Responsibility for LPN's actions?

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    I work on a cardiac/pulm/renal floor in my hospital. The normal nurse to patient ratio is max 6:1. Which I am normally okay with. Well an LPN has been hired to work on our floor recently and we have now had occasion to do team nursing with the RN doing all assessments, IV pushes, etc. and the LPN doing all meds, dressing changes, etc. We had 11 -12 patients the other day together (on a monitored floor I personally think that is too many but that's besides the point.) Well this LPN is so sweet - she is just a really good person and I'm sure she's a great nurse. However, a couple of med errors (could have been serious ones) occurred when she was giving meds. Now I know this could have happened with anyone -be it an LPN or RN- b/c I'm sure I will make mistakes in my career also. I just do not like my license being on the line with this team nursing thing. I mean am I supposed to do everything I'm doing AND also be expected to check off all the LPN's meds, walk with her to give them, etc. In my opinion, that is the only way to be positive that everything is getting done right and that is micromanaging and impossible with 11-12 pts. I dont mind being responsible for my own actions but to be held responsible for everything someone else does is difficult. My question is how responsible really is the RN for what the LPN does? I'm sorry if I offend anyone with this as I am not trying to bash LPN's - I appreciate every member of the healthcare team, I just want to know where MY responsibility lies. Thanks.
  2. 10 Comments so far...

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    I don't know if your responsibility includes the LVN's mistakes. I mean, a charge RN or NM is not responsible for you if you make med mistakes, right? While you would be responsible if you were to let her push meds, she is expected to be competent within her own scope of practice. If she screws up, I would think it would be on her.
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    hiya,

    you are not responsible for the LPN's Med errors, but you are responsible for your actions after notification of the med error (patient monitoring, notificiation to md, and so forth). The LPN has a license and is trained in medication administration and so forth.

    What compenticies has your floor established for the LPN? Med errors occur quite frequently, especially unreported med errors in fear of punitive actions.
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    As an LPN I am responsible for my own actions whether an RN is my supervisor or not. I'm not sure what is the sense of having an LPN do meds if you have to check them off? That doesn't make any sense at all. LPN's, at least in my state, are giving meds without being babysat by an RN. It seems like you are wasting a lot of time having to walk beside her to administer meds. Now, if you are signing these meds off, then you are responsible.
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    There is a clearly cut reason as to why LPNs/LVNs possess their own nursing licenses: accountability for their own actions. If the LPN in this situation has a license, she should be accountable for her own med passes, dressing changes, and nursing actions. If she happens to make a mistake while under your watch, you should not be accountable because you were not the one who made the error.

    Your original question reads: "My question is how responsible really is the RN for what the LPN does?" Unfortunately, that all depends on your state's board of nursing. Many states, especially the southern states, have extremely wide LPN/LVN scopes of practice and these nurses are expected to be responsible for their own actions. A few northern states, such as Minnesota and Pennsylvania, have extremely restrictive LPN scopes of practice which leads to more RN responsibility.

    I am going to opine that there should be only 1 uniform scope of practice for LPNs/LVNs instead of these minor and major differences that seem to exist from state to state.
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    Colter517, I dont walk beside her and administer the meds. That's what I was asking. I was asking if I was responsible for the meds she gives. And thanks everybody for the replies.
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    Quote from limabean
    Colter517, I dont walk beside her and administer the meds. That's what I was asking. I was asking if I was responsible for the meds she gives. And thanks everybody for the replies.
    If she's signing the meds off, I would imagine she's responsible. That would be terrible for you to have to worry about that. I wonder if your hospital has written standards for this.
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    Wouldn't a med error be a ''team'' mistake? Let's say an RN does all the assesments like the OP says, and the LPN administers all the meds. I mean all medications are NOT given until ALL assesments are done right? I haven't worked team nursing, but that's the prudent way to do things correct? It all depends, if it's a dosing mistake then yes whoever administers it is responsible. But since the OP is saying she's doing ALL the assesments, if a med error is a result of giving a medication that needed to be witheld because of what's found during assesment then wouldn't they be both accountable? Two nurses, one doing assesments, and another giving the medication, it's a team effort. Or do LPN's go their own way as soon as report is over and since they have so many medications to give, like let's say for twelve patients, doesn't it make it harder for them to check the patient and give those medications, almost as if it's a nursing home where there's so many people and so many meds, and so little hours. Then the RN goes her own way and does her assesments for the twelve patients, then checking lab, or however the responsibilities are split.
    Wouldn't that be more prone to error? Or does team nursing means, no medications are given until all assesments are done by the RN?

    I mean I don't understand ''team'' nursing I'm new to the idea. But wouldn't it be better for the LPN to have six patients and the RN to have the other six? You have your own load, and you can take care of them without having to depend on another person? I'm just trying to understand the purpose of team nursing. When both nurses, LPN and RN are able to take care of the same patients.
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    hrtprncss, I am in the process of trying to decide how I feel about team nursing. The posters here have answered my question about med admin. I mistakenly always thought that the RN was responsible for everything the LPN did (which was really stupid now that I think about it b/c that is why they have their own license). However, it seems most of the nurses on my floor thought this same way. Anyway, for me it was a lot harder doing team nursing b/c you cant really keep up with everything that is going on with your patients. The med errors that occurred in my situation where not assessment related, but I see what you mean. Also I think with a big patient load it would be really hard to wait to give meds before all the assessments were done. Of course I think the nurse who gives the meds should be responsible for finding out what vitals were prior to giving them. I dont know about team nursing....it just seems like I spent all day doing assessments then the rest charting, while running back and forth with orders trying to catch the LPN to write meds on the MARS, and making sure I gave all the IV pushes. I also felt like I was not in the patient's rooms checking on them and doing all the normal things I would do on a regular day. It was crazy! But maybe with less patients it would run a little more smoothly.
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    Thanks Lima! Yeh my question was basically trying to see wether team nursing would make it harder for both the nurses...


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