We've all heard RNs tell us, "We need more nurses." Sometimes they're right. But maybe what you need is another set of hands to relieve RNs of their non-technical duties and give them more time to perform primary patient-caregiving tasks. If that's the case, you may want to hire a certified nursing assistant (CNA)

Define your needs
Nurses' assistants fall into two categories: traditional "nurse's aides" (non-certified personnel trained on the job) and certified assistants trained in basic skills such as admitting patients, taking vital signs and knowing danger signs that must immediately be called to an RN's attention.

Certified assistants are usually paid slightly more than non-certified assistants, but their salaries are still at the low end of clinical staff pay. In the southeastern United States, for example, CNAs generally earn about $8 an hour, an RN about $24.

Decide whether you need new staff to perform strictly non-professional nursing duties or a little bit of everything. Hire an RN for a more varied job.

Training someone you've identified as a good employee is a great way to offer advancement and reduce the guesswork involved in staffing. For example, a housekeeper may be interested in becoming a CNA. The person is punctual, pleasant and reliable. You already know the person's work history and work ethic, and you've witnessed the employee's interactions with staff and patients. But first research how much it will cost the facility to send the employee to a certification program, how long it will take and whether the training will cut into employee availability.

Recognize CNA limitations
For several reasons, CNAs perform only prescribed duties. Their primary limitation is a lack of formal clinical education. They cannot relieve RNs for lunch or breaks, nor can CNAs perform pre-op assessments, start IVs or hang fluid bags, even if they seem capable of learning on the job. And depending on your facility layout, type (hospital, ASC or office-based surgery suite) and the surgeries you do, some non-technical tasks may be limited by law and accreditation requirements. For example, if your discharge area is a few feet from the PACU, the CNA can escort the patient. If the discharge area is downstairs or down a long hall (often the case in hospitals), an RN must accompany the patient.

Secondly, consider practical issues. While my experiences with CNAs have usually been good, I've heard charge nurses - particularly in hospitals - say CNAs slow turnaround and discharge because RNs assume the nursing assistants did non-technical tasks, such as making sure a patient's ride is there, that either did not get done because the CNA got pulled to help elsewhere, or they simply didn't do the task.

Hire with care
CNAs can help relieve your RNs and foster goodwill among patients and their families, who believe the facility has lots of attentive "nursing staff." Check the candidate's references closely, compare both your needs and use your intuition to tell if you've found the right person.