LPN nurse manager in LTC

Here's a situation that arose last year at one of my workplaces. An RN floor nurse was caring for an elderly woman who fell. The LPN unit manager suggested that the RN report the fall to the doctor, and perhaps obtain an order to send the resident to the ER for evaluation. When the RN stated, "I've assessed my resident and she's fine, so I'm not calling the doctor or sending her anywhere," the LPN unit manager had to legally accept the RN's clinical judgment.

Unfortunately, the lady who fell developed a subdural hematoma, and the facility subsequently got into trouble with state surveyors.

I am in Texas, where having LPN/LVN nurse managers is a common occurrence in the LTC facilities around here. All of my ADONs (assistant directors of nursing) and unit managers have been LPNs/LVNs because it is more cost-effective to the companies.

In my state of residence, the general rule is that the LPN nurse manager can supervise the RN floor nurse only in an administrative capacity. The LPN nurse manager cannot supervise the RN floor nurse in a clinical capacity. In other words, the LPN manager can discipline the RN floor nurse for non-clinical issues such as excessive tardiness, attendance issues, sleeping, profanity, incomplete paperwork, fighting, and so forth.

Here's a situation that arose last year at one of my workplaces. An RN floor nurse was caring for an elderly woman who fell. The LPN unit manager suggested that the RN report the fall to the doctor, and perhaps obtain an order to send the resident to the ER for evaluation. When the RN stated, "I've assessed my resident and she's fine, so I'm not calling the doctor or sending her anywhere," the LPN unit manager had to legally accept the RN's clinical judgment.

Unfortunately, the lady who fell developed a subdural hematoma, and the facility subsequently got into trouble with state surveyors.