RN vs. LPN scope conflict: what would you do? - page 2

by LuxCalidaNP

3,154 Views | 13 Comments

Hi all, I recently started working at a large community health center that is a wonderful home to 5 nurses, myself included. 2 of these nurses are seasoned LVNs, with lots of experience in elder care, wound care, and... Read More


  1. 0
    I would prepare a presentation comparing facility practice against the NPA. I would create suggested new policies that are in line with the law. The feelings of the employees that have been out of scope for years are not your concern, that is management's issue. Your RN would be at risk if the practice continues. Just because it hasn't come up in a lawsuit yet doesn't mean it can't. Good job and good luck.
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    I would immediately stop any hint of the LVN's initiating any care plans, pronto. The LVN's can contribute to the care plan. This is a number one priority.

    Any admission/initial assessments need to be countersigned by the RN. "I agree with/concur with /have reviewed the LVN's assessment." - or similar wording. An additional note can be added if the RN feels additional information is needed.

    Telephone triage can be tweaked where telephone messages are collected, and then "triaged" to the RN for further review until such a time when a decision tree can be decided upon and implemented. NO advice is to be given in the meantime, even if it is for something as simple sounding as a hang-nail. (Kaiser hospital uses some non-nurses for incoming calls....but they are extremely, very, highly scripted - and RN's "audit" the telephone calls intermittently.) Any deviation from the script and the call is kicked over to an RN.

    These are the things that I have learned after many years of being an LVN in California and having to report to an RN, as well as many subsequent years of being an RN in California and in turn, delegating to LVN's.

    Hope this helps. It may not be a pleasant experience for all involved, but ignorance of the law will not protect you, nor those who will be affected when the other shoe drops.
  3. 0
    Thanks everyone. I humbly placed the CA Board or Registered Nursing guidelines for delegation on my site directors desk this week, and she said she would look them over with the medical director. Thanks for your input everyone!
  4. 0
    How are things going? Curious because I'm in similar situation. Thanks.


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