNs who would start the shift as CNAs and then switch to their role as a RN once the admissions started to flow. It was sometimes troubling because even though they were just walking, feeding, bathing patients they were still expected to to assess the patient and take all appropriate behavior that a registered nurse would take.

happ09 · Jan 31, 2018

I just find this mind blowing. I've been a nurse since 1986 and have never been asked to work as an aide. But where I work now, they have you be an LPN for the first 4 hours and an aide for 8.

Just doesn't seem legal

happ09 · Jan 31, 2018

Lol try getting a human being. I am a LPN but they use us as aides. They don't ask the RNs

elkpark · Jan 31, 2018

I just find this mind blowing. I've been a nurse since 1986 and have never been asked to work as an aide. But where I work now, they have you be an LPN for the first 4 hours and an aide for 8.
Just doesn't seem legal

Apparently (based on threads on this topic in the past), there are a few states that specifically prohibit the practice, but, in most US states, it's completely legal. As already noted, the risk for the individual is that, while the employer will tell you you are limited to the scope of the "lower" level position, if anything goes sideways enough to end up in court, the courts will hold you to the standards of your highest level of education and licensure. Whether you're comfortable with the situation or not is up to you. But it is a common one.

MunoRN, RN · Jan 31, 2018

I think people often misunderstand the concept of being held to the expectations of your license and interpreting this to mean they shouldn't perform the role of a CNA or other role 'below' their license. In general, there's nothing that prevents an RN or LPN from performing the tasks that a CNA performs, and those tasks are actually well within the normal expectations of a nurse.

All this means is that you essentially can't play dumb and ignore something or otherwise pretend you don't know what a nurse knows. For instance, you're working a shift as an aide, and while helping a patient to the bathroom you notice wheezing that wasn't there before. CNA's aren't expected to recognize the clinical significance of wheezes, and would be less likely to be held accountable of something happened because this finding wasn't passed on to the nurse caring for the patient, while a nurse might be expected to communicate that to the nurse caring for the patient.

Sour Lemon · Jan 31, 2018

Lol try getting a human being. I am a LPN but they use us as aides. They don't ask the RNs

I'm an RN and have worked at the CNA on occasion. Most commonly, when I'm orienting someone who's doing really well and our CNA staffing is short. I've also been a sitter more than a few times.

There's no legal reason you can't do the work of a CNA as long as you don't "play dumb" when you encounter a situation you should be equipped to deal with as a nurse.

I probably wouldn't stick around forever if my employer utilized me as a CNA often, though. The role is easier in a way, but also more physical. The routine is also very different from what I'm used to doing, and for that reason, it can make me feel a little disjointed.

caliotter3 · Jan 31, 2018

I think people often misunderstand the concept of being held to the expectations of your license and interpreting this to mean they shouldn't perform the role of a CNA or other role 'below' their license. In general, there's nothing that prevents an RN or LPN from performing the tasks that a CNA performs, and those tasks are actually well within the normal expectations of a nurse.
All this means is that you essentially can't play dumb and ignore something or otherwise pretend you don't know what a nurse knows. For instance, you're working a shift as an aide, and while helping a patient to the bathroom you notice wheezing that wasn't there before. CNA's aren't expected to recognize the clinical significance of wheezes, and would be less likely to be held accountable of something happened because this finding wasn't passed on to the nurse caring for the patient, while a nurse might be expected to communicate that to the nurse caring for the patient.

I can't like this post enough. Finally someone clearly explains the reality behind the phrasing.

happ09 · Jan 31, 2018

True. What I'm talking about is using myself, an LPN, for part of the shift, then an aide because only 1 is assigned for 11p-7 am. The general consensus is "use the LPNs as aides". This was never communicated to me during hiring process. So if I refuse because I don't want anything to happen that would go against my license, can I be fired in a " at will state" .

MunoRN, RN · Jan 31, 2018

Whether you're in an at-will state or not, insubordination is a fireable offense. If you're job description specifically states you wouldn't have to perform these duties, then it's not insubordination, but job descriptions typically include the "other tasks as assigned" line.

Sour Lemon · Jan 31, 2018

True. What I'm talking about is using myself, an LPN, for part of the shift, then an aide because only 1 is assigned for 11p-7 am. The general consensus is "use the LPNs as aides". This was never communicated to me during hiring process. So if I refuse because I don't want anything to happen that would go against my license, can I be fired in a " at will state" .

You're dreaming. If they asked you to work as a physician, then you'd have legitimate license issues and concerns.