"Supervising" LPN's

  1. Sometimes in my hospital instead of having a full team of paitents with a CNA I am assigned a full team with an LPN...but really what that works out as is we split the team and work pretty much independently. What I do not understand and cannot seem to get a clear answer to is -Is the LPN working under my lisense? My management says, No, he/she is working under his/her own lisense. If that is the case why doesn't the charge nurse "assign" the LPN a team just like she assign's the RN's. What often happens is the LPN will come in early...look at the shared team and pick the patients she wants. Sometimes I am left to care for the more stable patients while she has,say, the fresh post-op. I sometimes think that it is because sometimes the stable patients are more "work" (eg. transfer to the commode vs monitor the Foley). I am not implying that the LPN cannot care for these patients safely. But I don't feel comfortable being responsible for an assignment that I really do not have any control over. In the case of one LPN she makes a huge fuss even if I request to have patients I have already had for several days. And I do not want to go to work 45 minutes earlier on the off-chance that I will have an LPN to work with. I have already spoken to one of our charge nurses about this and she basically put it back on me work it out with this one LPN. Only problem is this LPN is older and pretty intimidating. BTW I am in the state of Oregon. Any thoughts?
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  2. 9 Comments

  3. by   Brownms46
    Since the LPN is working 'with" you, and you're in charge of the team, then YOU should have the say over how the pts. are assigned on YOUR team! Yes the LPN is working under her own license... BUT every LPN works under the direction of a RN, MD or Dentist...depending on the state the LPN works in.

    You're responsible for seeing that the LPN performs the duties assigned in a skillful manner, and should be aware of what that LPN is capable of, and the limits of their practice, assigning them only what skills and duties which fall within these limits. They are responsible for the errors they make in the process of performing those duties that fall within the those limits.

    But YOU are the one in charge of making the assignment, as the LPN is working under your directions. I think your CN is a whuz..as she just didn't want to deal with this person, so she pushes it back on you. Or she wants you to take the charge and stand up for yourself with this person!

    If this LPN refuses to take your direction, then she is wrong, and I would take it up with your NM! I would also refused to work with this person until things are taken care of to your satisfaction. I'm a strong LP/VN and I believe that LPNs should have a say in assignments, but not the WHOLE say. When I work with an RN...I'm there to ASSIST her as a part of the team, and I will try to work WITH that RN.

    But I also refused to be taken advantage of! Maybe she is feeling that she was getting too many of the diffiuclt pts, and she is trying to make sure this doesn't happen again. But this is something you both need to discuss and come to an agreement with. But YOU should also let this LPN know YOU are in charge of the team, and if she doesn't like the assignments, she/he can discuss it with you....but you will make the final decisions...and make a fair assignment.

    There is NO way I would accept having my pts changed, after having them for several days. It's not good for the pt., and not condusive to giving good continuation of care! And what is best for the pt. ...should be the first concern...no matter who is who!
    Last edit by Brownms46 on Nov 2, '02
  4. by   renerian
    I would not feel bad about taking the post op clients. Would you feel comfortable changing the schedule? Does the LPN give you report and update you? Sometimes I found when working with LPNs I just needed to explain to them what you need as the team leader to feel comfortable in your job. I used to have the students I worked with write vitals on my worksheet and update me at certain intervals. I only have worked with LPNS in home health. At the hospital we did primary care so we had no aides or LPNs.

    renerian
  5. by   KaroSnowQueen
    As an LPN working in a hospital, I take a full team, and am responsible for my care under my license. The only RN responsible for me is the charge nurse, just as she is responsible for the RN's she is also directing. I have never been told that my care reflects on any other RN, other than it is my responsibility to find an RN to do things I am not allowed in this particular state to do, such as pulling central lines.
    So if you have a team with an LPN, are the both of you doing primary care? And why doesn't she just get her own team? I don't understand the logistics of your area, I guess. If you are in charge of the team, she should take your direction as to who gets what patient, or at least be willing to discuss it briefly.
  6. by   capgirl
    NYSDOH regulations require that each patient be assessed each shift by an RN. So.... even though an LPN is practicing under her own license, performing duties within her scope of practice, if an assignment is split, such as mine was today.....

    I'll take these 6 patients, the LPN takes those 5 patients, the regs REQUIRE that I also assess her patients. It can documented as a simple note on the bottom of her assessment form such as "I agree with above assessment", but it dictates that I myself have assessed the patient and either agree with her documentation of such, or make notes of my different findings.

    FAILURE to do this leaves us open to be cited for failing to follow the regs, also leaves the RN liable/responsible for any bad outcomes.
  7. by   ktwlpn
    Originally posted by shavsha
    Sometimes in my hospital instead of having a full team of paitents with a CNA I am assigned a full team with an LPN...but really what that works out as is we split the team and work pretty much independently. What I do not understand and cannot seem to get a clear answer to is -Is the LPN working under my lisense? My management says, No, he/she is working under his/her own lisense. If that is the case why doesn't the charge nurse "assign" the LPN a team just like she assign's the RN's. What often happens is the LPN will come in early...look at the shared team and pick the patients she wants. Sometimes I am left to care for the more stable patients while she has,say, the fresh post-op. I sometimes think that it is because sometimes the stable patients are more "work" (eg. transfer to the commode vs monitor the Foley). I am not implying that the LPN cannot care for these patients safely. But I don't feel comfortable being responsible for an assignment that I really do not have any control over. In the case of one LPN she makes a huge fuss even if I request to have patients I have already had for several days. And I do not want to go to work 45 minutes earlier on the off-chance that I will have an LPN to work with. I have already spoken to one of our charge nurses about this and she basically put it back on me work it out with this one LPN. Only problem is this LPN is older and pretty intimidating. BTW I am in the state of Oregon. Any thoughts?
    You need to first become very familiar with the LPN's scope of practice in your state-------http://www.osbn.state.or.us/-you will find your answers there...
  8. by   Youda
    Unless other states are much different than mine (you'd have to check with your own BON), LPNs cannot work independently. They are required to work under the "direct supervision" of an RN. But that doesn't mean you have to babysit a LPN. It means that EVERYTHING he/she does is a "delegated" task. And you can only delegate those tasks which the LPN is allowed to do under your specific nurse practice act.

    If you are comfortable with the LPNs skills, delegate and leave the LPN alone to do her job. But, that is assuming the LPN is responsible enough to KNOW when he/she needs to consult with you.

    In the event of a problem, BOTH the LPN and the RN is going to get your license looked at, or called into court. That doesn't necessarily mean that the RN will be in trouble. But, you will have to show that YOUR assignment and delegation and supervision was within appropriate guidelines.

    You have to be able to assess the strengths and weaknesses of the LPN. Some I would be very comfortable turning loose to take care of anyone. Others, I would be looking over their shoulder every minute. You know what I mean here.
  9. by   Q.
    Originally posted by ktwlpn
    You need to first become very familiar with the LPN's scope of practice in your state-------http://www.osbn.state.or.us/-you will find your answers there...

    Most of the time, individual organizations dictate what an LPN can or can't do, not necessarily in line with the practice act. So this might not be entirely helpful.

    Talk with the LPN and ask HER if she's familiar with her practice act and what limitations were placed on her by the organization. I'm assuming if anyone in that scenario is an "expert" at what this LPN can or can't do, it's the LPN.
  10. by   Agnus
    Originally posted by Susy K
    ask HER if she's familiar with her practice act and what limitations were placed on her by the organization. I'm assuming if anyone in that scenario is an "expert" at what this LPN can or can't do, it's the LPN.
    When I was an LPN I was the only one who knew my legal limitations.

    HOWEVER, I was not the only LPN. AND the other LPNs had not even laid eyes on the practice act for that state. They were often out of scope.

    I still keep a copy at home and a copy in my locker. I had to educate our management that CNA's could not do phlebotomy even though they took a course.
  11. by   NRSKarenRN
    1. Know the practice act of the state your are working in: both RN and LPN/LVN acts so you will understand each other's practice roles.

    2. Know your facilities Policy and Procedure manual especially scope of practice/job responsibilites of all staff you are working with. Helps to decrease misunderstandings OR ammunition for those slacking in performance.

    Facilities may restrict what some practice acts permit for LPN's/CNA's BUT can never permit those activites restricted by state law. RN's can not delegate tasks that state law restricts. Facility liccensure was prevented over the years to prevent employers from unfairly taking advantage of staff. CYA at all times and carry your own malpractice insurance. In a court of law it is always " what a reasonably prudent" LPN /RN would do in a situation.

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