Active RN license working as an LPN

Closed Account 12345 · Jun 5, 2021

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 · Jun 5, 2021

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 · Jun 5, 2021

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 · Jun 5, 2021

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 · Jun 5, 2021

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 · Jun 6, 2021

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 ?

downsouthlaff, LPN · Jun 6, 2021

3 hours ago, Hannahbanana said:

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.

Actually the RSD/MDS Nurse is an LPN. But the DON takes responsibility. I’m not arguing the point that your making. I’m simply saying that If another RN, who is the DON has set forth the care plan, after completing the initial assessment and performing nursing dx, and the staff nurses are implementing the care plan whether it be RN or LPN then they will be doing the same job. I just like a registered nurse who is doing my job can perform ongoing assessments and notify the MD directly of a change in condition. So yes my RN counter parts who can practice the nursing process independently, and perform more tasks that I can do can do things that I cannot. But when we are working as staff nurses we are both implementing the nursing process and conducting on doing assessments so therefore we are doing the same job at that time. But as an RN in LTC just like in the hospital the OP will charge over CNAs and over a unit of patients. She will be the primary nurse for these patients. She will pass the meds, do routine Medicare assessments and report to the DON and the MD. Similar to an acute care RN reporting to the charge RN. It’s no different. As long as she practices these duties as a prudent registered nurse she can’t be held liable for any wrong doing. RN staff nurses in LTC are not a new concept.

downsouthlaff, LPN · Jun 6, 2021

Dear OP, I wanna give you the least confusing and best advice possible to find out this answer for sure chat with your DON or ADON, and check to make sure there are no by default rules specific to your state. I can speak from years of experience in this environment that typically the answer is no. As I said I have worked along side RNs that have worked as floor nurses just as I have. They weren’t in a supervisory capacity, only a nurse for their own assignment and responsible for their residents and CNAs. The CMS requirement for all federal nursing homes is that an RN must be present for 8hrs a day. After that time the LPNs May work without an RN present as long as their is an RN (ADON, DON, RN supervisor) available to the LPN by phone. LTC DONs know going in that they will have to be very trusting of LPNs capabilities and of course if they take the position they have no issue with this. So it’s more than likely understood that your DON is filling the legal technicality to complete the practice requirements of the LPNs at your facility. That’s how it typically operates. But just chat with your DON to find out. Best wishes and best of luck in long term care.

Closed Account 12345 · Jun 6, 2021

1 hour ago, downsouthlaff said:

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 ?

On 5/29/2021 at 1:29 AM, Anon143 said:

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

Oh my goodness, reading matters. This is my last reply because I don't know I can possibly phrase this in a simpler way.

Yes, I'm pretty sure "most of us" do understand exactly what I've said. Even when RNs and LVNs are performing the same job roles in a long term care facility, or any work place, that does not mean they are "interchangeable." The RN must practice at an RN level established by the state Board of Nursing. The LVN practices according to LVN standards. When an RN is considered an LVN by her employer, things get a bit more complicated.

At no point have I implied that RNs should not work in LTC facilities. At no point have I expressed the viewpoint that RNs who work in LTC facilities are somehow less than. At no point have I said anything negative about LVNs. Take the time to re-read the original post (quoted above) and my responses. You will see how my responses directly address what the original poster asked.

No, obviously an RN following RN standards is not putting their license in jeopardy by working in a long term care facility. That's why nobody in this thread has said any such thing. If you re-read the original post, the registered nurse asked if she will be "held to the RN standard" regardless of her LVN assignment. The answer is yes; registered nurses are always held to the registered nurse standard regardless of job title. An RN who is employed as an LVN potentially risks conflicts between employment limitations (LVN job description and related employer policies) and the Board (RN licensure). This is a gray area. This has been noted in the multiple posts by people saying nurses are required to practice according to their highest nursing license.

At no point did I imply that LVNs are only capable of passing medications. Please see the bold words in the original post above mentioning medication cart duties. There is a reason I mentioned observations that might occur while the RN acting as an LVN is passing medications. The reason is not because I think LVNs are only capable of passing medications. The reason is because the RN specifically asked about being assigned to a medication cart and if she'd also be responsible for patients on other medication carts.

I have not said anything insulting about LVNs in any of my posts. Try reading them again without looking for a battle.

downsouthlaff, LPN · Jun 6, 2021

6 minutes ago, Closed Account 12345 said:

Oh my goodness, reading matters. This is my last reply because I don't know I can possibly phrase this in a simpler way.

Yes, I'm pretty sure "most of us" do understand exactly what I've said. Even when RNs and LVNs are performing the same job roles in a long term care facility, or any work place, that does not mean they are "interchangeable." The RN must practice at an RN level established by the state Board of Nursing. The LVN practices according to LVN standards. When an RN is considered an LVN by her employer, things get a bit more complicated.

At no point have I implied that RNs should not work in LTC facilities. At no point have I expressed the viewpoint that RNs who work in LTC facilities are somehow less than. At no point have I said anything negative about LVNs. Take the time to re-read the original post (quoted above) and my responses. You will see how my responses directly address what the original poster asked.

No, obviously an RN following RN standards is not putting their license in jeopardy by working in a long term care facility. That's why nobody in this thread has said any such thing. If you re-read the original post, the registered nurse asked if she will be "held to the RN standard" regardless of her LVN assignment. The answer is yes; registered nurses are always held to the registered nurse standard regardless of job title. An RN who is employed as an LVN potentially risks conflicts between employment limitations (LVN job description and related employer policies) and the Board (RN licensure). This is a gray area. This has been noted in the multiple posts by people saying nurses are required to practice according to their highest nursing license.

At no point did I imply that LVNs are only capable of passing medications. Please see the bold words in the original post above mentioning medication cart duties. There is a reason I mentioned observations that might occur while the RN acting as an LVN is passing medications. The reason is not because I think LVNs are only capable of passing medications. The reason is because the RN specifically asked about being assigned to a medication cart and if she'd also be responsible for patients on other medication carts.

I have not said anything insulting about LVNs in any of my posts. Try reading them again without looking for a battle.

I think we are just misunderstanding each other here because I hear what you are saying, but I don’t know if the OP is maybe confused thinking that her or she is working as an LPN, but an LPN just like an RN is a nurse your either or the other based on your license. But I don’t think it’s possible that an RN could work as an LPN per say. Especially without even having an LPN license. That’s where the confusion comes in. I am not 100 percent certain and I don’t mean to judge the OP, but my suspicion is that the OP may believe she’s working as an LPN because maybe at her facility being a floor nurse is predominantly an LPN job for cost saving measures or for whatever other reason, but the reality is that RNs who work the floor in LTC are not RNs working as LPNs , they are simply working as LTC floor nurses who are RNs.

Closed Account 12345 · Jun 6, 2021

29 minutes ago, downsouthlaff said:

But I don’t think it’s possible that an RN could work as an LPN per say.

Sometimes, management might have approval for a full time LVN position but not an RN position. Because RNs can meet the job requirements for the LVN position, they might find an RN willing to work for the lower pay "as an LVN." You're exactly right that unless an RN concurrently holds both RN and LVN licenses (which is possible in my state), she isn't technically working "as an LVN." She's an RN just filling an LVN staffing need.

That's where things get a bit murky. Theoretically, an RN working "as an LVN" should be just fine. RNs and LVNs are both capable of taking vital signs, providing wound care, checking blood glucose, passing meds, etc. No problem, right? Wrong! Problems can occur when employer policies conflict with Board standards for the nurse's highest license.

Example: You hold both LVN and RN licenses. In this facility, you are employed as an LVN. You signed the LVN job description, and policy states that LVNs at this facility can't do XYZ. However, according to Board standards, a reasonably prudent RN would respond to your patient's situation by doing XYZ. You are, by license, held to the RN standard.

If you do XYZ and meet the standards of your RN license, you have violated employer policy. If you don't do XYZ, you have failed to follow the RN standards of practice.

It's just a potential problem nurses need to be aware of when working "below" their highest license. The same considerations apply to new graduate RNs who continue working as patient care techs or NPs who keep working as bedside RNs. Most of the time, things are probably fine! Sometimes, they get tricky.

downsouthlaff, LPN · Jun 6, 2021

17 minutes ago, Closed Account 12345 said:

Sometimes, management might have approval for a full time LVN position but not an RN position. Because RNs can meet the job requirements for the LVN position, they might find an RN willing to work for the lower pay "as an LVN." You're exactly right that unless an RN concurrently holds both RN and LVN licenses (which is possible in my state), she isn't technically working "as an LVN." She's an RN just filling an LVN staffing need.

That's where things get a bit murky. Theoretically, an RN working "as an LVN" should be just fine. RNs and LVNs are both capable of taking vital signs, providing wound care, checking blood glucose, passing meds, etc. No problem, right? Wrong! Problems can occur when employer policies conflict with Board standards for the nurse's highest license.

Example: You hold both LVN and RN licenses. In this facility, you are employed as an LVN. You signed the LVN job description, and policy states that LVNs at this facility can't do XYZ. However, according to Board standards, a reasonably prudent RN would respond to your patient's situation by doing XYZ. You are, by license, held to the RN standard.

If you do XYZ and meet the standards of your RN license, you have violated employer policy. If you don't do XYZ, you have failed to follow the RN standards of practice.

It's just a potential problem nurses need to be aware of when working "below" their highest license. The same considerations apply to new graduate RNs who continue working as patient care techs or NPs who keep working as bedside RNs. Most of the time, things are probably fine! Sometimes, they get tricky.

In this case and scenario then your argument makes perfect sense. It’s not clear whether the RN/OP holds both licenses. And I wanna reitierate that I am in no delusion that RN and LPN scope is the same or interchangeable, the only point that I was trying to make was many LTCs however will use them interchangeably and the DON will assume responsibility for the practice of the LPN even though they will be entirely hands off, and in reality the LPN will be making most of the assessments, decisions etc. But in the OPs case, I get where your coming from if he/she only has an RN license it needs to be clear that she will be allowed to work under the title and scope of RN. I really don’t see why the wouldn’t other than getting away with paying a Lower wage. But even at my facility our RN staff nurses may make significant less than they do in acute care but they are still employed and called RNs.