RN in Long-Term Care

  1. 0 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?
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  3. Visit  Katie5 profile page

    About Katie5

    Joined Oct '08; Posts: 1,495; Likes: 1,549.

    25 Comments so far...

  4. Visit  Ruthiegal profile page
    7
    I have worked LTC a lot through the years. My take on working with LPN's is that they are nurses too, and you are co workers, if they have been there longer you can learn a lot from them about your facility the residents and how things get done. And what if you get something delegated to you from an LPN.... aren't you really there for the residents? You need to be a team player no matter whom you work with.... LPN, and CNA's will be your co workers, and you will need to learn to respect them all and listen to what they have to say!
  5. Visit  travellingsuitcase profile page
    0
    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.
  6. Visit  justiceforjoy profile page
    2
    Here, there is one RN or LPN per floor. RNs are NOT supervisors for LPNs, but they will have more of a scope to practice within, of course.

    Of course, this all is very dependent on where you are working (state or province).
    tattooednursie and Fiona59 like this.
  7. Visit  travellingsuitcase profile page
    1
    Quote from justiceforjoy
    Here, there is one RN or LPN per floor. RNs are NOT supervisors for LPNs, but they will have more of a scope to practice within, of course.

    Of course, this all is very dependent on where you are working (state or province).
    RN's will always be in charge over a LPN due to the scope of practice between the two roles. There is a big difference between the RN and LPN training. However ultimately RN's and LPN's should be working together as a team eh ?
    tattooednursie likes this.
  8. Visit  justiceforjoy profile page
    2
    I think you and I have a different opinion of "in charge", unless you're assuming that the RN is the CN?

    (I'm in Canada where LPNs can work without an RN present. When I think of "in charge", I think of an RN telling the LPN what they should be doing, but here LPNs carry out their patient workload autonomously. RNs can delegate to LPNs for sure, but they're not always in charge of the LPN)
    tattooednursie and Fiona59 like this.
  9. Visit  travellingsuitcase profile page
    1
    Quote from justiceforjoy
    I think you and I have a different opinion of "in charge", unless you're assuming that the RN is the CN?

    (I'm in Canada where LPNs can work without an RN present. When I think of "in charge", I think of an RN telling the LPN what they should be doing, but here LPNs carry out their patient workload autonomously. RNs can delegate to LPNs for sure, but they're not always in charge of the LPN)

    I was assuming the RN was the CN. I worked in places where they HAD to be a RN in charge of the shift and not the RPN. I know from my experiences of working in Canada that different provinces and the difference between public and private health care deemed completely different rules and regulations.
    justiceforjoy likes this.
  10. Visit  Nascar nurse profile page
    7
    Quote from travellingsuitcase
    As a RN you would automatically be their supervisor/in charge. You should also be orientated by a RN and not a LPN

    I have a feeling this poster has never actually worked in LTC. The chances are very high you will be oriented by a LPN as there are rarely many RN's in LTC.

    Please be cautious with this tone that RN are superior to LPNs in LTC. You are sure to meet resistance at work as well as in this forum. I have been in LTC for 23 years - 19 as LPN and 4 as RN. It takes everyone working together to get this overwhelming job done. Pulling rank is like running your head in a brick wall. I didn't like it as an LPN and I don't pull it now as an RN. Learned a long time ago that even a really good housekeeper is capable to saving a life!


    Best of luck to you
  11. Visit  travellingsuitcase profile page
    0
    Quote from Nascar nurse
    I have a feeling this poster has never actually worked in LTC. The chances are very high you will be oriented by a LPN as there are rarely many RN's in LTC.

    Please be cautious with this tone that RN are superior to LPNs in LTC. You are sure to meet resistance at work as well as in this forum. I have been in LTC for 23 years - 19 as LPN and 4 as RN. It takes everyone working together to get this overwhelming job done. Pulling rank is like running your head in a brick wall. I didn't like it as an LPN and I don't pull it now as an RN. Learned a long time ago that even a really good housekeeper is capable to saving a life!


    Best of luck to you
    I dont think that RN's are superior to RPN's at all and I agree that everyone should work together as a team as we are all there for the same reason , the patients. However I have just acknowledged that different provinces and the difference's between public and private health care have different rules and regulations.

    Maybe you should not be so quick to jump up and down and assume that I am being superior when you have nothing to validate your comments.
    Last edit by travellingsuitcase on Aug 29, '09 : Reason: missed a word
  12. Visit  leslie :-D profile page
    11
    Quote from Katie5
    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?
    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
  13. Visit  Thornbird profile page
    2
    Actually, LPN's can NEVER delegate to RN's. It may seem that one when the LPN is charge nurse (or in many places they can be supervisors) but legally an RN is always responsible for her own practice. The "delegating" in LTC is by the DON who has set the policies and assignments for what nurses will do in each assignment. Each nurse then is responsible for his/her own work. In places (like where I currently live, CT) where an RN must be present to supervise the LPN, the shift supervisor is the RN responsible for supervisionm even if there is an RN working the unit with an LPN. On any given day the LPN may be charge and the RN, med or treatment nurse. Since there is lttle to no difference, depending upon locale, in the duties of a staff nurse in LTC, you may be oriented by an LPN or, especially while you are new, work with one in charge.
    The presence of both an RN and an LPN in any given place, does not automatically make that RN supervisor of that LPN. Of course, any good nurse looks to his/her colleagues for support. The experienced LPN may still be lacking some of the knowledge that a brand new RN has and vice versa. Remember, I am talking ONLY about LTC.
    I think this advisory ruling by the MA Board of Nursing is a good summation:
    Licensed Practical Nurse Charge Nurses/Nurse Supervisors

    Authority:
    The Massachusetts Board of Registration in Nursing issues this Advisory Ruling on Nursing practice pursuant to Massachusetts General Laws, chapter 30A, section 8 and chapter 112, section 80B. Date Issued: November 12, 1997
    Date Revised: July 10, 2002
    Scope of Practice:
    Licensed Practical Nurse
    Purpose:
    To guide the practice of the Licensed Practical Nurse (LPN) who is employed and/or assigned to the functions of charge-nurse or supervisor and the Registered Nurse (RN) who is assigned to and/or employed as a staff nurse in the same facility.
    This is an administrative function only.
    Advisory:
    Pursuant to the Board's regulations at 244 Code of Massachusetts Regulations (CMR) 3.04: Responsibility and Functions-Practical Nurse, it states "making appropriate assignments, teaching, directing and supervising unlicensed personnel, delegating activities to unlicensed personnel, participating in collaborative planning, and making informed judgements as to the specific elements of nursing care mandated by a particular situation.
    The Registered Nurse (RN) who is employed or assigned to a staff position when the LPN is charge nurse or supervisor remains and retains full responsibility and accountability for the clinical course of the patients under his/her care.
    The LPN charge nurse/supervisor does not mean clinical decision-making authority regarding the patients that are assigned to the RN.

    This information is provided by the Division of Health Professions Licensure within the Department of Public Health.
    pagandeva2000 and SuesquatchRN like this.
  14. Visit  lisamc1RN profile page
    1
    My former unit manager was an LPN. She was obviously in charge of every nurse who came on the floor, RN or LPN. I have, personally, oriented several RN's and only ever had one who appeared offended by this.
    pagandeva2000 likes this.
  15. Visit  leslie :-D profile page
    1
    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
    pagandeva2000 likes this.


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