What are the policies behind LPNs reviewing RNs charting in Home health and LPNs overseeing RNs education and orientation training? I can't seem to find an answer on my State Board and was curious to know about this.
Last edit by Rnasn2017 on Apr 20
You're talking about Certified Nursing Assistants? Why in the world would a CNA be overseeing anything an RN does? An LPN/LVN, yes, I could see that, but a CNA? Makes no sense to me.
Yes, LPNs! Sorry, my mind is on auto pilot right now.
In regards to the chart reviews, I think it would depend on the type and extent of reviews being done. An LPN could review documentation to ensure quality elements were addressed, all the required boxes were checked, etc., but should not provide direction on the care plan itself. And I would think only an OASIS-qualified clinician should review OASIS documentation.
The education and orientation piece is more tricky- I don't feel good about that because of the differences in scope of practice. I suppose it would be okay for an LPN to sign off an RN on certain skills that both disciplines would perform, but not all aspects of the RN's orientation.
My state board's guidance was vague, so this is just my opinion.
I agree with Nurse on the Go.
Not in home health, but I ran into this at a SNF as the inservice director was an LPN. Actually she a did a great job orienting me to the policies and procedures of the facility and performed skills check-offs that were in both of our scopes of practice. She was very cognizant of the scopes of practice/ roles, but honestly most of the orientation was perfectly appropriate for her do. In some cases, it was showing me where to locate specific policies/ procedures that were only performed by RN's at that facility. An RN did any skills check-offs that were RN specific (either per policy of the company or per scope of practice).
My state's scope of practice, especially for LPNs, is rather vague in areas.
As for chart audits, there are so many "meanings" to audit. Where I work now, there is a chart audit checklist that simply looks to see if certain documents are present and signed - nothing else. Even our HHA's and volunteers can complete these audits. Clinical audits on the other hand are performed by our Quality RN and quarterly each RN is assigned a peer audit.
If you concerns, consider approaching the LPN performing your orientation in a pleasant, non-confrontational manner to seek more information or check with the RN within your chain of command (DON, Manager etc).
This is an important question and likely may not be the first time it's come up. Or if it is, maybe it's time to reevaluate the process.
Thank you all for your responses. I don't want to rock the boat and feel that if I say something, the company will take the side of the LPN as they have said that they are lucky to have an LPN that does more that she should be doing. I feel like there are some lines being crossed but the State Board does not list these in "stone". I have charting sent back to me for correction for notifying an MD of a patient's BP when it's not outside of our reporting parameters but it's not anywhere close to the patients baseline or when she believes I should of educated on something that was not the focus of my visit. It's frustrating but I don't think she should be telling me how to carry out a care plan for a patient who she has never met. I also thought that only RNs could assess unstable patients or assess patients with new signs and symptoms?
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