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 immunization clinics.
I was recently charged with restructuring our nursing model to create more patient contact and assessment, start a nurse-led admissions clinics, and maximize our scopes of practice! very exciting!
However...
As I assessed the interests of our nurses, the LVNs "definetely want to assess more, do more patient education, and triage!" ruh... roh.....
No one, in the 25 years one of them has been at this clinic, has bothered to check LVN scope of practice, and has been letting them determine normals and abnormals, assess patients and plan care, provide education, and do phone triage (without any written policy). They have had no RN "supervising," nor do they run these assessments by providers.
By my research (nursing practice act and info from BOTH boards of nursing), this is beyond the scope of the LVN in California, and puts the RNs in their clinic on the line for not adequately supervising or delegating.
So...What woudl you do?! would you challenge their "old seasoned" way of doing things? tell management? I am in the position of having to tell them that they can't legally assess and plan care in a nurse-led admission clinic. I am stuck! As a person who hates raising stinks, it might be the only thing that management takes seriously.
