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| This is one potential question on the NCLEX, the national licensure exam for RNs. Asking this to a CNA is like asking your dog to do calculus. With an abacus. Blindfolded. It's as wrong as two boys f**king. For any RN, it's a lay-up. An easy shot. Follow up questions: Why is this rhythm important? What should the (actual) nurse do next? Answers at the bottom. |
For whatever reason, Angus is under the severely-misled misimpression that a CNA with a one-month classroom and clinical certificate (total, all-in) is functionally identical to an RN with two to four years of upper-division college education and a nationally recognized license.
He states the difference between a CNA and an RN is "Not much."
A CNA is a 60 hour course, and less than 3 weeks' supervised clinical training. In CA.
Florida CNAs need even less than that. (Color me shocked.)
An RN, by contrast, is a two- to four year degree program leading to national licensure, including more clinical hands-on hours in any month than CNAs require for their entire certificate. (Florida RN licensure may be less rigorous, IDK, but that's why an RN from CA, NY, or IL can work in all 50 states, and nurses from the Gulf Coast belt can generally not get hired anywhere else without extensive testing and additional classes unless they go to similarly low-educated states. Mississippi nurses right out of school, for example, can generally not go out-of-state to anywhere else. That's not for nothing.)
Apparently we really have to go into why one of these things is not like the other one.
Starting with CNA's having a state-specific certificate, not a professional license recognized in 50 states and seven territories.
This is the difference between a vet tech, and an actual vet.
One of those cleans animal cages, and the other one diagnoses animal illness.
That's why a CNA (an expired-certificate CNA to boot) passing herself off as an RN is committing criminal malpractice.
A CNA has exactly zero training, experience, or competence in assessing patients, absolutely none in pharmacology, nor in pathophysiology, gerontology, obstetrics, pre- and post-op surgical care, pediatrics, psychology, critical care, or about a million other things large and small that even a new grad RN walks out the door with from school before they can pass their boards.
A CNA literally lacks the knowledge of about a dozen 800-page nursing textbooks, whereas to get a CNA certificate, if you don't put your shoes and socks on in that order, you'll likely pass the class. The number of CNAs anywhere who could take and pass the NCLEX without years of study is going to be 0.000%, nationwide, since ever, even one with 25 years of floor experience behind them.
A CNA literally doesn't know what she/he doesn't know, any more than the guy who sweeps out the hangars at Boeing is a qualified aeronautical engineer. (As recent unqualified DIE hires at Boeing have demonstrated, in case anyone was watching.)
It's that big a difference, and anyone - family or not - telling someone otherwise with a straight face is talking out their other end.
And by "early on", apparently Angus is referring to 150 years ago, when even doctors had less actual medical knowledge than a modern EMT possesses. Yeah, things have changed a wee bit in nursing since Florence Nightingale got the ball rolling in the Crimea. Which is why CNA is a few weeks of night school, and not a college degree plus 3-12 months of directly-supervised clinical hands-on experience that an RN license requires. (CA requires 500 hours, minimum. My program was closer to 1300 hours.)
Putting it gently, Angus kind of stepped in it with both feet.
A CNA takes vital signs (with a machine that does 90% of the work), helps change dirty diapers and linens, and walks patients to the bathroom. That about exhausts their entire clinical skill set, and many of them are hard-pressed to be barely competent at any of that. Like I-didn't-realize-that-a-pulse-of-180-should-be-immediately-flagged-to-the-nurse/doctor barely competent. I've only seen that one - or one like it - about a thousand times in 25 years.
That skill set was covered my first week of nursing school, and they expanded on that to quite a degree over several years. Almost like one was a dead-end entry-level cert, and the other was a bona fide medical profession.
I don't know why anyone would lead someone to believe it was otherwise, but anyone so informed has been rather egregiously misled.
In Angus' experience wheelhouse, on the skillset continuum, it's the difference between a tank loader 5 minutes out of school at Ft. Benning (it still makes me shudder that it's not at Ft. Knox any more), and a SFC with 16 years in Armor who's the Tank Commander. (In point of fact, that loader got more - and better - training at his 19K MOS in 8 weeks at Ft. Benning than most CNAs get in school. EVER.)
*(Answer: C. V-tach. It's important because if it's pulseless V-tach, the patient is in cardiac arrest, and the nurse should get the defibrillator and zap that patient pronto while calling "CODE BLUE" loud enough for everyone within earshot to hear and respond to. Total amount of time CNAs get educated and trained to know and do this: Never. Period.
Whereas for an RN, any RN, it should be automatic. Anyone who sincerely thinks the difference between a CNA and an RN is "not much" should let their grade-school-aged kids take out their appendix or gallbladder with kitchen utensils, and get back to us on how well that worked out. That's what expecting a CNA to be an RN is like.)
*** ADDENDUM ***:
If you came here, read this, and then ran over to dogpile Angus at his blog, please stop. (If anyone this applies to didn't read follow-ups there, that speaks for itself.)
1) Like most blogs (including this one) comments are moderated, meaning rude and obnoxious rejoinders disappear into the ether. Just like here.
2) Take the time to note Angus' multiple replies and amplifications on the original topic (and a couple of spicy ripostes for people doing it wrong. It's clear that what came out in his first post wasn't precisely what he meant to say, i.e. that CNAs doing CNA tasks do them as well as RNs. (We have no argument whatsoever with that contention, though we do wish it had been phrased better originally.) And that some jobs require far more licensure than the tasks that make up the job entail. We absolutely agree with him on that point as well, and we have no doubt some idiot managers over-mandate licensure levels a given job at hand doesn't require, in a phenomenon not limited to the medical arts.
3) That doesn't mean that the wingnut deliberately perpetrating a professional fraud in the OP deserves a pass (she deserves to get hammered into the ground, in fact) but it does illustrate that whoever classified that job as one requiring an RN license grossly over-stated the necessary qualifications to excel at it. Why anyone running a business would be as stupid as to do that in the first place is beyond explanation, but then so is demanding an RN license, and then performing no due diligence to ensure that anyone considered for the position actually possessed one. Stupid is as stupid does.
I got the clarification of what he intended by his second post on the topic. There have been at least two more since that, for a total of four, not counting the pointed reminders that going to his blog (or anybody else's, in nearly every case) to storm in and crap on the carpet will never see the light of day. The list of blogs on the internet where even being right, if you're a right dick about it, will get your missives discarded, is long, and distinguished. This should not be news to anyone.
FFS, I agree with Angus on many important things (guns, the military, and most current events, to name but three) more than even he thinks, even if we're not carbon copies of each other. What a boring internet that would be. And if you're going to disagree with anyone online who's worth the trouble, do it within the bounds of decorum. You'll get more flies with sugar than with vinegar.
If that's too much to ask of anyone, I don't want to know you.
19 comments:
Presupposition strikes again. A condition that is rampant in multiple occupations.
The same comments would apply, at some scale, to Nurse Practitioners, I would expect. Nuns working out of a mud hut in Africa a close example...save for the fact that I would have a modicum of respect for the nuns.
Y'all, and the flying monkeys that came from here missed the entire fucking point of the two posts I made on the topic.
Try re-reading them. They're in English and can be read as slow as necessary.
Hint, the person in question was doing the job that requires an RN rating long enough and well enough to get a promotion with just a CNA rating they'd let expire.
You need to explain why that's possible to refute what I said, not to cite that it's harder to get an RN rating (which I do say is harder to get and there's shit that CNA's cannot do in the second post).
And, yet people like you think that you can be competent engineers after reading a book or watching a Youtube video about a subject. .
To whom were you addressing that comment?
I read where you wrote the difference between a CNA and an RN was "Not much."
I demonstrated that such an assertion is a wildly erroneous impression. It still is.
As to why someone could get hired, and considered for promotion, without any of the basic qualifications to perform the job, it's explainable in very few words:
horrible supervision and utterly incompetent human resource vetting.
They didn't know what they hired, they failed in multiple ways to perform the most basic due diligence in hiring her or turning her loose on patients without a shred of proof she was licensed for that job. And her direct supervisors clearly can't differentiate between their own asses and a hole in the ground.
Health care HR and hospital management is incompetent?? Stop the presses.
I can top that story a hundredfold without breaking a sweat, purely from personal experience.
That hospital has opened itself up to individual and class-action liability that'll have attorneys lined up from Florida to New Mexico just to file suit, on top of any number of class action suits, and HIPPA fines in the seven- to eight-figure range from the feds.
The fact that it took them seven or eight months to realize they'd been jumping on their own dicks with cleats is just the tip of the iceberg.
(cont.)
(cont.)
The second question EVERYONE is going to ask them, is how many other smiling unqualified frauds they have ensconced within their ranks, if the exemplar dipshit walked right in the door without anything but one bogus license number.
She wasn't "faking it until she made it", she was a straight-up fraud from the get-go, and they couldn't tell the difference because they never checked.
I have to cough up about six different separate certifications, along with my current license, on a two-year endless hoop-jumping exercise going back nearly thirty years, and if so much as one-such is expired, I'm suspended on the spot until I can provide a bona fide current version.
This asshole bitch is only part of their problem. Somebody hired her without any proof of licensure, and who never vetted even what she claimed. That person needs firing for cause too, for opening up the entire company to million$ in liability and privacy violations. Then her direct managers never followed up either, and they were going to make her a charge nurse??
After a whole SEVEN MONTHS on the job?
WTAF???
This is layers upon layers of criminal and civil incompetence, and this fraud is merely the first of any ten people in that misbegotten organization who should be told to pack their shit in a box and GTFO by about 9:05AM Monday.
(cont.)
(cont.)
That's assuming the media got the facts straight in the article (which is a whole other pile of shit: I've seen how wildly and casually inaccurate reporters are firsthand as well, and they make the fraud nurse look like a piker).
As to your follow-up, published after I put this post up:
Yes, a basic CNA can do most of the duties of a home health aide. That's pretty much the same as a CNA.
Any company requiring an RN for that task is an idiot to begin with.
The number of people, let alone companies, that could afford my day rate for even a week's time at that task is about 0.5% of the population.
That's why they're generally assigning CNAs at near-minimum wage to do it, and having an actual RN come in once or twice a week for an hour or so to do tasks and assessments far beyond the training or scope of practice of any CNA.
Dumbasses like, oh Glen Filthie, for but one example, think they can put me in my place by calling me a bedpan cleaner, because everything he knows about nurses is what he saw on TV shows from 50 years ago written by TV writers that can barely spell "hospital". I currently get paid more than a three-star general or admiral with the appropriate time-in-service, and at that pay rate, neither I nor my employer has time for me to waste on duties handled ably by someone with a GED and a one-month cert, like a CNA. That's why they hire them for a fraction of my salary, to do the simple shit (literally, in that example) with minimal risk of harming a patient, assuming they have the basic competence to wipe a butt (usually accomplished by most of us before the age of 4 years) and successfully operate indoor plumbing.
(cont.)
(cont.)
Can a CNA flush a toilet as well as I can? Absolutely. That's why the simple stuff like that gets delegated to the lowest-trained employee competent and certified in doing it. That's frequently a (currently-) certified CNA.
It's also why 90% of them are just entry-level working in the biz, with the plan to become RNs, Physician Assistants, or MDs someday, once, unlike Miss Fraudulent, they actually go to school for that and pass their licensure board exams.
But the bimbo in the linked example wasn't competent to do anything, nor even certified to do her former CNA job, and deliberately forged the competency she claimed. She knew just enough to fake her way in the door, aided and abetted by the most incompetent hiring organization I've heard of in some years.
That isn't because the bar for employment was set too high, it's because the organization's hiring practice is slipshod in the extreme, and the bar for HR competence there is set vastly too low. They literally must have hired retards to do their hiring. She literally never should have been hired for anything she couldn't provide certification or licensure to perform. Never should have ever been hired and started work there at all. For anything. Which anything would include everything but being a volunteer candy-striper. That it took them seven months to catch up with that gargantuan initial error just means they're grossly negligent and incompetent at their own jobs as well.
And they're now going to have to look at 4000+ patient records, and see how many things she didn't do right, notify every single patient or their next-of-kin of the violation(s), and then fork over evidence of her direct supervisors' incompetence as well, after subpoena by 4000 attorneys with a slam-dunk payday coming.
(cont.)
(cont.)
AdventHealth just rung the dinner bell for the entire Central Florida Bar Association, and they're going to be buying their steak and lobster dinners and picking up their celebratory bar tabs for years to come. Every patient she saw, touched, charted on, or even heard about was a HIPPA violation: she was qualified and entitled to access not one single patient, in any way, shape, or form. 4000 HIPPA violations: $40,000,000 in federal fines, at $10K@. Payable by Advent Health. Then there are the violations of privacy and inappropriate care tort claims. Add a zero to that HIPPA fine total. Maybe two or three. This fraud and a couple of incompetent managers may have taken that entire hospital down forever when the dust settles.
Then, every certifying organization for hospitals and nurses, from Tallahassee to D.C., is going to be coming in hot to scrutinize how fucked up their entire lash-up is. They're probably already getting the mother of all proctological examinations, and will continue to be for some years to come.
County, federal, and state. JCAHO, the state hospital board, eighty-seven insurance companies from Tri-Care to Blue Cross, the state nursing board, Medicare and Medicaid, and a dozen specialty practice review boards. Checking on licenses and certs for every staff member from janitors to CMOs. Every policy and procedure, starting with hiring, and then moving to patient care. Word by word, line by line, times every employee in that and any other states. One nurse who grossly effed up one time cost Duke three years of Medicare, in the 8-figure punishment range. This is seven months' worth.
The fact that they let an unlicensed person have access to controlled substances will put the DEA so far up their ass - for YEARS - that whole organization isn't going to be able to shit normally this side of 2030, just from that. They could have their internal pharmacy de-certified, which kills the entire hospital deader than canned tuna.
The DEA is going to look at any and every time she accessed any RX meds, and every time she might have pulled a controlled substance. I don't know what she was doing, but for me, controlled substance access is at least 10-20 times per shift. Seven months? That'll be maybe 2000 specific accesses, every one of them a prosecutable federal crime btw. Maybe more.
Miss Fraud Of The Year from Tampa is looking at the shitty end of perhaps 2000 counts of violating 21 U.S. Code §844: That would be imprisonment for 2000 years in federal pound-you-in-the-ass prison, and a fine of up to $2,000,000, depending upon how much of a sense of humor the U.S. attorney for Tampa has. That's before the state court gets to her.
Life, as she knows it, just ended.
This wasn't because CNA=RN.
Not even for whatever this ding dong's hired job function was.
It's because Advent Health = demonstrated incompetence at every level.
The bill for this one cock-up is incalculable, and it will be years before the final tally can be added up.
That's how much every competent agency and any 4000 judges and juries see the difference between an expired CNA and a licensed RN.
If she could fake one with the other for 7 months, it doesn't point out how similar the jobs are. It points out how utterly that entire corporation failed to provide the most basic due diligence in hiring. When that's in play, they could hire somebody's dog to be a doctor, and promote them to head of surgery.
But it doesn't mean Fluffles is a competent sawbones.
I don't disagree with your explanation in the second post that a CNA or RN doing home health care are similar jobs, nor that a CNA is probably all you need for doing that, for the most part.
But the scope of what either can do is the difference between a silicon chip, and Silicon Valley, as I think you adequately clarified.
You among many others, for the same reasons you posted about the fact that a CNA is not the same as an RN.
Many folks think that learning the knowledge and skills for any particular trade or degree is easy, and they believe they can become instant experts after only an hour or so, giving them the knowledge and experience to question the other profession., But they lack the knowledge and the experience to even understand the issue, much less judge the person who has spent years and thousands of hours gaining that knowledge and experience. Yourself included. (I am probably guilty as well).
You seem to think that you are an expert on many subjects, as you comment on and judge the performance of others in other positions than yours, yet your knowledge is somewhat narrow and specialized.
My point is that it takes, often, years of experience and learning to do some jobs. One cannot become an RN or a physician or an engineer or a pilot overnight, yet many think they can and believe they are qualified to comment upon the jobs others do.
looks like polymorphic v-tach to me - ie torsades. besides shocking if pulseless better keep magnesium in mind.
Suprisingly in the IT field I know some PC hobbyists that can run rings around degreed IT dinks. I don't know a single one of my IT peers that have not confessed to watching a YT vid professionally.
Bottom line is nobody is good if they don't like what they do. If you can't put up with the Mgt BS, demanding customers, and shitty peers and at the end still think it was a good days work; well might want to find something else to do.
Perhaps you could demonstrate that assertion by citing one or two examples from among nearly 5000 posts on this blog.
I have a wider-than-average range of expertise, because I've lived and done things across a wide range of experience, far beyond only my last profession for the last 30 years.
I've never overstated my expertise nor experience on any topic, but the other way to know something is that it's so obvious a retard can spot the truth of it. For instance, unlike yourself, I'm not a rated pilot, and while I could absolutely get a plane off the ground, navigate it to another field, and perhaps even land it successfully, I also know there are hundreds of things I don't know that could kill me in the attempt. But even without ever having landed a multi-engine jetliner, I don't need five minutes of flight time nor even five minutes of flight school to know that landing a multi-engine passenger jet in the forests surrounding an airport was a colossal fuck-up, despite never sitting in the pilot's chair.
https://www.youtube.com/watch?v=a5NXpar4Ouw
Feel free to tell me where I got that wrong, despite my lack of an aerospace engineering degree.
I have never expressed any expertise at engineering per se, but when I read accounts of the Titanic, or watch newsreels of the botched landing of the Hindenburg, or see the film of the Tacoma Narrows Bridge flapping in the wind, the need for an engineering degree in order to offer a correct opinion has pretty much shit the bed.
I want to say it was an episode of Landman, but in some recent TV episode someone asked a question to the effect of
"So, based on your vast >sarcasm< knowledge and experience, you're telling me how to do this differently?"
"No. I'm telling you to do it differently because I'm a fucking idiot, and even I can see you're fucking this up a hundred different ways."
I worked with an awesome trauma doc, in charge of one of the top three physician trauma training programs in the world. He could and did unroll a taped-together wallet card roll of about 100 different certifications, papers, research studies, etc., which he had done, pioneered, or authored. And then he'd tell an audience "But if I don't know what I'm talking about, I'm still full of shit." That's my mantra.
Anytime you think I've stepped in it, you go right ahead and call me on it.
I'll bring what I know and can bring forth to demonstrate why I said what I said. You can knock it down, or die trying.
With the entire internet peanut gallery taking potshots on and off this blog, after fifteen years, I can count the number of people who've made a better case and won their arguments with evidence instead of bile and ad hominem to overcome my arguments and evidence, on my thumbs.
"A human being should be able to change a diaper, plan an invasion, butcher a hog, conn a ship, design a building, write a sonnet, balance accounts, build a wall, set a bone, comfort the dying, take orders, give orders, cooperate, act alone, solve equations, analyze a new problem, pitch manure, program a computer, cook a tasty meal, fight efficiently, die gallantly. Specialization is for insects." - Robert Heinlein
I'm 19 for 21 on that list. I've never conned a ship (though I'm able), and I'm not dead yet.
If anyone thinks all I've ever been or done is solely related to my nursing license, (which in and of itself is the only profession in medicine requiring the widest possible skill set, and interaction with every level of person at any hospital) they're so far off the mark it cannot be measured with existing instrumentation.
The list of things I'm a hands-on expert at would choke a decent-sized ox.
I have never once claimed engineering expertise, nor pointed to my Five Minute Degree from YouTube University as proof of my expertise on any subject. But when YouTube demonstrates something as plainly as that A320 fuck-up, further argument to the contrary is futile.
Here I stand. I can do no other.
The test key says simply V-tach, and Torsades isn't an answer option for the question. Horses, not zebras. ;)
Well...I expected to be flayed for my comment regarding Nurse Practitioners. I have lots of stories. Instrumental in my wife's death, for one.
If I'm in Megacode mode I call it V-Tach and say Next. BUT I would ALSO mutter something like Torsade's, though it ain't the clearest cycling around a point I've seen, either. Spend a year staring at Tele traces (as your whole job) and you WILL see damn near any rhythm described
NP's and PA/PAC's are rally neither fish nor fowl in the Medicine vs Nursing wars.
And, as a clinical Paramedic, I have spent a LOT of time dodging the punji stakes holes dug by BOTH sides in THERE.
Good grief.
Just...how? Do these people not know how to use the Internet? Maybe you could look on Facebook and see the two different pictures. Ok. You graduated from a school. Give me an unofficial transcript. What's the name of your program coordinator? Do you have a wedding invitation? 30 seconds of typing on a phone and I'm better and weeding fraud than these HR people...
When I was going to Nursing school in 1983, my grandmother, who was around 70 at that time, told me how back in the day, the nurses started out mopping the wards, emptying bedpans, and "sharpening nibs", and it was OJT after that until they eventually became a nurse.
That's what this sounds like. No relation to modern day, or even when I got my ASN in 1986. Just saying.
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