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Active RN license working as an LPN

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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

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership. Has 15 years experience.

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

Specializes in Physiology, CM, consulting, nsg edu, LNC, COB. Has 51 years experience.

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

Specializes in school nurse. Has 29 years experience.

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

Specializes in Physiology, CM, consulting, nsg edu, LNC, COB. Has 51 years experience.

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. 

hopefulRN'17, ASN, BSN, RN

Has 3 years experience.

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. 

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

Has 14 years experience.

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

Specializes in Nursing Home. Has 9 years experience.

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

Specializes in Nursing Home. Has 9 years experience.

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. 

Edited by downsouthlaff

downsouthlaff, LPN

Specializes in Nursing Home. Has 9 years experience.

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. 

 

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?"

Closed Account 12345

Has 14 years experience.

52 minutes ago, chare said:

How do you define "RN-level care?"

I don't define it. Each state's Nurse Practice Act does. Refer to your state's standards of practice and scope of practice guidelines for RNs.

In all states, the standards establish the minimally acceptable level of practice by those holding RN licenses. 

The reasonably prudent nurse standard also helps, on a practical level.  How would a reasonably prudent RN respond to the same patient situation?  In the case of someone who strictly holds LVN licensure, the standard would be that of a reasonably prudent LVN. 

 

Closed Account 12345

Has 14 years experience.

5 hours ago, downsouthlaff said:

Passing medications is patient care. LTCs hire LPNs and RNs interchangeably all the time.

Of course passing medications is patient care. My point is that if a registered nurse is working a task-oriented assignment instead of accepting a patient load for total nursing care, she is still held to RN-level care for all patient interactions. 

LVNs are a great asset to LTCs. However, LVNs and RNs, by virtue of license, are not interchangeable. Yes, they can both provide care within an LVN's scope; however, the RN must provide care according to RN standards of practice, which are technically higher-level standards and more comprehensive, regardless of job title/job duties.  That's not an insult to LVNs. It's just a legal fact. That's why when an RN accepts an LVN assignment, there is gray area, and there can be competing interests between employment and license requirements.

downsouthlaff, LPN

Specializes in Nursing Home. Has 9 years experience.

34 minutes ago, Closed Account 12345 said:

Of course passing medications is patient care. My point is that if a registered nurse is working a task-oriented assignment instead of accepting a patient load for total nursing care, she is still held to RN-level care for all patient interactions. 

LVNs are a great asset to LTCs. However, LVNs and RNs, by virtue of license, are not interchangeable. Yes, they can both provide care within an LVN's scope; however, the RN must provide care according to RN standards of practice, which are technically higher-level standards and more comprehensive, regardless of job title/job duties.  That's not an insult to LVNs. It's just a legal fact. That's why when an RN accepts an LVN assignment, there is gray area, and there can be competing interests between employment and license requirements.

I work as an LPN in an LTC and I’m sorry to inform you that we do use RNs and LPNs interchangeably. We are both considered charge nurses, have our own patients, we both pass meds for our assigned group, both chart, both follow the care plan set forth by the RSD/MDS Nurse, we complete nurses notes, and we both notify DON and Primary MD of abnormal assessment findings. Both RNs and LPNs can work as staff nurses in LTC and they will most likely be doing the exact same job to the T. And the reason for this is because they are both primarily IMPLEMENTING the care plan. And typically the patients only need PO meds and Injections maybe an occasional IV abx and a few PEGs. The OP is not putting her license at risk. She is simply working as an LTC staff nurse. As long as she follows nursing protocols for her assigned patients her license is not at risk. 

Hannahbanana, BSN, MSN

Specializes in Physiology, CM, consulting, nsg edu, LNC, COB. Has 51 years experience.

2 hours ago, downsouthlaff said:

We are both considered charge nurses, have our own patients, we both pass meds for our assigned group, both chart, both follow the care plan set forth by the RSD/MDS Nurse, we complete nurses notes, and we both notify DON and Primary MD of abnormal assessment findings. Both RNs and LPNs can work as staff nurses in LTC and they will most likely be doing the exact same job to the T. And the reason for this is because they are both primarily IMPLEMENTING the care plan.

This is because you see the job as primarily the tasks you list here. However, a registered nurse is the only nurse (in your example, the RSD/MDS nurse) authorized (mandated) by law to plan nursing care based on assessment and analysis, and implement and/or delegate it. An LPN cannot do that. You can look it up in your nurse practice act. 
This is a common misunderstanding. But still very important from a med-legal point of view. 

Closed Account 12345

Has 14 years experience.

3 hours ago, downsouthlaff said:

I work as an LPN in an LTC and I’m sorry to inform you that we do use RNs and LPNs interchangeably. We are both considered charge nurses, have our own patients, we both pass meds for our assigned group, both chart, both follow the care plan set forth by the RSD/MDS Nurse, we complete nurses notes, and we both notify DON and Primary MD of abnormal assessment findings. Both RNs and LPNs can work as staff nurses in LTC and they will most likely be doing the exact same job to the T. And the reason for this is because they are both primarily IMPLEMENTING the care plan. And typically the patients only need PO meds and Injections maybe an occasional IV abx and a few PEGs. The OP is not putting her license at risk. She is simply working as an LTC staff nurse. As long as she follows nursing protocols for her assigned patients her license is not at risk. 

You don't need to be sorry to inform me of anything.  I can't determine if you're trying to be argumentative just for the sake of it or if you truly don't understand this concept.

RNs and LVNs are not interchangeable.  They have different licenses.  They have different scopes.  They are required to follow different standards of practice.  They have followed distinct education pathways. In a court of law, the reasonably prudent nurse standard is determined by the type of nursing license one holds.   

Your job title and job description do not determine which type of nursing license you possess, nor which scope and standards you must follow.  You are confusing employment factors (job title, job descriptions, assigned duties) with Board factors (type of license, scope of practice, standards of practice).  Board rules always supersede employer policies.  Each state's Board of Nursing is the governing body of nurses. Employers do not have the authority to tell a registered nurse that she does not need to meet RN standards.  

Yes, some employers hire LVNs an RNs to work in similar roles.  Yes, LVNs and RNs can do many of the same duties.  That's because 100% of an LVN's scope is also within an RN's scope; however, the RN's scope is broader.  I feel like you're trying to negate the distinctions between the two types of nurses as a defensive tactic.  You don't need to be defensive.  I am well aware that there are some wonderful, competent LVNs.  

The original poster is a registered nurse.  She asked about her liability as a registered nurse (by license) when working as an LVN (by job title).  Regardless of job title, she is held to the RN practice standards. Why is she held to RN practice standards?  Because she is an RN. As the previous poster mentioned, that entails a level of assessment, analysis, planning, and intervening beyond the scope of an LVN - even when caring for similar patients and carrying out similar duties. 

When serving in an LVN capacity, an RN may encounter conflicting guidelines from her employer and the Board.  Employer policies and the LVN job description may limit the level of nursing care the original poster can provide in her facility to that an of LVN.  However, failure to provide RN level care to her patients could jeopardize her license. 

 

 

 

downsouthlaff, LPN

Specializes in Nursing Home. Has 9 years experience.

1 hour ago, Closed Account 12345 said:

You don't need to be sorry to inform me of anything.  I can't determine if you're trying to be argumentative just for the sake of it or if you truly don't understand this concept.

RNs and LVNs are not interchangeable.  They have different licenses.  They have different scopes.  They are required to follow different standards of practice.  They have followed distinct education pathways. In a court of law, the reasonably prudent nurse standard is determined by the type of nursing license one holds.   

Your job title and job description do not determine which type of nursing license you possess, nor which scope and standards you must follow.  You are confusing employment factors (job title, job descriptions, assigned duties) with Board factors (type of license, scope of practice, standards of practice).  Board rules always supersede employer policies.  Each state's Board of Nursing is the governing body of nurses. Employers do not have the authority to tell a registered nurse that she does not need to meet RN standards.  

Yes, some employers hire LVNs an RNs to work in similar roles.  Yes, LVNs and RNs can do many of the same duties.  That's because 100% of an LVN's scope is also within an RN's scope; however, the RN's scope is broader.  I feel like you're trying to negate the distinctions between the two types of nurses as a defensive tactic.  You don't need to be defensive.  I am well aware that there are some wonderful, competent LVNs.  

The original poster is a registered nurse.  She asked about her liability as a registered nurse (by license) when working as an LVN (by job title).  Regardless of job title, she is held to the RN practice standards. Why is she held to RN practice standards?  Because she is an RN. As the previous poster mentioned, that entails a level of assessment, analysis, planning, and intervening beyond the scope of an LVN - even when caring for similar patients and carrying out similar duties. 

When serving in an LVN capacity, an RN may encounter conflicting guidelines from her employer and the Board.  Employer policies and the LVN job description may limit the level of nursing care the original poster can provide in her facility to that an of LVN.  However, failure to provide RN level care to her patients could jeopardize her license. 

 

 

 

It sounds to me as if you speak from a place of ignorance Iike you don’t understand the way long term care works at all. First of all, I am not arguing that LPNs and RNs are interchangeable. RNs are responsible for the entirety of the nursing process. I get that. There are thing RNs do that LPNs aren’t allowed to do. But the reason that I think you speak from a place of ignorance is the comment you made earlier about LPNs being on the med cart and just passing meds. LPNs in LTC take an assignment of patients and do more than just pass meds for them. We do Medicare assessments, we determine when to send residents to the ED with the guidance of the MD, we carry out new MD orders, dress wounds, assess for injuries after falls, complete accident report. But again I will tell you that yes to be a staff nurse in LTC an RN and an LPN can be used interchangeably. It may bother you but it’s just a matter of fact. The RN passes meds, competes Medicare charting, provides emergency care and would care as needed, assesses condition. The LPN will do the same job. Because once again they are both implementing the care plan. Just because the RN who is a staff nurse can complete the entire process doesn’t mean that they will be. The OP can not be held responsible for every LPNs action in the building just I can’t be held responsible for every CNAs action in the building by default. Our DON remains accountable 24/7 for supervising nursing practice of all staff nurses if not in person by telephone. Being a staff nurse in a nursing home is perfectly OK for an RN to do. They are more than capable of passing Meds, charting on residents, and by doing so they are not putting there license in danger as they would any other job. Closed Account I think most of us just don’t understand what your arguing ? That by passing meds in a nursing home and performing assessments on residents that RNs are putting there license in jeopardy ? Nearly every acute care registered nurse I know passes meds. So what do you mean ?