RN's signing LPN Charts

  1. At our facility in VA, we are told we have to sign all the charts and orders for the LPNs, we are doing team nursing on days so that it is automatically done. The RN assess's and does all the charting. But from 3pm to 7 am we are told we have to sign.
    Get this, they have also said that it is fraud if you sign the nursing diagnosis collum if you haven't done an assessment. I agree ~ we hadrly have time to do a decent assessment on our own, much less someone else's. I was wondering if any other facilities are doing this.
    We use to have a charge nurse on first and second shift. But ever since they sold and went for profit. That position as well as several hundred others has been eliminated.
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  2. 18 Comments

  3. by   carcha
    We have had this problem so many times , this hospital is so clever, its employing non nursing staff, LPNS and getting the RNS to cover their asses to make the insurance carriers happy. If this hospital is insisting you check all that u sign then hell, DO IT. Then when everything is behind and everyone is screaming you are simply doing what you are told. At all costs protect yourself because no one else will. I have been there and went to my manager and told her yes I will sign but I will check everything and guess what the practice changed. Good luck.
  4. by   KriseeLPN
    Quote from carcha
    We have had this problem so many times , this hospital is so clever, its employing non nursing staff, LPNS and getting the RNS to cover their asses to make the insurance carriers happy. If this hospital is insisting you check all that u sign then hell, DO IT. Then when everything is behind and everyone is screaming you are simply doing what you are told. At all costs protect yourself because no one else will. I have been there and went to my manager and told her yes I will sign but I will check everything and guess what the practice changed. Good luck.

    Just a question....are you saying that LPNs are non nusting staff?
  5. by   busyrninva
    I think she is saying that the hospital was hiring staff like PCA's CNA's . Our hospital doesn't even require a program , they train tech's on the job like in the emergency room and other floors.
  6. by   Spidey's mom
    I'm not exactly clear about what you are saying.

    When I work with a LVN, I do the assessment. Any care after the initial assessment done by the LVN is charted by the LVN. At the end of the shift as I go through the chart, I also sign at the end that I agree (or disagree-which never happens as our LVN's are awesome) with the LVN's charting.

    Unfortunately is it the RN's legal responsibility to do the initial assessment . . even though an LVN can assess a patient just fine. I think all LVN/LPN's need to be grandfathered into being a RN and just do away with the LVN/LPN category, unless you want to work in LTC only and forever.

    I still don't understand how the differentiation came about anyway.

    steph
  7. by   pickledpepperRN
    Of course an LVN is a nurse!
    I was an LVN for many years. In order to challenge the BASIC NURSING semester of the RN program I had to take Chemistry, biology, anatome, physiology, microbiology, pharmacology, psychology, and child development in addition to the regular coursework required to earn an associates degree. The LVN program is too short to gain the scientific knowledge required to take responsibility for the nursing process. We just memorized vast amounts of data.
    True many LVNs continue learning as the care for patients. Unfortunately the additional knowledge and judgement do not equal authority under the law.
    Other states have different laws and regulations.


    General California Laws and regulations:
    http://www.calnurse.org/np/rnlvnscopeindex.html

    Regarding c- signing
    http://www.calnurse.org/np/cosignlvn52104.html

    NURSING PRACTICE AND PATIENT ADVOCACY ALERT
    Co-signing LVN Charting
    Question:

    What is the position of the Board of Registered Nursing (BRN) regarding Registered Nurses co-signing LVN charting?

    Answer:

    It is the position of the Board of Registered Nursing that there is no need for an RN to co-sign for an LVN either on the medication record or in the nurse's notes. The LVN has a legal license and therefore accountability for LVN practice. Co-signing implies validation the accuracy of the LVN's charted information, and unless the RN was side-by-side with the LVN, it is doubtful tha the RN could routinely validate the LVNs charting. (Source: BRN Letter dated 11/3/03)

    If you have further questions, want a copy of the letter, need more information or help, please call CNA's Nursing Practice Program at 510/273-2200 or send email to nursingpractice@calnurses.org
  8. by   wjf00
    The facility I work at requires an RN to cosign the LPN's chart. The LPN has an entirly seperate assignment. It has not come up, but if it did I would take the time time to assess all the patients before I would ever sign off on any chart. If I am going to have tea it might as well be OT.
  9. by   CHATSDALE
    I Had A Problem With An Rn Who Would Write In Nurses Notes But Not Sign Her Name...we Would Open A Chart At Beginning Of Shift And Would Not Sign Off Until End Of Shift..rn Would Observe Something And Add To Nn W/o Signing Her Name....she Would Say Anyone Could See The Handwriting Was Not The Same...finally I Wrote Below Her Entry."above Was Written By Jane Doe, Rn Who Did Not Put In Signature....she Read It And Became Very Upset Went To Charge Nurse And To Head Nurse Thereafter The Policy Was To Sign Off After Every Entry....made A Lot More Sense....everybody Has To Be Responsibile For Their Own Actions....
  10. by   pickledpepperRN
    Quote from CHATSDALE
    I Had A Problem With An Rn Who Would Write In Nurses Notes But Not Sign Her Name...we Would Open A Chart At Beginning Of Shift And Would Not Sign Off Until End Of Shift..rn Would Observe Something And Add To Nn W/o Signing Her Name....she Would Say Anyone Could See The Handwriting Was Not The Same...finally I Wrote Below Her Entry."above Was Written By Jane Doe, Rn Who Did Not Put In Signature....she Read It And Became Very Upset Went To Charge Nurse And To Head Nurse Thereafter The Policy Was To Sign Off After Every Entry....made A Lot More Sense....everybody Has To Be Responsibile For Their Own Actions....
    Good for you!

    LPN/LVNs are licensed as are RNs. No one can "validate" the charting of another unless the two are side by side. Then is it not silly to have one document, then the other follows up wit, "I agree"

    If you were not present how can you "validate" or co-sign.
    Check with your nursing board. It seems illogical to me.
  11. by   RN34TX
    That's just more cobwebs and outdated wisdom in nursing. Too many "old school" RN's (too many of whom are in management) making decisions based on "way back when I was in school LPN/LVN's put in foleys and gave Tylenol and that was it."
    I once worked in the upper midwest where they make some clear distinction that LPN's "collect data" and RN's "assess." I failed to see the difference.
    If RN's need to sign LPN assessments, (excuse me, I mean "data collecting") then why are they licensed at all?
    Why not have them be like nursing assistants where they tell you that the RN is responsible for all the care that they provide?
    And I love when I hear the job of an LPN/LVN described as "assisting the RN" when I see those occupational career outlook books, etc.
    I started out when I was an LPN thinking that I would be "assisting" the RN just like they described. Then I realized that I was taking my own group of patients like the other RN's and that my patients had not seen an RN all day on my shift. That's some "assisting."
    We all know that RN's end up signing off charts on patients that they had not seen all shift long.
    Aren't we as RN's forgetting that LPN's are LICENSED health professionals? Not merely "assisting" the RN's?
    LPN's learn in school how to listen to lung sounds, bowel sounds, neuro checks, etc. basically everything in an assessment.
    Why must their findings be validated by an RN?
  12. by   pickledpepperRN
    From the California Code of Regulations:

    TITLE 22. Social Security
    Division 5. Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies
    Chapter 1. General Acute Care Hospitals
    Article 3. Basic Services
    70215. Planning and Implementing Patient Care

    (a) A registered nurse shall directly provide:

    (1) Ongoing patient assessments as defined in the Business and Professions Code, Section 2725(d). Such assessments shall be performed, and the findings documented in the patient's medical record, for each shift, and upon receipt of the patient when he/she is transferred to another patient care area.

    (2) The planning, supervision, implementation, and evaluation of the nursing care provided to each patient. The implementation of nursing care may be delegated by the registered nurse responsible for the patient to other licensed nursing staff, or may be assigned to unlicensed staff, subject to any limitations of their licensure, certification, level of validated competency, and/or regulation.

    (3) The assessment, planning, implementation, and evaluation of patient education, including ongoing discharge teaching of each patient. Any assignment of specific patient education tasks to patient care personnel shall be made by the registered nurse responsible for the patient.

    (b) The planning and delivery of patient care shall reflect all elements of the nursing process: assessment, nursing diagnosis, planning, intervention, evaluation and, as circumstances require, patient advocacy, and shall be initiated by a registered nurse at the time of admission.

    (c) The nursing plan for the patient's care shall be discussed with and developed as a result of coordination with the patient, the patient's family, or other representatives, when appropriate, and staff of other disciplines involved in the care of the patient.

    (d) Information related to the patient's initial assessment and reassessments, nursing diagnosis, plan, intervention, evaluation, and patient advocacy shall be permanently recorded in the patient's medical record.


    Hospitals are cheating the patients and nurses by unsafe staffing levels. Any RN who does not collaborate with an LVN on the team is a fool.
    Assessment includes not only data collection, including such sophisticated data as lung and heart sounds. Assessment is the analysis and synthesis of data to come up with a plan of care.

    An LVN being licensed is responsible for nursing care assigned by the RN. The RN is responsible for effective supervision. Hospitals have staffed in such a way as to put the license of the LVN and the RN at risk. The RN MUST be available to all patients.
    They do this yet do not PAY the LVNs for this added responsibility! Not even one cent more much less what they pay an RN. Shame on them!
  13. by   shelynch
    I am confused, and knowledge-seeking. I'm a Texas LVN transitioning over to RN graduating in May (WOOHOO!!) and I would like clarification on this subject in particular because I have to write a change paper during spring break and I think I want this to be my topic. In ethics, we are taught that LVNs observe and collect data and RNs ASSESS. This is supposedly made clear in the Texas NPA. Is this a Texas assumption that only RNs assess, or is is across the board nationwide? We're taught that (and I'm talking semantics here) that RNs assess, LVNs collect data and observe and record/report, and RNs and LVNs delegate to UNLICENSED staff duties within their abilities. Duties are not delegated to licensed staff, they are assigned. Is this all verbage? Is the truth in the way it is stated? Any help will be appreciated. I've got 4 days left to write this paper. Otherwise, I will be stuck writing on automatic-flush pumps and the effects on hydration in a LTC facility . thanks in advance!
  14. by   RN34TX
    Quote from shelynch
    I am confused, and knowledge-seeking. I'm a Texas LVN transitioning over to RN graduating in May (WOOHOO!!) and I would like clarification on this subject in particular because I have to write a change paper during spring break and I think I want this to be my topic. In ethics, we are taught that LVNs observe and collect data and RNs ASSESS. This is supposedly made clear in the Texas NPA. Is this a Texas assumption that only RNs assess, or is is across the board nationwide? We're taught that (and I'm talking semantics here) that RNs assess, LVNs collect data and observe and record/report, and RNs and LVNs delegate to UNLICENSED staff duties within their abilities. Duties are not delegated to licensed staff, they are assigned. Is this all verbage? Is the truth in the way it is stated? Any help will be appreciated. I've got 4 days left to write this paper. Otherwise, I will be stuck writing on automatic-flush pumps and the effects on hydration in a LTC facility . thanks in advance!
    I was taught the same thing in LPN school in another state. Even my LPN instructors would have to catch and correct themselves using the terms "collect data" vs. assess. The two terms can be hair-splittingly close.
    LPN's listen to lungs and that is collecting data. An RN listens to lungs but they are assessing. The difference? You tell me, but we were always firmly told that we were merely collecting data and only an RN has the ability to assess.
    Delegation vs. assignment of duties:
    Anyone can correct me here but this has been my understanding regarding Texas Nurse practice:
    The RN delegates bathing to a CNA/PCT/UAP:
    The RN delegates the activity but assumes responsibility for the care of lack of care provided
    The RN assigns a patient requiring IV therapy to an LVN:
    The LVN accepts the assignment and is responsible for the specific care they provide, such as IV therapy and held accountable in situations such as infiltration, etc.
    I think that if the RN were to delegate the care to an LVN vs. assign the care, then the RN would be accepting the level of responsibility of care as they would to an unlicensed person, such as CNA/PCT, etc.
    Anyone else care to comment or expand on this here?

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