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?

[Hannahbanana, BSN, MSN]

On 6/5/2021 at 12:47 PM, chare said:

How do you define "RN-level care?"

Only RNs can assess, analyze, and make nursing diagnoses and then develop a nursing plan of care to be implemented. 

21 hours ago, downsouthlaff said:

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.

Tasks do not define level of practice. Yes, an RN is covered for performing LPN level tasks. Big but here: If an RN is not doing those Mcare and fall assessments and determining what comes next, that would be a big red flag in any injury case I would see. You don’t have to like that part, but it’s in your state nurse practice act and in the ANA Scope and Standards of Nursing Practice that applies to every nurse in the US (you can look it up).

 

21 hours ago, downsouthlaff said:

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. 

 

[downsouthlaff, LPN]

1 hour ago, Hannahbanana said:

Only RNs can assess, analyze, and make nursing diagnoses and then develop a nursing plan of care to be implemented. 

Tasks do not define level of practice. Yes, an RN is covered for performing LPN level tasks. Big but here: If an RN is not doing those Mcare and fall assessments and determining what comes next, that would be a big red flag in any injury case I would see. You don’t have to like that part, but it’s in your state nurse practice act and in the ANA Scope and Standards of Nursing Practice that applies to every nurse in the US (you can look it up)

 

Hanabannana, first of all you should know that every state the LVN/LPN is giving a different level of responsibility. In some states LPNs can push IV meds, hang blood, perform assessments in others they can simply gather data. The ANA does not make the rules for state scope of practice. My BON does allow LPNs to peform an assessment for injuries, and then use clinical judgement to determine who to notify. Don’t like that ? Take it up with the state BONs who Allow it. There is no such thing as LPN work. Administering meds, assessing patients, documenting nurses notes is RN work as well. I’m going to go out on a limb here and say that’s it’s perfectly legal for an RN to follow a care plan set forth by another RN. Unless it specifies as closed account written that she can only work to an LPN job description and cannot carry out RN tasks, then the OP has nothing to worry about. A competent RN should be able to carry out tasks of an LTC staff nurse without worrying about legal trouble 

 

1 hour ago, Hannahbanana said:

 

[downsouthlaff, LPN]

2 hours ago, Hannahbanana said:

Only RNs can assess, analyze, and make nursing diagnoses and then develop a nursing plan of care to be implemented. 

Tasks do not define level of practice. Yes, an RN is covered for performing LPN level tasks. Big but here: If an RN is not doing those Mcare and fall assessments and determining what comes next, that would be a big red flag in any injury case I would see. You don’t have to like that part, but it’s in your state nurse practice act and in the ANA Scope and Standards of Nursing Practice that applies to every nurse in the US (you can look it up)

Hanabanna, you also say that only an RN can assess, analyze, and interpret, and formulate a nursing diagnosis, but your statement is inaccurate. While in every state the RN must coordinate and review the process, some states do allow LPNs to assess, diagnose, and implement nursing care as long as the RN co signs and maintains responsibility. So saying that they cannot is just not accurate. 

Quote

 

[Hannahbanana, BSN, MSN]

13 hours ago, downsouthlaff said:

Hanabanna, you also say that only an RN can assess, analyze, and interpret, and formulate a nursing diagnosis, but your statement is inaccurate. While in every state the RN must coordinate and review the process, some states do allow LPNs to assess, diagnose, and implement nursing care as long as the RN co signs and maintains responsibility. So saying that they cannot is just not accurate. 

That’s a big difference, though, isn’t it! The LPN cannot be held accountable for these critical parts of the nursing process. It’s the RN who controls and is responsible. Saying the LPN can do data collection (they can) but the RN alone bears responsibility for the nursing plan of care isn’t saying that they have coequal status via  licensure and accountability. This is a significant distinction.
If you want legal professional accountability, achieve RN licensure. 

[Hannahbanana, BSN, MSN]

14 hours ago, downsouthlaff said:

Hanabannana, first of all you should know that every state the LVN/LPN is giving a different level of responsibility. In some states LPNs can push IV meds, hang blood, perform assessments in others they can simply gather data. The ANA does not make the rules for state scope of practice. My BON does allow LPNs to peform an assessment for injuries, and then use clinical judgement to determine who to notify. Don’t like that ? Take it up with the state BONs who Allow it. There is no such thing as LPN work. Administering meds, assessing patients, documenting nurses notes is RN work as well. I’m going to go out on a limb here and say that’s it’s perfectly legal for an RN to follow a care plan set forth by another RN. Unless it specifies as closed account written that she can only work to an LPN job description and cannot carry out RN tasks, then the OP has nothing to worry about. A competent RN should be able to carry out tasks of an LTC staff nurse without worrying about legal trouble 

I do know that. As a matter of fact, since you have clearly not read the ANA S&S, you don’t know that they do not address tasks, which are determined by the BoNs. I think you may well find that your state scope and standards mirror the ANA ones very closely— many states use them verbatim.

The “who to notify” part you mentioned is the important one: the LPN cannot independently  initiate and implement a plan of care that has not been approved by the RN. The ”work” you cite are tasks. The most important nursing work of determining needs and planning to meet them is a responsibility reserved to the RN licensure.

I don’t know what “closed account written that...” means. Regardless of job description, a nurse holding RN licensure will be held to that standard of practice.

[downsouthlaff, LPN]

11 hours ago, Hannahbanana said:

I do know that. As a matter of fact, since you have clearly not read the ANA S&S, you don’t know that they do not address tasks, which are determined by the BoNs. I think you may well find that your state scope and standards mirror the ANA ones very closely— many states use them verbatim.

The “who to notify” part you mentioned is the important one: the LPN cannot independently  initiate and implement a plan of care that has not been approved by the RN. The ”work” you cite are tasks. The most important nursing work of determining needs and planning to meet them is a responsibility reserved to the RN licensure.

I don’t know what “closed account written that...” means. Regardless of job description, a nurse holding RN licensure will be held to that standard of practice.

I think that you have completely lost me here and do not understand what point I am trying to make here. Yes the RN maintains responsibility for the nursing process. I understand that and I’m not arguing that point with you. But do you know how LTC facilities are set up ?? Do you know the style of nursing that these facilities use? Do you know the level of care that is provided in these facilities? You can sit here and argue with me about all the technicalities until heck freezes over it won’t change the fact that most LTCs use staff nurses interchangeably be it RN or LPN. The technicalities are met. And the law is not being broken. For example  in a scenario type situation, “The RN floor nurse is working at an LTC facility, during her Med pass she noted that a patient is hypoxic. She performs an assessment and diagnosis the patient with impaired gas exchange, she applies PRN 02 per standing order, she plans to monitor the patient and notify the NP on call. The NP gives new orders to send the resident to ER for eval, she carries out the order,” An LPN who is passing meds in a LTC facility notes this same scenario, resident hypoxic. The LPN places the resident on 02, and determines the need for immediate intervention, and reports the findings to the on call NP. The NP gives an order to send to the ED and the LPN carries out, the technicality has been met, and the outcome for the patient is the same. And the law of nursing was not violated. The technicalities and word play are very easy to get around and I’m not saying that’s a good thing just saying it’s the facts. And I don’t need to go back to gey my RN to have professional accountability. I may not be responsible for the entire nursing process but you best believe that I am independently accountable for Mr actions and decision making to my board of practical nursing. 

 

 

[downsouthlaff, LPN]

18 minutes ago, downsouthlaff said:

Hannahbanana, this has become about arguing LPN vs RN scope and I never intended to go their. The OP simply wanted to know that if she’s working as a floor nurse in a LTC facility and she happens to be the only RN in the building, is she responsible for all the LPNs and CNAs in the building. And my response is, as long as she’s working on a unit assigned to her by the DON, which it’s clear that she will be responsible for her residents and CNAs, and the state allows LPNs to work under telephone supervision, and the DON or an on call APRN is the LPNs designated telephone supervisor, then I say no, she can’t be held accountable. Do you agree with this ? Or disagree? I think that’s the answer the OP seeks. As far as the role as floor nurse role in LTC it’s very task oriented. It doesn’t mean that RNs cannot do it. The tasks require the skill and judgement of a licensed nurse whether it be RN or LPN but it doesn’t mean RNs in LTC who work as floor nurses can’t be held to their standard of practice. 

 

 

 

[NRSKarenRN, BSN, RN]

I started as LPN in 1977, When I passed  RN state boards in 1982, I was required to give up my LPN license  per PA BON regulations as only highest license permitted; it's listed as expired.

Please confirm with your Board of nursing -- link found bottom every allnurses page.

Elkpark answered this question well in previous thread

 

 

[Hannahbanana, BSN, MSN]

I am quite familiar c SNF operations. I completely understand that many RN and LPN functions overlap in them. I stand by my statement that an overlapping function set does not mean professional equivalence. I agree we’ve beat this one to death now, though. 

[downsouthlaff, LPN]

On 6/8/2021 at 5:24 AM, Hannahbanana said:

I am quite familiar c SNF operations. I completely understand that many RN and LPN functions overlap in them. I stand by my statement that an overlapping function set does not mean professional equivalence. I agree we’ve beat this one to death now, though. 

You’ve have my complete aggreance! LPN and RN practice isn’t the same. I agree that we had beat this one to death but I want you to know that completely agree with you on that. Law is law Even if facilities hire them for staff nurse positions interchangeably, and they perform identical tasks. 

[NRSKarenRN, BSN, RN]

Legal opinion:

I have an active RN license. Can I work in an LVN position?

[emergenceRN17, ASN, BSN, RN]

7 hours ago, NRSKarenRN said:

Legal opinion:

I have an active RN license. Can I work in an LVN position?

Exactly what most others have tried to convey.  First thing is to check the nursing practice in the State that you are currently in and go from there (and also are you licensed as an LVN/LPN in addition to RN)