New Grad LPN offered a Nurse Supervisor position in Post Acute

Hospice Nurse LPN, BSN, RN · Aug 11, 2011

Wow...I think you might be putting your license in jeopardy here. First, LPN's can't "assess". They can gather information, but assessments need to be done by an RN. New admits need to have quite a bit of paperwork done by an RN for Medicare reimbursement.
Second....it sounds like you've had little to no orientation/training. I would be out pounding the pavement looking for another job. I know they're not easy come by, but this doesn't sound safe.

The OP works in LTC. In my state, an LPN does the initial assessment in an LTC setting. Reason being, after 5 pm there are no RN's in the building. Just can't make the poor pt wait until the next day for an initial assessment. The scope of practice varies from state to state.

RNGrammie · Aug 11, 2011

WHOAAAA!!!! Better do your homework before posting such a claim.
I am not even going to comment any further than this because anything I say from here on in will not be nice.
Fellow LPN's care to comment?

Please don't read attitude into my post. I meant nothing derogatory. I was an LPN before becoming an RN. Enlighten me as to the homework you'd like me to do.

cappuccinoLPN · Aug 11, 2011

I'm also a new grad LPN and I would be terrified to be in that situation. I work in a LTC also and "supervise" the CNA's but it's not with a supervision title. I'm a floor nurse. I would definately talk with your DON - soon - and get some official training. You don't need to say that you're worried or anything, just say you'd like to ensure you're doing your job correctly for reimbursements, etc.

xtxrn, ASN, RN · Aug 11, 2011

In LTC/LTAC LPN's are supervisors.. not in the sense that they manage other nurses or are unit managers, but that they are direct supervisors to the CNA staff.
It's just a regular position in a LTC/LTAC as a staff nurse. They just call it 'LPN supervisor' since you're 'supervising' the CNA. You're the 'charge nurse'. It's different from a hospital.

But Medicare patients need an RN assessment every 24 hours in LTC facilities. It doesn't really matter what shift- but it's usually days to deal with MD calls and any need for more assessments.... IME:)

xtxrn, ASN, RN · Aug 11, 2011

I live and work in Canada as a LPN and we most certainly do assessments!!! I work on a very acute hospital unit and have sole responsibly for 4 -5 pt's on a day shift. If I am not responsible for assessments then that means my pt's must not be getting assessed. haha.

In the US, hospital patients may have LPN/LVN primary care nurses, but an RN still needs to do an assessment every shift- in TX I was the only RN for 27 beds, but had 4 LVNs on 7-11p and 3 LVNs from 11p-7a....and it worked fine :) I had great LVNs (and CNA- usually 1- sometimes none) and the stray RN on 7-11p (12 hour shifts). :)

xtxrn, ASN, RN · Aug 11, 2011

Not that long ago, LPN/LVNs (new) would be expected to take a 30 bed unit- do meds, treatments, charting (as needed), call docs, deal with families, supervise the CNAs (2-3 on days and evenings, 1 on nights), etc... it was how it was done :) And we didn't have the technology (some of it) so it had to be done by hand- it still had to be done :) A 12 patient assignment was for RNs on nights in acute care hospitals, not LTC !!!

waksbr · Aug 11, 2011

I work in acute care in GA, in my facility the initial assessment must be done by the RN. The data (all the med/surg history and pharm list) can be collected by the LPN. Our pts do not necessarily get an RN assessment Q24 hrs. We do primary nursing with an RN charge, the rest of the staff nurses are a mix of LPN's and RN's. Alarms would have went off to be given that much responsibility without a proper orientation and as a new grad no less. I have been lucky everywhere I worked I have received a good orientation with the exception of one agency job with quesitonable practices that I quickly left.

applewhitern, BSN, RN · Aug 11, 2011

Where I work LPN's cannot do initial assessments. An RN must do this, then the LPN can do ongoing assessments. The LPN also cannot do care plans, or the initial skin assessment.

agldragonRN · Aug 11, 2011

hello!
so i just recently got my license and this is going to be my first time ever working in the field of nursing, other than my clinicals. i accepted a full time position as a lpn nurse supervisor for a post acute wing in a ltc facility. i have been on the job for almost two weeks. running the cart for both mar and tar is not a problem. i usually have 12 patients and can get it all done within my 8 hour shift...however, all the paperwork, computer work and constantly having to assess and supervise my aides is really taking a toll. i do have previous supervisor experience in hospitality but its nothing like this. i love all the patient care experience i am getting in post acute but i have found it extremely difficult to get to all the documenting, calling po's, ordering labs, assessing new admins, and making sure my aides are doing their job.
i think i can do this but i have no previous experience with doing any of this paperwork, calling docs, labs, etc and as of yet, i have not received any training on how to do so. this place was supposed to give me orientation but my first day of orientation was with a nurse who had not worked in post acute for over a year, the second day was spent passing meds only, and every day since i have just been told to treat and pass meds...
should i consider looking elsewhere, where i can actually go through an orientation process so i can learn how to do the things that are not being taught to me here or am i being unreasonable?

are you really in a supervisory role like supervising other nurses(lpns) and cnas? or are you the floor nurse who supervise cnas?

if it is the former, then it would be hard to supervise other nurses who have more experience than you. how would you be able to help the nurses when you did not even receive proper orientation? if it is the latter, then 12 patients is good for sub-acute/rehab. it is 15-20 patients to 1 nurse on my sub-acute floor.

i know job openings are scarce now due to this economy that's why you cannot really be picky so i just want to wish you luck.

agldragonRN · Aug 11, 2011

in ltc/ltac lpn's are supervisors.. not in the sense that they manage other nurses or are unit managers, but that they are direct supervisors to the cna staff.
it's just a regular position in a ltc/ltac as a staff nurse. they just call it 'lpn supervisor' since you're 'supervising' the cna. you're the 'charge nurse'. it's different from a hospital.

not in my ltc facility. i was never an lpn supervisor when i was an lpn. i was a floor nurse. we always have a "real" supervisor, who supervise all nurses(lpn/rn) and cnas.

agldragonRN · Aug 11, 2011

i was never allowed to do the initial assessment in my ltc facility when i was an lpn. if it's the lpns patient, then the rn supervisor and lpn would assess the patient together then the rn supervisor must co-sign the assessment forms immediately. only then can the lpn call the doctor to verify the medication orders from the hospital.

i am still a floor nurse so i just co-assess & co-sign my lpn coworker if he/she has readmissions or new admissions so that we don't have to bother the supervisor.

xtxrn, ASN, RN · Aug 11, 2011

Did the restriction to RNs only doing the first assessment have anything to do with SNF vs ECF patients?? I mostly worked in TX, and LVNs did the full admission on ECF residents...the RNs had to see the SNFs, so we had an RN on the heavy Medicare wing and arranged admissions for M-F 8a-6p when possible. That way pharmacy had time to get the meds ready for the nightly delivery as well.