Active RN license working as an LPN

[Anon143]

While working in a long term facility, if you work as an LVN with active RN license, are you legally responsible for not only your patients, but ALL of the patients in the building & held to the RN standard?

For Example, as an LVN, you are assigned to pass medications to a selective amount of patients. These are the patients that you pass meds & chart of and are in charge of care for. BUT, if something happens to other patients on another cart or another side, even if you aren’t their LVN, can you be responsible for them & have it fall on you as an RN because you hold an RN license?

[klone, MSN, RN]

Let me ask you this....if you are an RN working as an RN, and another patient in another wing  being taken care of by another RN is harmed, and you had nothing to do with their care, would you be held responsible? 

[Hannahbanana, BSN, MSN]

I can’t speak to the organizational structure in your building, but there is overwhelming precedent in state nurse practice acts that no matter what your job description or title, if you hold a valid RN license that determines your standard of practice.
You can never say, “I’m just a CNA/LPN/LVN/MA today.” If you don’t meet RN std of care in something, that will not protect you for an instant. 

[Jedrnurse, BSN, RN]

If your job isn't that of building supervisor why would you think that having an RN license automatically puts you in that position? Yes, you would be held to that level of professional expectations re: your patients, but why everybody...?

[Hannahbanana, BSN, MSN]

On 5/29/2021 at 8:52 AM, Jedrnurse said:

If your job isn't that of building supervisor why would you think that having an RN license automatically puts you in that position? Yes, you would be held to that level of professional expectations re: your patients, but why everybody...?

The only thing I could think of was that maybe they had a policy that any RN in the building would respond to certain events or situations and/or cover for an absent RN on the other side, and if she were working “as an LPN/CNA” she could skip that responsibility… but she can’t. 

[emergenceRN17, ASN, BSN, RN]

I didn't even know that you could still work as an LPN with an RN license.  Where I am, we are held to our highest license. 

[caliotter3]

33 minutes ago, hopefulRN'17 said:

I didn't even know that you could still work as an LPN with an RN license.  Where I am, we are held to our highest license. 

Depends on where this is to happen.  But generally, even where an RN is working in an LPN slot, they are going to be held to the RN standards of practice.  This situation primarily comes into question when a licensed nurse is working in the role of a CNA/PCT where there is a more clear divide between professional accountabilities.

[Closed Account 12345]

Do you actually hold an LVN license?  Otherwise, you're not working as an LVN. You're working as an RN with a task-oriented job description and the pay of an LVN.  Regardless, you're accountable for adhering to the standards of practice of your highest license.

Let's say that the LVN job description only requires you to pass meds, not assume the role of patient care. If you notice someone has skin breakdown, you, as an RN, are still responsible for making sure it's addressed. You can't pretend you don't see the problem with your RN assessment skills. That doesn't mean you need to be the one personally treating the problem, but you'd need to document your findings and which responsible nurse you informed. If you noticed one of the patients you were passing meds to was in acute respiratory distress, and the patient's nurse wasn't immediately available at the bedside, you'd need to respond with RN-level care.  Having an RN license doesn't make you responsible for all patients in a building or other nurses' patients, but it does make you responsible for addressing issues you observe.

Many times, nurses are discouraged from working "below" their highest license because this can pose a problem. You are required to provide RN-level care because you hold an RN license, regardless of your job title. Your employer's policies and the scope of practice for the LVN position you have accepted may conflict with your duty as an RN. By responding in the way an RN should, you may be violating your employer's policy. By failing to respond to certain situations as an RN should, you would be risking your license (and the patient's well-being).

As a side note, I'd hope if any patient in your unit was having a true medical crisis requiring RN-level intervention that it wouldn't sit well with you to be like "dang, too bad I'm just working as the med cart LVN today and can't help."

[downsouthlaff, LPN]

If you have an RN license and your working as a staff nurse in LTC, your working as an RN not an LPN. Passing meds and doing routine floor nurse duties is not just an LPN thing in LTC. And no even if your the only RN present, if it’s not understood that your the supervisor you will not be held liable for the other LPNs doing the same job as you. That’s what the DON or supervisor is for. LPNs can work under supervision of the DON/RN or APRN by telephone consultation it doesn’t have to be direct supervision. So if your job is floor nurse, and to only take care of residents under your assignment then no your not responsible as long as the LPN is caring for his her patients within his or her scope and reporting to an established supervisor (DON, NP, MD). In LTC typically there’s rarely any kind of occurrence that an LPN can’t handle within their own scope in Mr experience. 

[downsouthlaff, LPN]

15 hours ago, Closed Account 12345 said:

Do you actually hold an LVN license?  Otherwise, you're not working as an LVN. You're working as an RN with a task-oriented job description and the pay of an LVN.  Regardless, you're accountable for adhering to the standards of practice of your highest license.

Let's say that the LVN job description only requires you to pass meds, not assume the role of patient care. If you notice someone has skin breakdown, you, as an RN, are still responsible for making sure it's addressed. You can't pretend you don't see the problem with your RN assessment skills. That doesn't mean you need to be the one personally treating the problem, but you'd need to document your findings and which responsible nurse you informed. If you noticed one of the patients you were passing meds to was in acute respiratory distress, and the patient's nurse wasn't immediately available at the bedside, you'd need to respond with RN-level care.  Having an RN license doesn't make you responsible for all patients in a building or other nurses' patients, but it does make you responsible for addressing issues you observe.

Many times, nurses are discouraged from working "below" their highest license because this can pose a problem. You are required to provide RN-level care because you hold an RN license, regardless of your job title. Your employer's policies and the scope of practice for the LVN position you have accepted may conflict with your duty as an RN. By responding in the way an RN should, you may be violating your employer's policy. By failing to respond to certain situations as an RN should, you would be risking your license (and the patient's well-being).

As a side note, I'd hope if any patient in your unit was having a true medical crisis requiring RN-level intervention that it wouldn't sit well with you to be like "dang, too bad I'm just working as the med cart LVN today and can't help."

Passing medications is patient care. LTCs hire LPNs and RNs interchangeably all the time. In LTC the plan of care is typically established and the LPN or RN floor nurse implements the care plan. Pass meds, consult MD as needed, Note skin problems wounds etc. I really don’t see how an RN is putting his or her  license in jeopardy working in an LTC nurse position being that everything that’s In an LPN scope an RN can legally do. 

[downsouthlaff, LPN]

3 hours ago, downsouthlaff said:

Passing medications is patient care. LTCs hire LPNs and RNs interchangeably all the time. In LTC the plan of care is typically established and the LPN or RN floor nurse implements the care plan. Pass meds, consult MD as needed, Note skin problems wounds etc. I really don’t see how an RN is putting his or her  license in jeopardy working in an LTC nurse position being that everything that’s In an LPN scope an RN can legally do. Also, an LPN or LVN in a nursing home setting is not a skill jockey as you have painted. Most state boards require LPN/LVNs to use clinical judgment, and LPNs nursing homes typically not only pass meds for the unit but respond to emergencies and condition changes with their patients at well. As far as the patient requiring RN intervention, there’s really not much more that an RN can do in the LTC setting that an LPN can when responding to emergencies. You can’t push Epi, the patients not intubated. The best you can do is slap on 02 and call an ambulance, maybe administer a PRN bronchodilator if ordered for the patient but that’s about it. Both the RN and LPN will be acting as a BLS provider until EMS arrives. No disrespect to RNs at all, I could never do the the things RNs do in a Critical care setting. But LTC is the the basic of the basic when it comes to nursing care, and quite frankly in LTC a nurse is a nurse. 

 

[chare]

19 hours ago, Closed Account 12345 said:

[...]

Many times, nurses are discouraged from working "below" their highest license because this can pose a problem. You are required to provide RN-level care because you hold an RN license, regardless of your job title. ...

[...]

How do you define "RN-level care?"