RN vs LPN assessments

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    How are LPNs utilized at your facility? When I started on a med surg floor 6 years ago on nights, LPNs would have their own patients to assess/care for and the RNs would split the re-assessments between them. For example, if an LPN was assigned 6 pts and there were 3 RNs, each RN would have 2 pts (in addition to their own 6 pts) to assess some time during the shift. We pretty much would check the pt. over fast and document "Agree with above assessment." and move on. After I had been on the floor about 6 months, the assessment was taken away from the LPN. The reason being it was not using the LPNs time effectively since the patient had to be assessed by an RN anyway. So, we began team nursing - an RN and an LPN with the RN doing the assessments/documentation and the LPN passing meds and doing tasks (dsg changes, etc.) Soon after that I left to ICU where we were all RNs, so it has been awhile since I have done team nursing.

    The other day, our cardiac/telemetry floor had 2 call-ins, so they were staffed 2 RNs and 3 LPNs for 33 patients. My unit was working short so we could not float anyone (the same with the rest of the floors). I made a comment to a co-worker that 33 patients between 2 RNs was not safe. She stated that there were 5 nurses on that floor and they would be fine. We then had a disagreement over assessments. I said it was ridiculous for one RN to be held responsible for 15 or 16 patient assessments during a shift. She argued that LPNs could also assess and therefore each nurse would only have 6 assessments. She freq works extra on the med-surg floors and states the LPNs do assessments and tell the RNs when something is abnormal. Otherwise, she doesn't assess a pt with a negative LPN assessment.

    Don't take this the wrong way -- I could never have made it without the LPNs when I worked med-surg, and I am not saying I believe LPNs incapable of doing an assessment. I am talking about licensure. Isn't the initial admission or per/shift assessment the RNs responsibility? How is it done at other hospitals? Just curious.

    P.S. The manager of this floor was in meetings all day and got to go home at 3pm. The 2 RNs worked their 12 hrs and then did their charting until midnight. Both returned the next morning for another 12 hrs,-- their manager called in stating she was taking the day off.
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  4. 9 Comments so far...

  5. 0
    I am an LPN at a LTC facility and I never have my assessments co-signed by an RN. I am the Charge Nurse and it is always my total responsibility. Perhaps it depends on what area of nursing you are in or in what state you live, but the whole responsibilty of what happens on my unit of 41 residents comes back to me. Our House supervisor is also an LPN. I feel I have excellent assessment skills and I have done my job long enough that I am not questioned as to my ability. I am not certain why many places require an RN to co-sign because I have seen many cases where the RN only signs but has never even seen the patient. I am a nurse, therefore I am responsible for my own actions and how good I am at my job depends on me. Why should someone else have to double check what I do when I have been trained to do it myself. If the system has so little faith in my skills then why give me a title of "Nurse". I can appreciate the fact that RN's do go to school longer but as a 20+ year nurse, on the job experience goes a long way.
  6. 0
    As a soon to be new grad, I've been wondering about this subject too. On the med-surg floor I'm on now, there is an RN and an LPN working together for every 10 patients. It is up to each individual team as to whether the nurses split pts or assign tasks, i.e. passing meds vs doing assessments. If the nurses choose to split pts, the RN is supposed to assess all of the LPN's pts once a shift and document this. Now I know that the experienced LPNs don't need me, a brand new nurse, checking off their pts! I don't want anyone to feel like I'm second guessing their assessments, however, wouldn't I also be responsible if something was going on with one the pts and wasn't acted on?
  7. 0
    It depends on what your state Board of Nursing dictates. In most states, the RN must perform the assessment and delegate accordingly.
  8. 0
    Originally posted by MartyL:
    Here we go again guys. This RN vs non-RN hogwash. It depends upon your STATE PRACTICE ACT what is deemed an "RN" task vs a task that can be "delegated." It has NOTHING to do with 20+ years or any + years and ability. It has to do with what our nursing law in each state! There's enough "outsiders" ready to throw rotten eggs at us to have us bashing each other.
    Look to your state boards for assistance in what can or cannot be delegated!
    I agree with you 100%.
  9. 0
    Originally posted by st4304:
    How are LPNs utilized at your facility? When I started on a med surg floor 6 years ago on nights, LPNs would have their own patients to assess/care for and the RNs would split the re-assessments between them. For example, if an LPN was assigned 6 pts and there were 3 RNs, each RN would have 2 pts (in addition to their own 6 pts) to assess some time during the shift. We pretty much would check the pt. over fast and document "Agree with above assessment." and move on. After I had been on the floor about 6 months, the assessment was taken away from the LPN. The reason being it was not using the LPNs time effectively since the patient had to be assessed by an RN anyway. So, we began team nursing - an RN and an LPN with the RN doing the assessments/documentation and the LPN passing meds and doing tasks (dsg changes, etc.) Soon after that I left to ICU where we were all RNs, so it has been awhile since I have done team nursing.

    The other day, our cardiac/telemetry floor had 2 call-ins, so they were staffed 2 RNs and 3 LPNs for 33 patients. My unit was working short so we could not float anyone (the same with the rest of the floors). I made a comment to a co-worker that 33 patients between 2 RNs was not safe. She stated that there were 5 nurses on that floor and they would be fine. We then had a disagreement over assessments. I said it was ridiculous for one RN to be held responsible for 15 or 16 patient assessments during a shift. She argued that LPNs could also assess and therefore each nurse would only have 6 assessments. She freq works extra on the med-surg floors and states the LPNs do assessments and tell the RNs when something is abnormal. Otherwise, she doesn't assess a pt with a negative LPN assessment.

    Don't take this the wrong way -- I could never have made it without the LPNs when I worked med-surg, and I am not saying I believe LPNs incapable of doing an assessment. I am talking about licensure. Isn't the initial admission or per/shift assessment the RNs responsibility? How is it done at other hospitals? Just curious.

    P.S. The manager of this floor was in meetings all day and got to go home at 3pm. The 2 RNs worked their 12 hrs and then did their charting until midnight. Both returned the next morning for another 12 hrs,-- their manager called in stating she was taking the day off.
    In our med/surg unit we usually have one charge RN and 2-3 LVNs and 1 CNA for each shift (same on days and nights- go figure).
    12 hour shifts; The days RN is responsible for shift assessments on 1/2 of the floor and nights RN is responsible for the other 1/2 of the floor.LVNs do their own assessments and the RN on that shift can either review and agree, or do their own separate assessment on the 1/2 of the floor they are responsible for that shift.
    16 pts for one RN to assess AND do everything else you are responsible for is ridiculous! With 33 pts on that floor I can see the only nursing that gets done is putting out fires all day and nothing else gets done does it!? But unfortunately this is the norm anymore.Sad isn't it?

  10. 0
    In Texas, it is the normal hospital policy that an RN do an assessment every 24 hours. I know for a fact that this is a statewide policy per the RN board here. I have worked statewide as a travel nurse. Along with that, I as an RN (who has a BSN....not that it MATTERS at all in reality) have worked with LVN's that I trust way more than just about any RN. I have worked ER's where it was me, another RN and a LVN, and whenever I needed assistance I called on the LVN because he was a better nurse than the RN.
  11. 0
    Here we go again guys. This RN vs non-RN hogwash. It depends upon your STATE PRACTICE ACT what is deemed an "RN" task vs a task that can be "delegated." It has NOTHING to do with 20+ years or any + years and ability. It has to do with what our nursing law in each state! There's enough "outsiders" ready to throw rotten eggs at us to have us bashing each other.
    Look to your state boards for assistance in what can or cannot be delegated!
  12. 0
    Originally posted by MartyL:
    Here we go again guys. This RN vs non-RN hogwash. It depends upon your STATE PRACTICE ACT what is deemed an "RN" task vs a task that can be "delegated." It has NOTHING to do with 20+ years or any + years and ability. It has to do with what our nursing law in each state! There's enough "outsiders" ready to throw rotten eggs at us to have us bashing each other.
    Look to your state boards for assistance in what can or cannot be delegated!
    I sincerely apologize if anyone felt my original post was "bashing" anyone. I was really just curious how other hospitals handled their assessments. I have the highest respect for ALL nurses and feel as if all of you are my sisters and brothers!

  13. 0
    It ALL depends on your state board of nursing practice act. I have worked in TX in LA and in each state the RN is responsible for signing off on any assessment done by a LPN/LVN. A current issue I am dealing with is I am unwilling to sign off on one LPN's assessments because I do not trust her assessment skills. I have worked side by side with her and have yet seen her take a stethoscope into a patient's room, yet will chart HR and Breath sounds. I have found skin assessments charted as intact, yet breakdown was noted on the prior shift.... did we have miraculous healing in 8 hrs? This has lead to some passive/agressive behavior from the LPN and since she has been at the facility longer than I have I am hesitant to go to management over it. What would you do in this case?


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