No RN coverage in LTC facility

Nurses LPN/LVN

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I have some concerns or questions regarding my new job... It's a smaller facility and staffed primarily with LPNs. There's RNs in the facility on the day shift (DON, Shift manager, MDS and Infection control nurses) there is also a PM RN manager Mon-Fri. But there are plenty of times when there is no RN in house, sometimes PMs always NOCs. The Wisconsin scope if practice is pretty vague in my opinion. It says that LPNs can work in the charge nurse role and under the "general supervision" of an RN. I thought I had read somewhere that LPNs could work in a LTC facility without an RN in house as long as one was readily available if they were needed. Can't find that now and don't remember where I had read it... I know that LPNs cannot assess for any acute change in condition an RN has to do the initial assessment. LPNs can "collect data" and f/u with residents after that initial assessment. I am working nocs and there is no RN in house on that shift. I asked one of the other nurses what is to be done in the event of a fall, or a death, or an acute change in condition in the middle if the NOC. Who would I call? How is the person to be assessed. I was told I could try and call the DON but she's not always easy to get a hold of and there isn't anyone who is going to come in to do the assessment. I'm not worried about doing the actual assessment on my own but I am concerned about working out of my scope of practice and jeopardizing my own license. Has anyone else dealt with this? I've never worked in a facility that didnt have at least one RN in house at all times. I know the state requires that any residents with any acute problems must have assessments and documentation by an RN every 24 hours, I know that is not being done in this facility.....

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"It says that LPNs can work in the charge nurse role and under the "general supervision" of an RN. I thought I had read somewhere that LPNs could work in a LTC facility without an RN in house as long as one was readily available if they were needed"

I'm in Florida so I don't know what Wisconsin's scope of practice says, however...the way I understand it, the RN doesn't have to be physically on the unit, but must be available and nearby. You should always get the phone number of the RN on duty, and request for weekend coverage by a RN even if they're only available to you by phone. Ideally, there should always be a nursing manager or supervisor on call if not on duty. Find out if this is the case and ask for phone numbers of anyone on call/covering for the shifts where none are present.

**If ever a patient condition changes, gather the data and get or call your RN or the physician. If one is not available, immediately call 911.

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That's the thing, there is no RN on call. When I asked the other LPN about this she said "if you need to call someone for advice or whatever you can try the DON but she doesn't usually answer, so than I would just go down the list and call every RN until someone answers their phone". She didnt understand that I wasn't talking about if I needed advice in what to do should something happen, I was talking about who would be the on-call RN should an RN be needed. I've been working as an LPN for 12 years I'm not worried about what to do in an acute situation. If there's a fall at 0330 and I'm the only nurse in the facility to do an assessment and a month down the road state walks in and decides to investigate this fall how's this going to affect me or my license?

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Sadly thats the way it works a lot of the time in LTC . Which I have been in now for 15 yrs. There is suppose to be an RN on Call at when there is not one in the building but they just don't answer their phone. When i am in that situation I document that I placed a call to the on Call RN and am waiting a return call back from them, If they call back I also document that and what they had to say. just like you would if you were waiting for a doctor to call.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
If there's a fall at 0330 and I'm the only nurse in the facility to do an assessment and a month down the road state walks in and decides to investigate this fall how's this going to affect me or my license?
During my years an an LPN in LTC, I always performed my own fall assessments. We all work under our own licensure.
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That's the thing, there is no RN on call. When I asked the other LPN about this she said "if you need to call someone for advice or whatever you can try the DON but she doesn't usually answer, so than I would just go down the list and call every RN until someone answers their phone". She didnt understand that I wasn't talking about if I needed advice in what to do should something happen, I was talking about who would be the on-call RN should an RN be needed. I've been working as an LPN for 12 years I'm not worried about what to do in an acute situation. If there's a fall at 0330 and I'm the only nurse in the facility to do an assessment and a month down the road state walks in and decides to investigate this fall how's this going to affect me or my license?

Speak to you DON about your concerns and she what he/she advises. There should be a written protocol regarding this type of situation. See if you can get your hands on a copy and have it at home. Should anything happen in the future (which I hope it doesn't), you can take that facility protocol to the board or to any investigators and state that you followed protocol, and went above and beyond by calling each RN and physician. In all documentation you should state who you called, when you called, reply, no reply, message left...still waiting for a return call etc.

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I worked 10 years in ltc and almost never had rn in the building on nights. They started staffing rn's when we had piccs.

Maybe your state is different than ohio but an Lpn works under the direction of an rn and a physician.

In other words, I didn't need an rn if my pt became confused, febrile.

Maybe there was just a 'change' in a resident. I would get a set of vitals, a blood sugar and call out to md. I took orders from md and then did whatever he said, most likely transfer to hosp.

I didn't need an rn for this step or most steps.

The under the direction language, again, in my state, means I can't just take it upon myself to do just anything. I gather information and then notify a doc for instructions. I had the right, if my pt say, turned unresponsive or cardiac arrest, I didn't need to wait to get ahold of doc to call 911.

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Also, in my state. The dayshift rn staff counted for rn 'hours' and they could do all that 'needed in 24' rn stuff during the day.

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