LPN as supervisor?

  1. My question....I practice in the state of Massachusetts in a SNF. I have always been under the impression that an RN "outranks" an LPN and therefore an LPN cannot supervise an RN. Does anyone know where I can find the regs? I tried the state website and this issue wasn't addressed. (and please, don't think I care what initials are after someone's name. I've worked with some outstanding LPN's)
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  2. 53 Comments

  3. by   donmomofnine
    I certainly don't know about your state regs, but I have wonderful LPN supervisors. The way we get around our regs in PA, is to designate an RN who is the "shift" supervisor (the required RN on duty) and then the LPN is the unit supervisor. The two that I presently have are wonderful! It was done out of necessity, due to the fact that none of my RN BSNs wanted to lead! They do not mind reporting to these very capable supervisors.
  4. by   chris_at_lucas_RN
    Check your nurse practice act. Mine has a long list of various responsibilities related to the various levels of licensure and education. Some things a BSN can do that an ADN cannot, an ADN can do but an LVN cannot, etc.

    It would seem pretty clear that "supervisor" implies more education and a higher professional licensure. Afterall, RN's can write nursing orders and delegate them to LVN's or PCT's, and RN's receive and follow doctor's orders, but you don't see RN's writing orders for doctors to carry out, right? LVN's, to my knowlege (and I could be wrong), don't write orders for anyone, do they?

    Your point is well taken. Perhaps there is some missing info?
  5. by   Marty LPN
    Quote from CapeCodMermaid
    My question....I practice in the state of Massachusetts in a SNF. I have always been under the impression that an RN "outranks" an LPN and therefore an LPN cannot supervise an RN. Does anyone know where I can find the regs? I tried the state website and this issue wasn't addressed. (and please, don't think I care what initials are after someone's name. I've worked with some outstanding LPN's)
    Long term care regulations vary from state to state, however, Federal Regulations apply to all states, and each state must have regulations equal to or above this set standard.
    Federal regulations state that a LPN may supervise, other LPN's, and un-licensed personal(such as a Nursing assistant). LPN's may take charge of the entire facility after normal business hours, as long as there is a RN on call 24 hours per day. ( usually the Director of Nursing is this RN, as their license is listed as the person responsible for the nursing care for that facility) Federal regualtions also state that the Director of Nursing for a long term care facility (SNF) must be a RN. (Under special circumstances the facility may apply with the federal govermant, that there is a severe shortage of a qualified RN to take this role, and request that a LPN hold this position...This is extremely rare, and the facility must prove, that after a aggressive recruitment search, no RN's are available and also must continue to actively recruite a RN). LPN's may hold Administrative positions, where they are indeed in charge over other LPN's, CNA's and RN's. Keep in mind that this is strictly on a Administrative level. ie- LPN that holds the title of Assistant Director of Nursing, Assistant Administrator, etc. ( I have held these type of positions myself). The RN who is the Director of Nursing would be responsible for the clinical coordination and supervision of the nursing staff. As far as a LPN supervising a RN on a ward/unit/floor; NO, A RN's clinical practice cannot be supervised by a LPN. I am not one who puts much emphasis on someone's title. I have worked with outstanding nurses, both LPN's and RN's. Remember WE ARE ALL NURSES. However, we still must follow the regulatory process.
    Last edit by Marty LPN on Jun 19, '04
  6. by   donmomofnine
    "NO, A RN's clinical practice cannot be supervised by a LPN. I am not one who puts much emphasis on someone's title. I have worked with outstanding nurses, both LPN's and RN's. Remember WE ARE ALL NURSES. However, we still must follow the regulatory process"

    We have investigated this thoroughly and have found that it is not true in our state. We just had our survey and it was not an issue. The first year we did this, the surveyors questioned this practice, examined the regs, and decided it was okay to do it! A surveyor's blessing! What more could you ask for!
  7. by   Blackcat99
    Many years ago I worked as an LPN at a state psych hospital in Calif. We had RN'S,LPN's and LPT's(licensed psychiatric technicians). We had an RN who refused to be the "charge nurse". She said she didn't want all that aggravation. Apparently, she got this OK'ed by management. I worked with her for one year and sure enough she was "never in charge."
  8. by   NursesRmofun
    Here is my basic understanding, but I do not know exactly how the laws are written in my own state or any other. Again, this is my understanding from what I was taught in my NY colleges.....LPNS can be a Supervisor with a RN within a phone call away or somewhere on the premises. However, that really leads me to believe the RN is really in charge....However, the LPN is acting Supervisor as long as there are no problems that require a RN to assess or even a higher level management or administrator to make decisions. i.e., One time in one LTC facility, the roof caved in in a resident's room during a rain storm....Luckily, no residents were in the room! But the Administrator was called.
  9. by   CapeCodMermaid
    OK....here's the thing...IF there is an RN who is more than qualified for the job, could an LPN be hired instead?
  10. by   NursesRmofun
    Quote from CapeCodMermaid
    OK....here's the thing...IF there is an RN who is more than qualified for the job, could an LPN be hired instead?
    Yes, for $$ savings....especially if they have a very good LPN applying.
  11. by   chris_at_lucas_RN
    I thought the question was, "can an LVN/LPN supervise staff which includes RN's?"

    Certainly if you have two people with different licenses, one cheaper to pay, and you can hire who you want--why pay more for the same job (assuming it is in fact the same job)?

    State psychiatric facilities do some odd things (I've worked in a few myself), but I cannot imagine continuing to employ an RN who refuses to do part of her job because she cannot abide the paperwork. Oh, wait..... I can....

    I have nothing against anyone, based on their license, politics, heritage, etc., but as an RN you will not find me working under the supervision of an LVN. I would not be able to depend upon her judgment, because she will not have had the education I will have had. We all have our places, and we are all important, but we cannot be all things to all people, all the time.

    Weird world, eh?
  12. by   Todd SPN
    [QUOTE=chris_at_lucas]I thought the question was, "can an LVN/LPN supervise staff which includes RN's?"

    I have nothing against anyone, based on their license, politics, heritage, etc., but as an RN you will not find me working under the supervision of an LVN. I would not be able to depend upon her judgment, because she will not have had the education I will have had. We all have our places, and we are all important, but we cannot be all things to all people, all the time.QUOTE]

    I work under an LPN supervisor in LTC which also has an RN on staff that does not wish to have that position. When/if it comes to a question of resident care where the two disagree, I take my cue from the RN. The LPN supervisor does the same. Our state law says the RN trumps the LPN and I feel safer that way.
  13. by   NursesRmofun
    Quote from chris_at_lucas
    I thought the question was, "can an LVN/LPN supervise staff which includes RN's?"

    Certainly if you have two people with different licenses, one cheaper to pay, and you can hire who you want--why pay more for the same job (assuming it is in fact the same job)?

    State psychiatric facilities do some odd things (I've worked in a few myself), but I cannot imagine continuing to employ an RN who refuses to do part of her job because she cannot abide the paperwork. Oh, wait..... I can....

    I have nothing against anyone, based on their license, politics, heritage, etc., but as an RN you will not find me working under the supervision of an LVN. I would not be able to depend upon her judgment, because she will not have had the education I will have had. We all have our places, and we are all important, but we cannot be all things to all people, all the time.

    Weird world, eh?
    Chris, if you reread what I said in 2-3 total messages, what I think is true is that a LPN can be the acting supervisor....meaning, she is doing the work,...but if a RN is also in the building, she is *really* in charge, even if the LPN is going around with a notebook and the census in tow. What I mean is, the LPN can fullfill the the duties but, if something happens,...an emergency, the RN is ultimately in charge. I believe a LPN CAN be in charge of a RN as far as title....but not when it comes to clinical judgement. It's hard to explain! LOL! ARGH. A LPN can be ADON and even DON in some states, I believe. But that does not mean her judgement will supersede the RN in a clinical circumstance. Does that say it better? That is my understanding.
  14. by   BBFRN
    In KY, LPNs do write orders and can be ADONs.

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