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

  1. 1
    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 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.
    Feedback welcome!
    Thanks!
    lindarn likes this.
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  3. 13 Comments so far...

  4. 3
    I would take this knowledge to the management team and see how they would like to handle it.
    LovebugLPN, IowaKaren, and lindarn like this.
  5. 3
    They know their scope of practice. As an LVN they need to function within their role, no matter their years of experience. I would not discredit their skills.
    Fiona59, sevensonnets, and lindarn like this.
  6. 2
    I am an LPN and in my facility, management sometimes forgets that we are governed by our scope of practice, not our bosses. They like to ask us to do a lot of things beyond our scope. I think it's important to let these nurses know that while you are sure they are and have been more than capable of these tasks, for the protection of your license and their licenses things will have to change. Better you tell them than the BON.
    TheSquire and Batman25 like this.
  7. 1
    Follow the BON scopes of practice for LPN/RN with anything you do, whether it is writing the policies (that's challenging and actually quite informative and you sound like just the person for this--your enthusiasm shows), or whatever. If you are the RN working with a LPN who practices out of her scope of practice, what will happen to YOUR license?
    sevensonnets likes this.
  8. 0
    Always follow the board or nursing and nurse practice acts. This is the only way.
  9. 1
    Following the BON is not the only way... it is the only correct way.

    To the OP:

    Make the plan, submit it to management, and rustle a few feathers of the "old seasoned" nurses. And yes you are in the position to tell the LVN's not to assess and admit... because you are the RN and that is beyond their scope of practice.

    You're just protecting both licenses.
    Last edit by nursenick20 on Jan 18, '11 : Reason: grammar
    TheSquire likes this.
  10. 1
    You do not need to risk anyone's license or ruffle any feathers. The BVNPT allows LVN's to collect data, just not interpret that data. The LVN's can collect all of the admit information, then an RN signs-off and initiates the nursing plan of care.

    I think it's funny how now I can chart "wound is healing well," when as an LVN, I had to chart "wound is beefy red, with scant, non-purulent, drainage and evidence of granulation tissue."
    nursel56 likes this.
  11. 0
    Surely on their annual vist it has come up? Staffing........x RNs, X LPNs, XCNAs. I bet they're counting management and others and not floor RNs. (Guess you could have someone anonymous call the BON and ask why therre are not any RNs working the floor?)
  12. 0
    they're probably (at least one or some of them) not comfortable doing things outside of their scope, but do it anyway bc they're also not comfortable saying NO when they're told to do something.

    i'm afraid of being put in this position actually. i'll hopefully start working as a CNA soon to get some experience while i go through the BSN program. it's an 18 month program so chances are i'll know how to do a lot of things that i'm not supposed to do until i'm licensed. i've already been warned by instructors who are RNs that this happens and will likely happen so when it does to "remind" the nurses it's out of my (and fellow classmates) scope.

    i would make sure to say that while you know they've been doing it and are competent/capable that it has to change for safety reasons. i don't see how they could be upset by that - i'd be relieved - not that i'd do anything out of my scope to begin with. also, from what i understand, they can ASSIST the RN so i'd make that clear also so it doesn't turn into a hostile "that's out of my scope" everytime they're asked to help do something.


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