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What are the ethical considerations and implications of using CNAs and LPNs to address nursing shortages, and how do these relate to patient safety, quality of care, and the healthcare workforce?
I believe that solution thought of was a let’s start somewhere solution. However, we realized at the end that RN hands are still falling short and despite the attempt nurses seem to still feel the heat. CNA’s and LPNs, as crucial as they are to the medical team, have a different level of training and scope than RNs. Asking them to do assessments in place of the RNs can lead to complex medical situations. Asking them to lead complex medical situations or critical decisions can lead to potentially more harm than good, ultimately compromising patient safety. And when CNAs and LVNs do step into that role, that also requires RNs to provide more time and effort looking through the work and providing effective supervision – which can add to the patient load and burden even more. “Interprofessional collaboration is the responsibility of all nurses at the bedside, at the organizational level, and at the policymaking level” (Prentice et.al., 2020). And over-extending the roles of LVNs and CNAs can also lead them to burnout, role confusion, and other ethical dilemmas.
In this episode, what ethical principles or values are at stake for hospital administrators, the nurse educator, the nursing team, and the patients?
I think as hospital administrators it is important that nonmaleficence is ensured by avoiding harm to the patients and not placing those that have not trained for roles into more advanced positions and responsibilities. As the nurse educator suggests in the video it is important that high quality training and education be provided first to CNAs and LVNS to ensure they are well-prepared for their roles to ensure that beneficence is adhered to. I think that the nursing team confronts concerns with justice and fair workload distribution. The team remains to be shorthanded, and stresses and it is important that the nursing team is prevented from burnout and can maintain quality of care. As patients, when care is rushed or not delivered as needed, their autonomy or ability to choose and decide what is best for their health is also compromised in the process.
Imagine you are a nurse educator or part of the hospital administration team. How would you approach the integration of CNAs and LPNs into your nursing staff to combat the nursing shortage? What ethical principles would guide your decision-making process?
If I was put in this position, I would begin by assessing the current staffing levels and the patient acuity levels on each floor. If we were to integrate CNAs and LVNs into their new roles I would establish clear guidelines for the supervision of them to maintain patient safety and quality of care. As the biggest step I would make sure to take, it to implement continuous education and training programs for them to enhance skills and training. These courses would be mandatory and paid. The biggest concern would be to ensure that no harm is done to patients in the process. Ensuring nonmaleficence would be the utmost of concerns and that is why tasks are assigned based on competency and scop is crucial for this to work.
References
Prentice, D., Moore, J., Crawford, J., Lankshear, S., & Limoges, J. (2020). Collaboration among Registered Nurses and Licensed Practical Nurses: A Scoping Review of Practice Guidelines. Nursing research and practice, 2020, 5057084. https://doi.org/10.1155/2020/5057084
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