RNs, LPNs, and shift assessments

[splendid, BSN, DNP, RN, NP]

I work in a Critical Access Hospital with a very low patient census. I'm a new RN and this is my first nursing job. During my clinical placements in my nursing program, I was never placed on a unit that had RNs and LPNs; all I ever saw were RNs working with CNAs. Although I studied LaCharity for NCLEX, actually working with LPNs is completely new to me.

Typically our inpatient floor is staffed with one RN and one LPN. My preference at the beginning of shift is to do shift assessments on all of our patients while the LPN does some of the other beginning of shift tasks. Most of the LPNs I work with are fine with this, but there is one who finds it offensive and stated that it makes her feel like I (and the one other RN at our hospital who does this, who has been there longer than anyone else) don't believe she's capable of doing adequate assessments. My sense is that the RN should be the one who assesses each patient (there are never so many that I can't assess them all), because if push comes to shove the responsibility for having missed something will be on the RN, not the LPN.

However, I understand that LPNs are nurses too, and she does have much, much more experience in nursing than I do. I do not at all doubt this person's ability to do thorough shift assessments.

I did not mean to question her competence, and now I feel stuck because I don't want to offend her or get on her bad side (given how tiny our staff is it would be terrible if I got on anyone's bad side to that extent), but I also feel rather strongly that the RN needs to do that assessment first thing in the shift.

As far as I can tell there is no policy on this at my hospital. Apparently the former nursing supervisor didn't think much of LPNs and this really rubbed our LPN staff the wrong way. The new nursing supervisor doesn't seem to care much as long as everything that needs to get done gets done. I would much rather work this out between me and this particular LPN than take it to our supervisor. Preserving my ability to work as a member of a team with every other nurse at this hospital is extremely important to me given the fact that I really do need to be on good terms with all of them given just how few of us there are. Plus, I'm the least experienced nurse there and everyone is well aware of that. I need to stay in people's good graces given that I have to ask them for help/guidance multiple times per shift.

Any ideas about how to handle this in a professional but friendly manner? I am not dead set on telling her not to do morning assessments, but I also feel like not doing them myself would be a bad idea on my part. Am I wrong in my thinking that the RN should be doing these? Is it okay if I agree to divide them up between her and I? Or should I hold my ground and insist that I do them, even if it means she suddenly becomes far more difficult to work with (which I think is what would happen given how new I am, and how much she has expressed a dislike for RNs thinking they're automatically better nurses than LPNs)?

[Pangea Reunited, ASN, RN]

When I was a new grad, the hospital I worked for had a few LVNs who'd been "grandfathered in" and had years of experience. In some cases, I would ask them to check out my patient when I wasn't sure what was going on.

If I had been unsure of their abilities, or just worried about a particular patient, I would have had no trouble stepping in, though. Is it possible you could tell her what you wrote here? It seems pretty well thought out, respectful and reasonable. Hopefully she's had experience with other new grads and knows they have a tendency to do things by the book.

[HouTx, BSN, MSN, EdD]

Refer to your state nurse practice act which determines the scope of practice for LPNs. In my state, we have a few very well defined things that can only be done by RNs. We also have a formally defined process for delegation that includes all the variables that must be considered.

"Disrespect" is a subjective feeling on the part of the recipient - based on his/her feelings about the situation. It is not enough to simply deny that you meant to do it... you can't unring that bell. You will need to take steps to repair the relationship. Clear communication is essential. Make sure you are coming from a place of integrity; adherence to your NPA and a commitment to provide high quality and safe patient care. Be sure to acknowledge her expertise and let her know how much you value her insight and advice.