how do you feel about RN covering for LPN on the floor?

  1. Hello all,

    First, this post is not meant to be geared as an LPN v RN post. I have been an LPN for a decade and have recently graduated from a 2 year RN program. I hope to take boards in the next few months. I am just interested in how other RN's feel about this subject and if anyone else shares my concerns.

    I tried a hospital job at a smaller hospital...thinking it would be a great place to start. I did not like the way they had things set up. On the medical floor they had 5 LPN's and 2 RN's. The LPN's required the RN "covering" them to co-sign on assessments, hang blood, and do all the IVP meds. I spent my second week of orientation following an LPN around who did a 5 second assessment (checking pedal pulses through socks, listening to lungs over bones, not examining the skin completely, or even listening for BS). This nurse also charted teaching she really didn't do and even pre signed some meds. I watched her go from room to room passing meds and looking at IV sites without washing inbetween (didn't use the gel either). My problem with it all is that I would not feel comfortable co-signing anything that I did not check...especially after observing this! The unit was busy with barely anytime to waste--blood transfusions, mag and K+ protocals, lots of IVP meds...how on earth can I verify the accuracy of the LPN on top of all my work??? So in reality on top of my 6 assigned patients I would then be required to "cover" 2-3 LPN assignments. Needless to say I don't feel comfortable at this hospital. Two of the three RN's in orientation have already quit. I talked with one Friday who said she was on her third day of orientation and was left with 6 patients and covering for 2 LPN assignments after her preceptor went home sick. She was there until 11 p.m. (started at 7 a.m.) She said she called Friday and told them she would not be back. Her mother is a nurse and said they don't use LPN's as much at many of the other hospitals. I love LPN's, but unless I know their work quality (and even then I would still want to check) I don't want to co-sign for anything without verification....and there is no time! I guess I do see why many hospitals are shifting to all RN's. I want to protect my license. I know LPN's are great and very capable but to me if all the co-signing is required it sure puts a big strain on the RN--especially when there are only 2 working the floor!

    How do you feel about this work load??? To me it is unsafe!
    Karen
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  2. 11 Comments

  3. by   GingerSue
    I spent my second week of orientation following an LPN around who did a 5 second assessment (checking pedal pulses through socks, listening to lungs over bones, not examining the skin completely, or even listening for BS). This nurse also charted teaching she really didn't do and even pre signed some meds. I watched her go from room to room passing meds and looking at IV sites without washing inbetween (didn't use the gel either).

    My problem with it all is that I would not feel comfortable co-signing anything that I did not check...especially after observing this! ...how on earth can I verify the accuracy of the LPN on top of all my work??? [Quote]


    Just my initial reaction: why would anyone co-sign this?
  4. by   meownsmile
    I guess i dont understand,, why are you having to co-sign for a LPN anyway. We have LPN's that work under our direction but I dont have to go back and co-sign everything they do. Whats the point, why not just do it yourself and not use LPN's?
    Our LPN's dont do physical assessments,, only PO & IVPB meds, dressing changes, drain and cath care, that type of thing. But we still dont have to go back and sign behind them.
  5. by   barefootlady
    Why would any RN sign for a physical assessment she did not do? There is a way to make the assignments more compliant with licensure. It's called team nursing and if this facility is going to rely on LPN staff as much as you describe then that is the model of nursing care you should push for practice. Good luck but I would consider looking at other facilities.
  6. by   GN1974
    To answer your questions this facility uses LPN's in a very similar capacity HOWEVER they do not allow LPN's to hang blood, give IVP meds, and they CAN assess but it needs to be co-signed by the RN. This is common practice in some places. I searched the boards here and found others concerned with this same issue. The RN co-signs for the LPN assessment because it is part of her assignment. Yes, I will be finding a new job. I don't think this is safe. If I sign it, I want to check it....if time doesn't allow for it then I can't put my license under that! I wish they would use the model described above where the LPN gives meds, manages drains, etc and just not assess at all if it must be co-signed. They can't hire enough RN's that are willing to stay. One of the girls I started with already said it was too much liability and found work else where by the end of the week. They use LPN's similar to RN's because they just can't get enough RN's! This strains the few that are working to "cover" all this and do her assignments. This is a very busy med-surg floor with tele also. Thank you for your input.
    Karen
    Last edit by GN1974 on Mar 14, '05
  7. by   Antikigirl
    I am with you totally, I too had to co-sign for things and LPN in a group home did, lets just say I didn't stay at that job for long because I have a responsibility to my patients, and my signature means I was involved in whatever I signed. If something was missed, I would be absolutely held accountable...nope, I couldn't do it even if that LPN was really really good and knew the residents for over 7 years...

    If you are as uncomfortable as I was, I would start looking for another job where this will not happen. I felt like I was cheating my patients by signing since I wasn't there...and in my heart and conscious...well..I couldn't do it and it made me to nervous and miserable....
  8. by   austin heart
    I once worked as a charge in a stepdown unit that occasionally used LVNs and I would have to co-sign their assessments. Luckily it was only an 8 bed unit because I did not feel comfortable signing an assessment that I did not do so I would assess all the patiants. If I felt that something pertinant was left out of the documentation done by the LVN I would chart it then sign off everthing. VERY time consuming but I figured it is my licence on the line.
    The hospital that I work in now is an all RN hospital.
  9. by   Jenny99
    RN's are not - in California anyway - obligated, by law or the BRN - to co-sign for the LVN's. The co-sign thing is for the birds. LVN's have their own License. The employers / hospital adminstrators mandate this practice of co-signing.

    Jenny99 - a California LVN

  10. by   meownsmile
    Well i find it not only double charting but rediculous. If they want and will allow LPN's to do assessments then they should have enough confidence in their LPN's to let their assessment stand without having to have it co-signed. I would NOT co-sign someone elses assignment unless i have gone and done one myself and if i had to do that there is NO reason for a LPN to do one.

    It sounds as if it is their way of removing responsibility from the LPN and ultimately from the facilities shoulders if a patient is not assessed completely and something is missed. Run for your professional life.
  11. by   Spidey's mom
    Quote from Jenny99
    RN's are not - in California anyway - obligated, by law or the BRN - to co-sign for the LVN's. The co-sign thing is for the birds. LVN's have their own License. The employers / hospital adminstrators mandate this practice of co-signing.

    Jenny99 - a California LVN


    Hmmmm . . . when I work with an LVN, I do the physical assessment and then she can take over care of the patient from there, except hanging blood and IV meds. If she is IV certified, she can start IV's. That is a big help. I do read her nurse's notes and sign that I agree with them. Or not. And I live in California.

    steph
  12. by   catrn10
    Many hospitals in my area require that an Rn co-sign the LPN's. I refused to do it and actually got written up for it! I was agency. so I refused to work outside of the units ever again. This same hospital would also leave an LPN as the lone nurse in the ICU. They said she was working under the RN on the floor. They had trouble getting RN's to work for them for very long for SOME reason........... :chuckle
  13. by   mickeymouse1205
    I'm an LPN and I don't blame you I would not co sign either. As an LPN I would not cosign with an RN say for a narcotic that dropped on the floor if I didn't see the " wasted narcotic" If I didn't see it, I wasn't involved is my motto, just like if you didn't document it you did not do it. Find another job, there are plenty out there. Good luck
    Cheryl

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