LPN goin beyond scope of practice

Nurses Safety

Published

LPN was doing assessments and discharges on patients. This is beyond her scope of practice but no patients have been harmed as a result of this so if reported the BON will most likely just "tap her on the hand" right? Nursing Staff development came and told her to stop doing it and she has stopped. I figure as long as she nows realizes she shouldn't be doing it, no harm no foul correct?

My only issue is that our Nurse Manager knew she would be doing these things and still hired her in the department and knowingly allowed her to do these tasks???:confused: Its like she didn't care that this could potentially get this nurse and herself in trouble? Or maybe she feels like its not that big a deal and no serious actions would ever be taken if it were ever to be reported?:rolleyes:

Should I bother or not?

Specializes in LTC Rehab Med/Surg.

Whistle blowers never win. Consider that every time you're trying to decide whether or not to report your boss, your facility, or your fellow nurse.

Ethically, sometimes you have a choice and sometimes you don't.

Specializes in LTC, Pediatrics, Renal Med/Surg.
SweetheartRN, you have a lot to learn about the nursing profession.#1. You should not assume the role of administration/management by making it your duty to report what you think someone should/should not be doing. #2. Be careful who you throw under the bus because you may be in a situation one day where you need help and no one will come to your aid. #3. Do not have this high and mighty sense of self (because you are an RN)because rememember everyone is a part of the team and each role is important. #4. MIND YOUR BUSINESS, do your own work, focus on administering care to your patients who you are responsible for,and focus on how you can improve yourself to become a stronger nurse.#5. Brown nosing and whistleblowing gets you nowhere.

Hardygirl, I think you are coming from a good place with your response and I really appreciate your objective viewpoint. However it isn't what I think but what the state thinks.....don't know why this seems to be difficult to understand...each role is important and that's the point of roles....to work within your role as a part of a team. I feel I have learned quite a great deal about the nursing profession and alot of it involves covering things up/helping those you want to help, playing by the rules when its convenient for you and lots of favoritism. I was an lpn before I was an rn so I know what its like to be in that role. I have also come to see that brownosing works quite well...it did for the lpn in question. Favoritism is fine in nursing but whistleblowing is a big no no.

I digress as obviously it is my decision to make but thanks for all the responses!

I am an LPN in NYS, and in the past, some of the RN's in our facility told us to do assessments and that they would cosign them. This practice was discovered during a mock state survey we had. Our policy is now based on the NYS law that says 'only RN's can do skin/wound assessments', but still the 'busy' RN's ask us to do it. It was also discovered that LPN's were doing alot of work on care plans, and NYS law states that only an RN can initiate care plan. But we still are asked to start care plans. When we leave care plan paperwork for the RN to do, our RN nurse manager hands it right back to us and says you have to do this. Maybe some LPN's feel good that they know how to do RN work and are proud of their accomplishments, or just want to keep their superior happy. But just because they tell you to do it doesn't mean that you are legally allowed to. They're are ramifications for the RN who delegates, and the LPN whe agrees to work out of her scope. Many of us are between a rock and a bigger rock.

Specializes in Geriatric, Pediatric, Hospice,Psych.

SweetheartRN, I am glad that you understand the roles of the healthcare team, and I completely understand that you are trying to uphold the law of the land, however, what you fail to understand is that if you feel that this matter is reportable, then go through your chain of command. The rest is up to administration to follow up with the issue of the nurse who is practicing outside her scope. Contacting the BON can open a can of worms and could possibly jeopordize someone's career. I can understand calling the BON if there is a case of patient abuse, diverting meds, etc, etc. But if administration is already made aware that this nurse is doing admissions and discharges and they didnt make a big deal, then why are you? As you probably already know, if you go over administration's head it won't be pretty. But hey, it is your decision as you said, so good luck to you, hope your mission is accomplished ;)

In our state, LPNs are allowed to do assessments and discharges, as long as an RN cosigns the paperwork with them. At our hospital, we utilize the help of the LPNs and don't complain when one steps up and says, "it's okay, I've done that assessment," or, "don't worry, I'll handle that discharge." I don't want to sound rude, but I feel like it's a little ridiculous to consider reporting this to the BON. However, I do admire the fact that you are so concerned with patient safety and correct procedure. The best advice I can give is to Google state policies and procedures for whatever state you live in and find out for sure what the scope of practice for an LPN is. If you do that, there won't ever be another question about whether an LPN is doing something outside the scope of their practice. Also, like you said in your post, no one was harmed so the LPN, or LPNs, involved obviously know what they are doing. I say just relax, let it go, and look up the scope of practice.

Where I live I can do assessments, discharges, admissions, and initiate care plans. In some facilities I can also initiate wound treatments. An RN has to sign off on them, and I pass them off per protocol, but it's not my fault if the RN doesn't get to them when they should. Why report the LPN for that?

Why would it be necessary to even report the RN when they're probably up to their earlobes in paperwork and are unable to stay on top of every little thing that they should be doing?

If the LPN is doing these tasks and the State BON says it outside the scope of practice, my first concern would be that the fault lies in the facility that is making LPNs practice outside their scope and is then not making it possible for the RN to follow up.

That then puts both the RN and the LPN at risk when they are just trying to do their jobs to the best of their abilities in a facility that doesn't give a crap.

I have no opinion on the OP topic.

What I do have strong feelings on are the statements that this is none of the OPs business.

Under the ANA Code of Ethics this would fall under:

3.5 Acting on Questionable Practice

6.2 Influence of the Environment on Ethical Obligations

6.3 Responsibility for the Health Care Environment

Not to mention the OP almost certainly has a legal obligation under her NPA to question and report perceived questionable practice by a fellow nurse.

Every nurse has the legal and ethical obligation to monitor and report any perceived questionable acts of practice, I give kudos to the OP for having the courage to ask her cohorts what their advice is knowing full well that she would not receive favorable attention from many.

Specializes in Peds/outpatient FP,derm,allergy/private duty.

SweetHeartRN-

Normally I don't read prior posts but in your case I did, which details the history of your employment with the hospital and all the politics and your resentment of this person because you basically feel she got hired for the job you felt entitled to have. You commented about how because you were hired as a nurse's aide, you were upset because you were "stuck doing vitals", and how she can't even get meds without help" etc. You talked about the "underhanded maneuvering".

You've called the employee helpline, talked to numerous other nurses and ascertained their feeling that an RN was a better choice because this particular person can't do all the things you would be able to do. I would be upset, too if two more RNs were hired while all of this was going on and you had worked there as a unit secretary and as an NA.

Now you and your family are (or want to) talk to the Public Relations Department of your hospital because of the injustice you feel has occurred here that "reflects badly on the hospital". So I respect what Systole and others have said, I don't think this is simply an objective case because you are concerned someone might be harmed by this individual. They might not see it as courageous at this point if your facility is the same gossip mill that every place I've worked for has been to some degree.

I hope things get better for you and that you can be hired as a new grad RN someplace and that you got a raw deal from the hospital. ...

Specializes in ER, Family Practice, Free Clinics.
In my state(NY) LPN's are absolutely not allowed to assess or discharge patients. They are allowed to collect data and consult with the RN about what they have collected but the RN has the final say.

Yikes, that sounds like a tech/ nursing assistant job.

I feel bad that people go to college, become an LPN, and can't get hired/get pigeonholed into nursing assistant roles. We should either let them do everything they are trained to do or get rid of LPN training programs all together. Just feels like a bait and switch.

Specializes in Family Practice, Mental Health.
I have no opinion on the OP topic.

What I do have strong feelings on are the statements that this is none of the OPs business.

Under the ANA Code of Ethics this would fall under:

3.5 Acting on Questionable Practice

6.2 Influence of the Environment on Ethical Obligations

6.3 Responsibility for the Health Care Environment

Not to mention the OP almost certainly has a legal obligation under her NPA to question and report perceived questionable practice by a fellow nurse.

Every nurse has the legal and ethical obligation to monitor and report any perceived questionable acts of practice, I give kudos to the OP for having the courage to ask her cohorts what their advice is knowing full well that she would not receive favorable attention from many.

I concur.

Doing a full assessment on a patient and signing "LPN" behind it - in and of itself - does not constitute gross negligence or incompetence. The fact that the employer took that assessment as final and complete is not the fault of the LPN.

HOWEVER.....

If the LPN willfully and knowingly performed functions that were limited to the RN scope of practice in the state that the LPN is practicing in, is this going to be the consensus of this forum to state that the OP is going overboard in questioning this practice and to turn a blind eye to this incident since the employer decided to remove their blessings from the practice in question?

Specializes in LTC, Pediatrics, Renal Med/Surg.
SweetHeartRN-

Normally I don't read prior posts but in your case I did, which details the history of your employment with the hospital and all the politics and your resentment of this person because you basically feel she got hired for the job you felt entitled to have. You commented about how because you were hired as a nurse's aide, you were upset because you were "stuck doing vitals", and how she can't even get meds without help" etc. You talked about the "underhanded maneuvering".

You've called the employee helpline, talked to numerous other nurses and ascertained their feeling that an RN was a better choice because this particular person can't do all the things you would be able to do. I would be upset, too if two more RNs were hired while all of this was going on and you had worked there as a unit secretary and as an NA.

Now you and your family are (or want to) talk to the Public Relations Department of your hospital because of the injustice you feel has occurred here that "reflects badly on the hospital". So I respect what Systole and others have said, I don't think this is simply an objective case because you are concerned someone might be harmed by this individual. They might not see it as courageous at this point if your facility is the same gossip mill that every place I've worked for has been to some degree.

I hope things get better for you and that you can be hired as a new grad RN someplace and that you got a raw deal from the hospital. ...

Thankyou Nursel56:heartbeat

Edited to say I forgot to say I have been working with PSA because that is all I could find plus its kiddies so that part of it is nice.

+ Add a Comment