LPN as Charge?? - page 2

Just a quick question......I'm an LPN and the charge nurse on my hall (LTC). I often work with 2 different RN's, even when I work with them I am still charge. One doens't want to be charge, she... Read More

  1. by   Tweety
    I don't know about LTC, as I know LPN's are very strong, active and leaders in those areas. But the nurse practice act here in Florida is very clear...the LPN works under the direction and supervision of the RN, not the other way around.

    So while, in practice you may be in charge, ultimately your facility and the state probably considers you working under the direction of one of the RNs. Meaning if the state came in and asked your facility who was the charge nurse, they wouldn't say it was you as an LPN, even though you might unofficially have that role. Am I making any sense here?

    It's that way here int he hospital too. The LPNs have their own assignments and do their own thing managing their paper. Ultimately however, they are under the direction of an RN, which is usually the charge nurse.
  2. by   pkapple
    I guess if the responsibility of the nurse working the desk (in "charge") is to place calls to the doctor, then you are ultimately responsible to make those calls whether requested by an RN or an LPN. If you failed to do your job, the RN would need to call the doc to protect her license, or the house super or whoever to report you.

    It seems in your facility "charge" is a task and paperwork shift, someone to keep track of whats going on.

    I worked in a hospital where we have made the LPN charge--she had to do the computer chart checks,give the unit clerk and tele tech breaks and update the house sup re status and acuity. This LPN had several years experience and was working with travel nurse and float staff-none of whom could access the computer to do chart checks. She was available as a resource for policy questions. She was not actually IN CHARGE of anyone. Technically we had no charge nurse on those nights.
  3. by   CHPN1680
    Quote from Nurse Hatchett
    What about the days that there isn't an RN if the facility?? I'm not "calling myself charge" as you put it, that's the way it is on the sched. Whom ever does the "desk" is the charge nurse, that's just the way it is. I answer to my house supervisor LPN, ADON LPN then DON RN. I didn't ask the question to stir up a big controversy over LPN/RN. I realize that an RN is over me, not question about that, She went to school longer and deserves that recognition. Like I stated prev. remember this is LTC and not a hospital, which I understand then it wouldn't even be an issue, as far as I am aware, they don't have LPN's do charge at a hospital and have a lot more RN's then we do in LTC. As I also stated prev. we only have 2 RN's who work the floor. All other RN's are DON, MDS and one 3rd shift RN every other weekend.
    I worked as an LPN in LTC for 12 years. Most of those years, I was in a supervisory position and yes, I supervised R.N.'s even in a sub-acute setting. Now, when I say supervised, I mean that I made the assignments, intervened in staffing issues, and was on call for staffing issues. I still had to practice within the State Practice Act for LPN's. I could not give IV push medications or hang TPN.

    I don't believe that just because there is an R.N. in the building, that he/she is utlimately responsible for the whole building. The R.N. is responsible for the care delivered to his/her assigned patients. If a patient falls on one unit where there is an LPN charge nurse, and the charge nurse on the other unit happens to be an R.N., that does not make the R.N. responsible for any issues concerning the fall. Ultimately, there must be a supervising R.N. available on-call for any issues especially if the House Supervisor is a LPN. This usually is the ADON or DON.

    R.N. or L.P.N., nurses must work withing their scope of practice. LPN's cannot give the final word in terms of clinical decisions and any R.N. who may disagree with the suggestions of the LPN (supervisor or not) has the duty to do what is clinically appropriate and within the scope of practice.

    I am now an R.N. but have tremendous respect for LPN's. There are many LPN's who make better "charge nurses" or supervisors than a lot of R.N.'s.I think that there are two issues here. Hierarchy within a facility and Scope of Practice. I can see how the two can get intertwined but they are really quite separate.
  4. by   Nurse Hatchett
    Quote from BobL
    I worked as an LPN in LTC for 12 years. Most of those years, I was in a supervisory position and yes, I supervised R.N.'s even in a sub-acute setting. Now, when I say supervised, I mean that I made the assignments, intervened in staffing issues, and was on call for staffing issues. I still had to practice within the State Practice Act for LPN's. I could not give IV push medications or hang TPN.

    I don't believe that just because there is an R.N. in the building, that he/she is utlimately responsible for the whole building. The R.N. is responsible for the care delivered to his/her assigned patients. If a patient falls on one unit where there is an LPN charge nurse, and the charge nurse on the other unit happens to be an R.N., that does not make the R.N. responsible for any issues concerning the fall. Ultimately, there must be a supervising R.N. available on-call for any issues especially if the House Supervisor is a LPN. This usually is the ADON or DON.

    R.N. or L.P.N., nurses must work withing their scope of practice. LPN's cannot give the final word in terms of clinical decisions and any R.N. who may disagree with the suggestions of the LPN (supervisor or not) has the duty to do what is clinically appropriate and within the scope of practice.

    I am now an R.N. but have tremendous respect for LPN's. There are many LPN's who make better "charge nurses" or supervisors than a lot of R.N.'s.I think that there are two issues here. Hierarchy within a facility and Scope of Practice. I can see how the two can get intertwined but they are really quite separate.

    That answers my question basically, what brought the whole thing up was we had an incident where there was 2 LPN's and one RN on the hall, something happened, and the word was the RN was going to take the fall. The pt in question wasn't hers and she wasn't the charge nurse. It actually ended up when state got involved that she didn't get in trouble for the issue at hand. That's what made me ask the question in the first place.
  5. by   Nurse Hatchett
    Quote from 3rdShiftGuy
    I don't know about LTC, as I know LPN's are very strong, active and leaders in those areas. But the nurse practice act here in Florida is very clear...the LPN works under the direction and supervision of the RN, not the other way around.

    So while, in practice you may be in charge, ultimately your facility and the state probably considers you working under the direction of one of the RNs. Meaning if the state came in and asked your facility who was the charge nurse, they wouldn't say it was you as an LPN, even though you might unofficially have that role. Am I making any sense here?

    It's that way here int he hospital too. The LPNs have their own assignments and do their own thing managing their paper. Ultimately however, they are under the direction of an RN, which is usually the charge nurse.

    Maybe they consider me working under the DON's license?? Don't know for sure,
  6. by   zippyLPN
    Quote from Speculating
    No, anywhere you work anywhere as an LPN you answer first to the RN. As was said earlier you can call yourself charge all day long if you wish too. Something can happen down the hall it might not even be your pt but if you're the only RN on duty you take the fall. Just ask the judge!
    I think ya both need to move out of the states your in.....I dont answer to anyone but the Supervisor or DON ! I am a Charge nurse on my unit with yes another charge nurse. we are both responsible for the unit (split into 2 wings) Did I mention that we are both LPNS.....Wait, my supervisor is an LPN.....I delegate the cna's, I do the assesments, I do the md orders and oh my god.....I do my own admissions! I have been a supervisor of a 150 bed SNF/LTC facility....And I have known plenty of Unit managers that have been LPN's ....LPN's have come a long way in nursing, I think its time to get rid of the RN-"itis". !!!!!!!!!!! Were all in nursing for one reason and it comes down to caring for the pts!
  7. by   LPNer
    Quote from The Veridican
    They can call you charge all day long. The RN is responsible for the patients he/she has assigned to him/her. If the facility has put you in charge of managing the facility, that's fine. The RNs know full well that when it comes to apporpriate and safe care of their patients in that facility; they are on their own with the MDs orders, the BON scope of practice, and the facility policies. They may come to you with their time card corrections, but they would be ill advised to come to you with a question like "Do you think I need to call the MD about this or that?"

    The Veridican
    I am beginning to reallyl wonder about some of your replies to a variety of posts, but I am going to ask you anyway...
    Why would an RN be ill advised to ask an LPN her opinion?
    Your response was fine until that point. In LTC an RN needs to be available for the charge LPN, that RN does not have to be in the facility so any RN who happens to be working in the facility while the LPN in charge is not inherantly responsible for anything other than her own pts. No RN is ever responsible for anything an LPN does or does not do.
    That aside, even in a hospital or home care setting for that matter, there is never a harm in one professional asking another professional her/his opinion. It doesn't matter if it is RN asking LPN or LPN asking RN, both are responsible for their own actions and an extra experienced opinion helps a person make the correct decision.
    Gees, if you are going to talk legalities in nursing scope of practice, you really should learn about them.
  8. by   Dixiecup
    I work in Missouri. There are several LTC facilities in my town. Almost all of them have an LPN as the ADON. And yes, the ADON delegates, supervises,takes call and also gives write ups to the RN's in addition to all the other things I mentioned. I've been through state inspections and it's not a problem with the state. It is a common occurance here. I was an LPN for a lot of years before I got my RN and totally respect LPN's but I had to leave a job at a LTC facility because as hard as I tried I just could not take orders from or be supervised by an LPN after working so hard to get my RN degree. Other RN's don't seem to have a problem with it.
  9. by   LPNer
    Quote from Nurse Hatchett
    Maybe they consider me working under the DON's license?? Don't know for sure,
    LPNs do not work "under" anybodies license but there own in any state.
    LPNs work under the direction of an MD, RN, etc. This does not mean they are responsible for us.
    The DON is your resource, s/he is the RN whom you get your direction from. Another nurse who happens to be an RN, another nurse who happens to work the same shift you do is not neccessarily the nurse you get your direction from.
  10. by   suebird3
    I had been an LPN for 17 years, and just recently got my RN last year. In my experiences, if 2 LPN's were on the floor, the LPN with the most seniority was "in charge".
  11. by   Tweety
    Quote from Nurse Hatchett
    Maybe they consider me working under the DON's license?? Don't know for sure,

    Probably. The chain of command you mentioned that inlucded the RN DON is who is your supervisor. I think as long as it's an RN. As I said, I'm not as familiar with LTC, because as you say sometimes there isn't an RN on the facility. But here in Florida LPNs don't "officially" operate independently under their own license, LTC or not.
  12. by   Tweety
    Quote from zippyLPN
    I think ya both need to move out of the states your in.....I dont answer to anyone but the Supervisor or DON ! I am a Charge nurse on my unit with yes another charge nurse. we are both responsible for the unit (split into 2 wings) Did I mention that we are both LPNS.....Wait, my supervisor is an LPN.....I delegate the cna's, I do the assesments, I do the md orders and oh my god.....I do my own admissions! I have been a supervisor of a 150 bed SNF/LTC facility....And I have known plenty of Unit managers that have been LPN's ....LPN's have come a long way in nursing, I think its time to get rid of the RN-"itis". !!!!!!!!!!! Were all in nursing for one reason and it comes down to caring for the pts!
    It's not a matter of RNitis and I hope I'm not coming across that way. It's what the board of nursing states, here in Florida.

    Here's what the Nurse Practice Act in Florida states about practical nurses. " "Practice of practical nursing" means the performance of selected acts, including the administration of treatments and medications, in the care of the ill, injured, or infirm and the promotion of wellness, maintenance of health, and prevention of illness of others under the direction of a resgistered nurse, a licensed physician, a licensed osteopathic physician, a licensed podiatric physician, or a licensed dentist. "
    Last edit by Tweety on Mar 9, '05
  13. by   LPNer
    Quote from 3rdShiftGuy
    It's not a matter of RNitis and I hope I'm not coming across that way. It's what the board of nursing states, here in Florida.

    Here's what the Nurse Practice Act in Florida states about practical nurses. " "Practice of practical nursing" means the performance of selected acts, including the administration of treatments and medications, in the care of the ill, injured, or infirm and the promotion of wellness, maintenance of health, and prevention of illness of others under the direction of a resgistered nurse, a licensed physician, a licensed osteopathic physician, a licensed podiatric physician, or a licensed dentist. "
    And that's exactly what the BON says in most states I have worked in. However, I believe you are reading more into than there is. "under the direction of" does not mean if there is an RN within shouting distance, that RN is allowing an LPN to work "under" his/her license.
    It means that an LPN works under the direction of an .....
    It does not say every RN in the building and in the case of LTC the MD, RN doesn't have to be in the building.
    By the way, that includes Florida, where I worked many years ago as the supervisor in a LTC facility.

    Y'all are reading way too much into "at the direction of"

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