Help! LTC facility LPN scope?

[blardyblardyhelp!!]

I am a new LPN grad starting her first job at a LTC skilled facility and I want to stay under my scope of practice, but the nurse practice act seems so ambiguis and it's hard to know if the facility will keep me under my scope. My summerized position states that I will be initiating and recieving calls to the Dr., doing admit,transfers and discharg, and developing work assignments. Iam a little unsure about those particular things as I feel like they are out of my scope, but I am not sure and too new to know, can somebody help me out? I feel so lost!:sofahider I also cant figure out what exactly it means to "under the direction of a RN teach utilizing established protocols?" I feel like I can't figure anything out right now ( I do take my NKLEX_PN boards in two days,......ahhhh:uhoh3: :smiley_ab , who's going to win,...I don't know!) Anyway, I informed my nursing director about my concerns r/t the admission and d/c being involved in the teaching role, and she said I could look at it like "giving instructions" vrs teaching. I also clarified my concerns about initiating a call to the Dr. vrs the RN when I established that there was an abnormal or change in patient condition, and she said yes that was what they did here at the facility and that as long as I gave the information to someone (in a position to do something) that the responsibilty was no longer in my hands. I thought I had to report straight to the RN and not the Dr. I just want to know that what I am doing is right so that I can feel confident in nuring care and staying with-in my scope of practice. Does anyone know, do these position functions sound right? I would appreciate any advice or conformation that I am staying with-in my scope, thank you, from a too new nurse, blardyblardyhelp!!

[CoffeeRTC, BSN, RN]

In PA our LPNs do all of the above. The only real difference in my ltc is with central or picc lines. Those they do not touch and no IVP meds.

[catlady, BSN, RN]

I am a new LPN grad starting her first job at a LTC skilled facility and I want to stay under my scope of practice, but the nurse practice act seems so ambiguis and it's hard to know if the facility will keep me under my scope. My summerized position states that I will be initiating and recieving calls to the Dr., doing admit,transfers and discharg, and developing work assignments. Iam a little unsure about those particular things as I feel like they are out of my scope, but I am not sure and too new to know, can somebody help me out? I feel so lost!:sofahider I also cant figure out what exactly it means to "under the direction of a RN teach utilizing established protocols?" I feel like I can't figure anything out right now ( I do take my NKLEX_PN boards in two days,......ahhhh:uhoh3: :smiley_ab , who's going to win,...I don't know!) Anyway, I informed my nursing director about my concerns r/t the admission and d/c being involved in the teaching role, and she said I could look at it like "giving instructions" vrs teaching. I also clarified my concerns about initiating a call to the Dr. vrs the RN when I established that there was an abnormal or change in patient condition, and she said yes that was what they did here at the facility and that as long as I gave the information to someone (in a position to do something) that the responsibilty was no longer in my hands. I thought I had to report straight to the RN and not the Dr. I just want to know that what I am doing is right so that I can feel confident in nuring care and staying with-in my scope of practice. Does anyone know, do these position functions sound right? I would appreciate any advice or conformation that I am staying with-in my scope, thank you, from a too new nurse, blardyblardyhelp!!

You'll get better. Don't worry. :)

In LTC, the LPNs are usually very independent. Except when someone needs an IV push med or a PICC flush, the LPNs are often indistinguishable from the RNs except on the name badge. You are the charge nurse on your unit and that means you are in charge. You shouldn't have to call the RN to call the doctor, or do patient teaching, or assess your resident, unless that's the way your facility wants it. The policy says you act under the direction of the RN because that's how LPNs are set up to practice, but that can mean simply that you are following the policies signed off by the director of nursing and that an RN is in charge of the building. Yes, there are distinctions in the licensure, and by all means report abnormal findings to the RN house supervisor regardless of who's making the phone call, but you can generally feel comfortable managing almost every aspect of your residents' care.

[newLPN04]

We do all the mentioned and more. It's all part of a normal shift in LTC. You'll also be pill pusher, comforter, go-between, peacekeeper and much more. Just go in and do your job and don't be afraid to ask questions or for help. You have the same concerns we all had when we started, and probably always will....Good luck and let us know how it goes once you do start to work...:welcome: to the world of LTC.

[AlmostBeth]

I have worked in facilities where the RN talked/faxed the MD's. It didn't work very well for the residents. If your resident is in need of orders and your RN doesn't do anything with the information then you still need to call. It is not out of your hands. Did they add my favorite ending to LPN job description? 'and anything else we need you to do' ? :)

Good luck!