RN in Long-Term Care

[Katie5]

I have a question on this pls.I am a new RN graduate and considering a Long-term care facility. In this facility, most of the nurses are LPNs( no beef with that at all), but in order not to step on toes or have mine stepped upon, I'd like to seek advice from other RNs who have worked in this system.

How does it work?I mean, no offence intended, but I'm absolutely certain, that I may not like being delegated to by an LPN, to me, that's like a role reversal. What are your opinions, suggestions and thoughts on this pls?

[leslie :-D]

while an lpn can do charge in ltc, s/he still cannot supervise a staff rn, clinically speaking.

any charge authority refers to administrative areas only.

leslie

[LUVNURSING2008]

I worked at a LTC and LVNs and RNs are both Charge Nurses.

[TheCommuter, BSN, RN]

In LTC facilities, the LPN nurse manager or LPN charge nurse can legally supervise the RN floor nurse in an administrative capacity. This occurs all the time, every day of the year. However, LPNs cannot supervise RNs in a clinical capacity.

For example, all of the LTC facilities where I live employ LPNs to serve as ADONs (assistant directors of nursing) and charge nurses because they are cheaper and more cost effective managers than their RN counterparts. These LPN-ADONs and charge nurses supervise and delegate to the RN floor nurses in an administrative capacity, and it is perfectly legal. However, it is the DON (always an RN) who has clinical supervision over the RN floor nurses, whether or not he/she is even in the building.

[michelleroussimoff]

CNA's will probably be more problem than LPN's LOL but that depends on your DON and who she values more, nurses or CNA's

[Katie5]

As a RN you would automatically be their supervisor/in charge. You should also be orientated by a RN and not a LPN as your job roles will be completely different. However as a new graduate there may be a subtle difference in the way LPN's treat you to the other RN's at the facility as you have not had any hands on experience as a RN as of yet. However like any new job trust/respect is earned and not automatic. I am sure you will be fine however just wanted to make the above points. Good luck in your decision.

I am to be orientated by an LPN.

[Katie5]

are you specifically worried about an lpn being cn, and delegating to you?

what is the big deal?

one's character means lots more than one's title.

and so, anyone w/character, will allow you to do your job and not try to pull rank or play any other mind games.

if he/she tries, you are bound by your scope of practice, and handle it accordingly.

dang, if i worried about rank/title, i would have never learned the tons of stuff the nsg assts taught me over the years.

i could go on and on about who has taught me what over the course of my lifetime...

and looking back, i would have to say it was the 'little guy' who showed me the way, time and time again.

life is too darned short to be sweating the small stuff.

take pride in what you've accomplished, yet treat everyone equally and respectfully.

seriously katie, let it go.

let your conscience guide you - and not your ego.

ideally all will be working cohesively for the good of the pts.

if it doesn't work out, i'm pretty certain it will have little to do w/lpn vs rn.

more likely, will have to do with the person behind the title.

and that's who you'd have to confront - the person, not the title.

wishing you the very best.

leslie

Thanks Leslie, you made much sense. But where I am coming with this is, after being told all these while in Nursing school about reverse delegation and having a more broader scope of practise than an LPN. I honestly admit that it sort of galls me to think that I would be delegated to.Of what use is the fours years of study then?And I will always be the first to say, that my patients come first.

[Katie5]

while an lpn can do charge in ltc, s/he still cannot supervise a staff rn, clinically speaking.

any charge authority refers to administrative areas only.

leslie

Herein lies the dilema, this is the point I'm trying to make.

[southernbeegirl, BSN, RN]

I've been in LTC for 17 yrs, the last 13 as an RN.

I think you need to stop worrying about who can "delegate" anything and concentrate on learning the ropes in LTC. Not only do you need to work the floor for a long while to learn skills and assessment skills, you need to learn the medicare guidelines under which we all work in LTC.

so what if the supervisor might be an LPN? so what if the ADON is an LPN? all that matters is that you take care of your patients to the best of your ability and that you learn all you can so that when you step into the supervisor role, and you will as an RN in LTC..that you know all you can to make you a better supervisor.

i've had LPN supervisors. if there is a clinical issue then you will deal with it. if there is an administrative issue...patient complaints, staffing issues, budget issues..thats her job.

You will often be the only RN in the building. staffing in LTC is mostly LPNs.

you will almost always be oriented by an LPN. so what? believe you me, they know their job. and that is what you need to learn. my LPNs always orient the new nurses no matter what their title. as the RN, i orient them to working the desk and most of the paperwork. it's my LPNs that show the new nurse the ropes.

forget about what title is on a badge. if you dont...i cant see LTC being a rewarding experience for you.

[southernbeegirl, BSN, RN]

Herein lies the dilema, this is the point I'm trying to make.

I think i understand your question.

LPNs can supervise in an administrative capacity. the house supervisor position is basically an administrative position. her job is making sure the work assignments cover all the patients, taking care of budget issues, patient complaints, family complaints, staff complaint, anything that is not part of clinical care.

she cant manage an RN clinically because of the scope of practice.

so you make the clinical decisions that directly affect the patient and let her deal with the management/administrative issues as that is her job.

that is how facilities get away with using LPNs as supervisors. they are not clinical supervisors. they are administrative. you are clinically responsible for your own patients.

like i said...stop worrying about who is in charge. you need to learn to be a nurse first.

[LockportRN]

LesleD, love your posts! Katie5, in LTC read Lesle's post and I just want to add this....In LTC, each nurse is responsibuble for her own practice. Any 'delegating' that you do will be to the CNA's, not to another nurse (unless you are the CN/Supervisor/ADON/DON). Each nurse has her assigned group and is responsible for that care. I have the feeling that you think that as a 'floor nurse' you will have your assigned group as well as be responsible for the oversite of the other nurses. Now since the NPA was changed and LPN's can no longer start IV's, the supervise, ADON, DON may 'delegate' to you to start the LPN's IV's, but other than that you will be only responsible for your assigned patient group.

In Illinois, an LPN can be an ADON as long as there are fewer than 100 patients. In these cases, that LPN will delegate to you but if you read the other posts, you'll see that this delegation is all administrative...keeping in mind that she has the responsibility (under the direct supervision of the DON) of all the residents in the building and may ask you to call the MD for certain orders or get vitals or follow up with the family.

Kstie, as a new nurse, RN or LPN, your real training will begin the day of your orientation. While you have learned much, and yes, you have learned and probably understand more of the rationale behind the 'tasks' you do, a seasoned LPN is worth her weight in gold! She will teach you things and show you 'how' to do things that you, in all likelyhood only learned in theory, while in the classroom. And the CNA's, know the residents and their families and what they will and can teach you (as a nurse, get ready, you never stop learning) will serve your nursing practice in invaluable ways! So, as many of the other nurses have said, be open and be ready, it takes the whole 'team' to make it work. While you could function as an island in an ocean, you will bear the storms all on your own, risking not only your sanity in the long haul, but risk resident safety.

Don't worry, you will have much to contribute. It takes at least a year to really get your time management down and 2 to get really comfortable. There are nurses that come into the field with only 'management' on their minds (for the money or for the power) but I've seen it backfire more times than I can count. How can you lead until you 'walk a mile in their shoes'? How can you lead until you until you earn the respect of your peers...? How can you teach/lead unless you are willing to learn/be led? Just food for thought.

Katie5, while a nurse may 'tell' you to do a thing, you will have to rely on the NPA and what it says as the 'scope of practice' and then do that thing. It is your license and your practice that ultimately should guide you. You also have the faciltiy policy and procedure manuals and state and federal guidelines with which you should use. Just remember, someone has to 'oversee' a unit, a floor, and facility. Someone who can look at the big picture while you are in a code, or with someone in respiratory distress or with difficult family members. Not to mention, that in these types of emergency situations (esp with a new grad or if you haven't yet been in a particular situation and don't know what to do) it won't matter RN/LPN, some people just naturally will have a more clear head and will take charge...trust me, you want that person there...one person has to have a clear head to 'direct' the flow ie, "Nurse one, copy the DNR, H&P, and MAR", "Nurse 2, call the MD/911", "CNA, clear the elevator and call the receptionist to direct the ambulance/fire dept to room ____", etc. If this was your patient sooo many things will be going through your head (could it be an MI? a CVA? low blood sugar? Resp arrest?) that you will be concentrating on the patient and will not be able to delegate tasks to anyone in most cases.

Sorry, I always write too much but you sound like you really are detail oriented and will be good in nursing (and we need you in LTC) and I woundn't want you to get hung up on this issue. In time, you will be fully autonomous and if you wish to rise the ranks of managment will have the opportunity as an RN. But dear, we all have to 'listen' to someone. Even as a DON I get 'delegated to' by the Administrator and owners (wether nurse or not) and it is up to me as a nurse first and DON second, to educate them and be a patient and staff advocate if what they are asking is contrary to the NPA and State/Federal Regs. Good luck to you and forgive me again for being wordy:).

[CoffeeRTC, BSN, RN]

LesleD, love your posts! Katie5, in LTC read Lesle's post and I just want to add this....In LTC, each nurse is responsibuble for her own practice. Any 'delegating' that you do will be to the CNA's, not to another nurse (unless you are the CN/Supervisor/ADON/DON). Each nurse has her assigned group and is responsible for that care. I have the feeling that you think that as a 'floor nurse' you will have your assigned group as well as be responsible for the oversite of the other nurses. Now since the NPA was changed and LPN's can no longer start IV's, the supervise, ADON, DON may 'delegate' to you to start the LPN's IV's, but other than that you will be only responsible for your assigned patient group.

In Illinois, an LPN can be an ADON as long as there are fewer than 100 patients. In these cases, that LPN will delegate to you but if you read the other posts, you'll see that this delegation is all administrative...keeping in mind that she has the responsibility (under the direct supervision of the DON) of all the residents in the building and may ask you to call the MD for certain orders or get vitals or follow up with the family.

Kstie, as a new nurse, RN or LPN, your real training will begin the day of your orientation. While you have learned much, and yes, you have learned and probably understand more of the rationale behind the 'tasks' you do, a seasoned LPN is worth her weight in gold! She will teach you things and show you 'how' to do things that you, in all likelyhood only learned in theory, while in the classroom. And the CNA's, know the residents and their families and what they will and can teach you (as a nurse, get ready, you never stop learning) will serve your nursing practice in invaluable ways! So, as many of the other nurses have said, be open and be ready, it takes the whole 'team' to make it work. While you could function as an island in an ocean, you will bear the storms all on your own, risking not only your sanity in the long haul, but risk resident safety.

Don't worry, you will have much to contribute. It takes at least a year to really get your time management down and 2 to get really comfortable. There are nurses that come into the field with only 'management' on their minds (for the money or for the power) but I've seen it backfire more times than I can count. How can you lead until you 'walk a mile in their shoes'? How can you lead until you until you earn the respect of your peers...? How can you teach/lead unless you are willing to learn/be led? Just food for thought.

Katie5, while a nurse may 'tell' you to do a thing, you will have to rely on the NPA and what it says as the 'scope of practice' and then do that thing. It is your license and your practice that ultimately should guide you. You also have the faciltiy policy and procedure manuals and state and federal guidelines with which you should use. Just remember, someone has to 'oversee' a unit, a floor, and facility. Someone who can look at the big picture while you are in a code, or with someone in respiratory distress or with difficult family members. Not to mention, that in these types of emergency situations (esp with a new grad or if you haven't yet been in a particular situation and don't know what to do) it won't matter RN/LPN, some people just naturally will have a more clear head and will take charge...trust me, you want that person there...one person has to have a clear head to 'direct' the flow ie, "Nurse one, copy the DNR, H&P, and MAR", "Nurse 2, call the MD/911", "CNA, clear the elevator and call the receptionist to direct the ambulance/fire dept to room ____", etc. If this was your patient sooo many things will be going through your head (could it be an MI? a CVA? low blood sugar? Resp arrest?) that you will be concentrating on the patient and will not be able to delegate tasks to anyone in most cases.

Sorry, I always write too much but you sound like you really are detail oriented and will be good in nursing (and we need you in LTC) and I woundn't want you to get hung up on this issue. In time, you will be fully autonomous and if you wish to rise the ranks of managment will have the opportunity as an RN. But dear, we all have to 'listen' to someone. Even as a DON I get 'delegated to' by the Administrator and owners (wether nurse or not) and it is up to me as a nurse first and DON second, to educate them and be a patient and staff advocate if what they are asking is contrary to the NPA and State/Federal Regs. Good luck to you and forgive me again for being wordy:).

Exactly what I would have said!

I might be the charge nurse or supervisor,but the LPN I work with holds her own. There is and RN and LPN in the building. Each have thier own pt and CNAs. She does everything that I could or would do except push IV meds. She or he can delegate to the CNAs and has even asked me to do stuff. I might be the person in charge, but for the most part I let the other nurse aka LPN run the show. Not being lazy, but she is an excellent nurse and has taught many an RN a thing or two!

[pagandeva2000, LPN]

I can also say that more than likely, there is one LPN per floor and maybe one RN in the entire building on evenings and nights. So, it can be very possible that after the few days of orientation, you may be alone and may have to count on the rest of the staff to see you through.