RNs, LPNs, UAPs, Oh My! Scope of Practice

BrandonLPN, LPN · Jul 25, 2012

Interesting article. Thanks for sharing.

Though I don't care what anybody says, LPNs DO assess in LTC. Call it "collecting data" or whatever you want. If I "collect data" and then decide to either perform an

intervention or notify the doctor based on said data aren't I assessing?? If I can only legally collect data, but not assess it, that would really limit what I can do. I mean, if I had a pt in COPD

exacerbation and I "collect" that his spo2 is 80% and respers are 32 am I supposed to call a RN before elevating the HOB and slowing down his breathing? Should I notify a RN before calling the doc on a pt who's going downhill? After all, if

we go by these rules I can only gather the data, not interpret it.

C'mon, we all know the whole "data collection" stipulation is nothing but a joke....

HouTx, BSN, MSN, EdD · Jul 25, 2012

Each state is different in how it defines scopes of practice. In Tx, LVNs cannot work without direct supervision in an acute care setting. Supervision is somewhat more lax in other settings - the RN must be immediately available by phone & physically available in a reasonable period of time when needed. The key is to ensure that there is ongoing and relevant communication between the RN & LVN - any sudden changes in patient status should trigger the RN's immediate (personal) response. LVNs must consult with their supervising RN or MD before carrying out a PRN intervention UNLESS that intervention has been specifically outlined as part of a clinical algorithm -- eg "Give ASA for temp > 100". Even in these cases, they must then inform their supervisor as soon as possible.

It's important to understand and adhere to one's scope of practice. In TX, the vast majority of BON 'issues' are due to this problem, especially for LVNs. They do not see any of it as a 'joke'.

BrandonLPN, LPN · Jul 25, 2012

You must not work in LTC. In most LTC facilities the LPN is often the only nurse in the facility on 2nd or 3rd shift. In these cases, for the LPN to be unable to "assess" or to have to inform the RN "immediately" of any thing would indeed be a joke. I mean, am I to call the RN unit manager at home when I give Tylenol for a fever? Do I call some random RN at home to "consult" with before sending a pt to the ER? Of course not! Heck, I don't always consult with one even if there's one in the building. You seem to be basing your assertions from your experience in the hospital. In LTC, all the "the LPN works under the supervision of the RN" stuff are just hollow words nobody pays attention to. And we can do independent nursing interventions, not just those outlined in the plan of care.

kakamegamama · Jul 25, 2012

BrandonLPN-are you in TX? From "LPN" I'm not sure as the role is "LVN" in TX. Anyway, whether you are or not, follow the scope as outlined by the BON for your state. If you are sued, it is better for you that you've done that. I know that sometimes in the "real world" things are different.....and, it does seem if I recall directly, that there are some differences in LTC as well as nursing homes as to the LVN scope of practice. However, that doesn't absolve us of the responsibility to follow what our scope is. Your agency's policies about your scope of practice should be based on what your state/accrediting agency says it is.....

BrandonLPN, LPN · Jul 25, 2012

No, I'm in Michigan.

And I follow the BON rules. I just think it's hilarious that we LPNs technically can't assess, only "gather data". We all know it amounts to the same thing, so why do we have to play such silly word

games? And in LTC the whole "working under the supervision of the RN" thing is true in only the most abstract way imaginable. When I'm the only nurse (most of the time) there is a RN (the DON) technically a phone call away. But

no LPN, as far as I know, has EVER telephoned a RN for advice. We might call the doc for orders, but then so would a RN.

And to do what HouTx seems to suggest in their post, calling a RN re: PRN Tylenol or something, would only serve to get the LPN fired for incompetence. I'm expected to float my own boat in LTC.

LPNs ARE primary nurses in LTC. I know we pretend otherwise with such double speak as "data gathering". But it's all a farce to give the appearance we are adhering to archaic scope of practice rules.

BrandonLPN, LPN · Jul 25, 2012

I guess what I'm saying is that I DO understand my scope of practice as a LPN. I know every state's BON says that LPNs function under the direct supervision of the RN. My point is, though, that in LTC this is something given lip service at best. They expect us to function independently as both the charge nurse and the primary nurse. This is a job expectation. Then they turn around and come up with such euphemisms as "data collection" or "we always have a RN a phone call away" to appease the BON guidelines. You can't tell me you don't see the humor in that?

Asystole RN · Jul 25, 2012

I guess what I'm saying is that I DO understand my scope of practice as a LPN. I know every state's BON says that LPNs function under the direct supervision of the RN. My point is, though, that in LTC this is something given lip service at best. They expect us to function independently as both the charge nurse and the primary nurse. This is a job expectation. Then they turn around and come up with such euphemisms as "data collection" or "we always have a RN a phone call away" to appease the BON guidelines. You can't tell me you don't see the humor in that?

Reality rarely reflects the ideal.

Practice as you wish, as you already do I am sure, but having the RN "assess" is a layer of legal protection for you as the LPN...

BrandonLPN, LPN · Jul 25, 2012

Reality rarely reflects the ideal. Practice as you wish, as you already do I am sure, but having the RN "assess" is a layer of legal protection for you as the LPN...

I appreciate that, and when there is a RN supervisor working with me I follow that chain of command. You better believe that when I'm working with a RN and a pt goes downhill, the last sentence in my nurses note is always "notified RN supervisor." but what am I supposed to do when (9 times out of 10) there's just me? I find many hospital RNs just cannot grasp this. They seem to assume I'm working on some sort of team or something. I am on a team, me and a few CNAs....

Asystole RN · Jul 27, 2012

I appreciate that, and when there is a RN supervisor working with me I follow that chain of command. You better believe that when I'm working with a RN and a pt goes downhill, the last sentence in my nurses note is always "notified RN supervisor." but what am I supposed to do when (9 times out of 10) there's just me? I find many hospital RNs just cannot grasp this. They seem to assume I'm working on some sort of team or something. I am on a team, me and a few CNAs....

You call the RN who is in charge.

Having worked in LTC I understand what you are saying. There is always a DON or charge nurse who takes call, or a physician. You are to gather the information by your observations and report it to the RN in charge (on-call) or the physician, actually both, and follow their orders.

You chart that you reported your observations to the RN and/or physician and followed their orders.

BrandonLPN, LPN · Jul 27, 2012

Right, all I was saying was I've never heard of any LPN, ever, calling the "on call" RN for any reason. If we call anybody, we call the doctor. Just like a RN would in the same situation. The whole concept of having a RN "on call" is pretty much a charade. In the world of LTC the LPN functions AS the RN in his/her absence. I know that's not strictly following the BON rules, but that's the way it is, right or wrong.