Working "below your license"

JeanettePNP, MSN, RN, NP · Oct 4, 2010

It does depend on the state and facility. Many places will not allow you to work below your license for liability reasons. Basically, if something goes wrong and you have the knowledge and qualifications to intervene as an RN but are on contract to work as a CNA, you're not on firm footing either way. If you intervene, you're doomed, if you do nothing, you're doomed.

BabyLady, BSN, RN · Oct 4, 2010

This was sort of brought up in another thread but I wanted to expand the topic a bit...as we all know, the market is tough right now for nurses, esp. new grads. I've been contemplating changing strategy and looking for ANY job in healthcare that I can find-whether it's unit secretary, CNA, or even a janitor at this point!
Ideally I would love to be an ER-tech, as my dream job is to be an ER nurse once I'm an RN (I'm an LPN right now). The requirements for that seem a little vague-basically it says you need to be either a CNA or EMT and then you have a couple weeks of paid on the job training. I called a couple places and they told me they really didn't know if it was legal or not!
Does anyone know what the kaws are regarding this? Does it vary from state to state?

It doesn't vary between states.

There is nothing illegal about working below your title...slavery ended the last century and you can take any job for any pay that you want.

However, laws in every state are very consistent on holding you accountable to your highest level of training....so anything you were taught as an LPN, that is the standard you will be held to, regardless if you are working as a tech, CNA or any other position where you technically do less.

To me, it is the same as having the liability without getting the pay.

MattiesMama · Oct 4, 2010

See the thing is, technical responsibilites for an ED tech, based on what I've observed during clinicals, are very similar to those of a nurse. And that is not in any way saying that they are the same thing-but the techs I worked with started IV's, put in foleys, and started EKG's...The only thing I didn't see them do that I would do as an LPN were giving meds and charting. And they were right next to the nurses the whole time. So I guess I'm just trying to think of a situation where it would be a problem...

Boog'sCRRN246, RN · Oct 4, 2010

I'm a LPN and I wanted to try to get a tech job too, since most hospitals around me won't hire LPNs, but one of the requirements for tech positions in my area is that you cannot hold an active state license. Which I do. So I'm stuck.

ObtundedRN, BSN, RN · Oct 4, 2010

I'm in NC. And they actually put an article in their magazine recently, that talks about this. They say that it anything below your license is covered in your education, so you could obtain that license/certification and work as that. But they also say that you would be held accountable to the highest level. They suggest not taking a position below your license. And they suggest that if you're a retired nurse that just wants a job as a tech or something, then to retire or inactivate you license so you won't run into any trouble, or be held to that higher level of licensure

MattiesMama · Oct 4, 2010

I'm in NC. And they actually put an article in their magazine recently, that talks about this. They say that it anything below your license is covered in your education, so you could obtain that license/certification and work as that. But they also say that you would be held accountable to the highest level. They suggest not taking a position below your license. And they suggest that if you're a retired nurse that just wants a job as a tech or something, then to retire or inactivate you license so you won't run into any trouble, or be held to that higher level of licensure

Now I gotta ask you since your username is RN/EMT-Do you work as both? Because that's another thing I thought about doing...

ObtundedRN, BSN, RN · Oct 4, 2010

Now I gotta ask you since your username is RN/EMT-Do you work as both? Because that's another thing I thought about doing...

Currently no. The EMS agency I used to work for has been going through lots of changes that are going to take some time to complete. So they are not looking for part time employees right now. I'd like to be able to work for them again when they are done with changes, but they have a couple more years ahead of them. I've been considering volunteering, but not too many volunteer stations still exist around me. EMS is a great place to see some interesting things. As well as how to deal with things without the help of so many other healthcare providers (RNs, MDs, mid-level providers, pharmacy, etc.). Its fun, but can be boring and frustrating too. As a critical care nurse, I can go to work every night and know that my patients are truely sick and need medical care. As opposed to so many of the people that call 911 for a medicab ride to the ED for primary care type treatment.

GreyGull · Oct 4, 2010

As opposed to so many of the people that call 911 for a medicab ride to the ED for primary care type treatment.

Still thinking like an EMT. Many of those "BS" patients end up in your ICU. Too many EMTs and Paramedics have judged patients as just complainers and have refused transport. You also have to take into consideration the lack of decent alternatives in most areas especially with so many clinics and public transit cuts. This issue is bigger than just "BS" calls.

Recent cases are the two in Washington DC involving a little girl and a man with CP, a headliner in MO where the decision was recently reversed and not in favor of the EMT and Paramedic and a NC young (minor) athlete with cramps...alll fatal. Washington DC also had the David Rosenbaum case. We also see many street people whe require a second ambulance call since the first crew did not want to touch the patient or put them in their truck. That just wastes time and resources.

In the field you have very little equipment, poor lighting and a very limited scope of practice not to mention the limitiations of EMS training and education. I also know of very few EMTs or Paramedic that want to remove even the top layer of clothes for assessment and so they miss some very important lung sounds or injuries.

Elderly patients, especially from nursing homes, get blown off as "BS" as well. The reports given by the EMTs or Paramedics reflect a poor assessment or a lack of understanding of sepsis.

You may not see many of these patients in ICU because they die in the ED.

The ICUs also see a lot of patients who probably should not be occupying that bed but are admitted at the insistance of the physician who wants a 1:1 or 1:2 ratio for his/her patient for whatever reason which can include personalized care for a friend.

As for the licenses, many of our LVNs were given tech positions (ED or PCT) when the hospital eliminated them in the workplace. However, their title was "tech".

For Flight, a Paramedic who becomes an RN but does not meet the requirements must continue to work with a Paramedic scope of practice. Even it they have the RN license, they may not be able to work with certain meds like paralytics and many of the pressors as well as no titration of meds. The medical devices like ventilators, VADs and IABP may also be restricted until they meet the qualifications of a Flight RN which might be 3 - 5 years of ICU experience.

The conflict with prehospital certs and RN licenses has caused some states to make provisions for RNs. I believe there was already a thread about that.

LoveMyBugs, BSN, CNA, RN · Oct 4, 2010

I am a RN and work as a CNA2 in the ED, as I have worked in that ED for 3 years now, and maintained my job while going to nursing school. I did my senior practicum in my ED and well, Honestly I die a little inside every day that I work as a CNA. Becasue I know that I can do the job and I want to be a ED RN, and yet there are not openings anywhere in my metro area that will hire without the magical 1 year.

I am sure that you can work below your license, as it hasn't been an issue for me

MJB2010 · Oct 4, 2010

My hospital has hired many new grad RNS into tech and secratary positions, they just have to sign something saying they will not work out of their scope of practice.

elkpark · Oct 4, 2010

My hospital has hired many new grad RNS into tech and secratary positions, they just have to sign something saying they will not work out of their scope of practice.

But this is exactly where the conflict/dilemma arises. As long as nothing goes seriously wrong, you're fine. But if something goes wrong enough to end up in court (and, admittedly, the chances of that are comparatively slim), the courts will hold you to the standard of your highest level of education and licensure (did you perform as a careful, prudent RN would?) The court won't care that your employer told you not to work outside a tech or secretary scope of practice; legally, you don't get to forget you're an RN just because you have a different job title.