Am I wrong for thinking that this APRN was wrong?...

ElectricCabbage · Sep 12, 2016

I began working in LTC 9 months ago as a new grad RN, which means that after 2 months of orientation I am now often the charge nurse- responsible for 130 residents, 25+ staff, and the building itself, including when management is not in the building. The best piece of advice that I have for as, as a new grad myself, is that you are responsible and accountable for your own actions now. This wasn't the case as a student, or even as a consolidating nursing student, but now it is. For me, that means if the off going RN says that "the doctor needs to be called right now about Mrs. X's whatever problem", I still need to actually go and personally assess Mrs. X before calling. In your case, it would have meant understanding that leaving something that was your responsibility for another nurse is still YOUR fault, even though you had deferred it to the next nurse.

It's a hard lesson! One that I myself also learned the hard way. But, it's a good lesson! And I think that the earlier us new grads learn it, the better :) All the best!

Palliative Care, DNP · Sep 13, 2016

As a new graduate LPN you have been set up for failure by not being properly oriented to the job. That said, you must realize that "you don't know what you don't know." Meaning that you need to be cognizant of how much you have to learn. Healthcare requires all of us to constantly learn and update our knowledge base in order to provide optimal care for patients. Your job requires you to keep people alive and you need to always keep that in the forefront of your mind. The APRN was quizzing you because she sensed a knowledge deficit. That was an educational opportunity. When you don't know a diagnosis or medication then look it up. Nursing requires a lot of self teaching. If that doesn't interest you then this isn't for you. Good luck!

mystcnurse, MSN, APRN, NP · Sep 14, 2016

I hate the term "passing meds" that is often used by nurses, and in my experience, very often by LPNs and their instructors. Medications are not "passed", at least not by registered nurse , they are administered, and the difference in the terms, in my opinion, is extremely important. I think this brand new LPN has been shown some very poor examples, has not received sufficient orientation, and really has no idea what she does not know, which is not entirely her fault. How can a nine month education prepare her to be on the same level as any of the RNs who were questioning her? How can those she is working with expect her to have the knowledge gained by a higher level of education OR experience. If she is working UNDER an RN, then the RN should take more responsibility for her actions. I would have probably asked the same questions as the APRN, but maybe in a different manner that actually FELT, to the LPN, like I was trying to help her. Maybe in a more Socratic style, to enhance her learning. She should not be in the position that she is, without adequate training or supervision. If she is "passing" meds, which is what she is doing, as LPNs do not ASSESS, they perform tasks, delegated to them by an RN, who by the very nature of his or her degree is responsible for assuring the safety and appropriateness of those tasks, then someone must be responsible for the administration of those medications. So, to the OP, I believe that you are in a position that could easily cause harm to your license, but more importantly, cause harm to your patients, as it sounds like your superiors are not taking you under their wings, as I believe they should. Given this, you should probably make absolutely sure that you look up every single thing that you don't know, until you are at a point that you have a very good understanding of the dangers of medication administration with specific disease states, in combination with other medications, etc. And most importantly, go back and research the Laws regarding medication administration and your scope of practice in your state. Good luck.

Horseshoe, BSN, RN · Sep 14, 2016

I hate the term "passing meds" that is often used by nurses, and in my experience, very often by LPNs and their instructors. Medications are not "passed", at least not by registered nurse , they are administered, and the difference in the terms, in my opinion, is extremely important. I think this brand new LPN has been shown some very poor examples, has not received sufficient orientation, and really has no idea what she does not know, which is not entirely her fault. How can a nine month education prepare her to be on the same level as any of the RNs who were questioning her? How can those she is working with expect her to have the knowledge gained by a higher level of education OR experience. If she is working UNDER an RN, then the RN should take more responsibility for her actions. I would have probably asked the same questions as the APRN, but maybe in a different manner that actually FELT, to the LPN, like I was trying to help her. Maybe in a more Socratic style, to enhance her learning. She should not be in the position that she is, without adequate training or supervision. If she is "passing" meds, which is what she is doing, as LPNs do not ASSESS, they perform tasks, delegated to them by an RN, who by the very nature of his or her degree is responsible for assuring the safety and appropriateness of those tasks, then someone must be responsible for the administration of those medications. So, to the OP, I believe that you are in a position that could easily cause harm to your license, but more importantly, cause harm to your patients, as it sounds like your superiors are not taking you under their wings, as I believe they should. Given this, you should probably make absolutely sure that you look up every single thing that you don't know, until you are at a point that you have a very good understanding of the dangers of medication administration with specific disease states, in combination with other medications, etc. And most importantly, go back and research the Laws regarding medication administration and your scope of practice in your state. Good luck.

LPNs most CERTAINLY DO assess. They do focused assessments rather than comprehensive, but assessments are definitely within their scope.

mystcnurse, MSN, APRN, NP · Sep 15, 2016

Actually, assessment is not within the scope of an LPN practice, except in collaboration with a registered nurse or physician, although I will admit, LPNs are often put in a position to assess. LPNs collect data and report that data to the MD or RN who then analyzes the data to determine the relevance need for changes to the plan based on the data. The point is, that the registered nurse is ultimately responsible for the patient's care, and if the RN delegates a task to a brand new LPN without assuring the ability of that LPN to perform the task safely, then the RN has not upheld the standard of professional nursing care. Assessments documented by LPNs, at least in the states where I live, must generally be signed off by an RN or MD.

Horseshoe, BSN, RN · Sep 15, 2016

Actually, assessment is not within the scope of an LPN practice, except in collaboration with a registered nurse or physician, although I will admit, LPNs are often put in a position to assess. LPNs collect data and report that data to the MD or RN who then analyzes the data to determine the relevance need for changes to the plan based on the data. The point is, that the registered nurse is ultimately responsible for the patient's care, and if the RN delegates a task to a brand new LPN without assuring the ability of that LPN to perform the task safely, then the RN has not upheld the standard of professional nursing care. Assessments documented by LPNs, at least in the states where I live, must generally be signed off by an RN or MD.

In my state LPNs may do focused assessments; yes, always under the supervision of a RN, advanced practice nurse, or MD. They may not do comprehensive assessments.

AssessmentThe LVN assists in determining the physical and mental health status, needs, and preferences of culturally, ethnically, and socially diverse patients and their families based on interpretation of health-related data. The LVN collects data and information, recognizes changes in conditions and reports this to the RN supervisor or another appropriate clinical supervisor to assist in the identification of problems and formulation of goals, outcomes and patient-centered plans of care that are developed in collaboration with patients, their families, and the interdisciplinary health care team. The LVN cannot perform independent assessments as the LVN has a directed scope of practice under supervision. The LVN participates in the nursing process by appraising the individual patient's status or situation at hand. Also known as a focused assessment, this appraisal may be considered a component of a more comprehensive assessment performed by a RN or another appropriate clinical supervisor. For example, a RN may utilize the data and information collected and reported by the LVN in the formation of the nursing process; however, the RN's comprehensive assessment lays the foundation for the nursing process. The LVN reports the data and information collected either verbally or in writing. Written documentation must be accurate and complete, and according to policies, procedures and guidelines for the employment setting.⁸

^{LVN scope with respect to assessments:}

Assists, contributes and participates in the nursing process by performing a focused assessment on individual patients to collect data and gather information. A focused assessment is an appraisal of the situation at hand for an individual patient and may be performed prior to the RN's initial and comprehensive assessment.
The LVN reports and documents the assessment information and changes in patient conditions to an appropriate clinical supervisor.

Bad Request

Horseshoe, BSN, RN · Sep 15, 2016

I don't know why the link above says "Bad Request." When I click on it, it takes me to the Texas BON position statements link.

bekind_andtrue · Jun 16, 2017

Just an update for anyone who may read this or commented on this post?! Reading this over again (comments included) was very interesting. I worked at that SNF for four more months. The charge nurse and some of the other nurses there were definitely NETY. The hall that I was on when I wrote this post was the absolute hardest assignment in the facility. It was on the rehab unit and the only assignment which had 100% rehab patients -- no long term residents. It was the hall with the most rotating patients (constantly new admits). Other nurses who worked the shift before me told me that they couldn't believe the charge nurse assigned me to that hall on my first week-- that they were not assigned to that hall until they had worked there for MONTHS. After a week or so - one nurse (who used to be charge nurse) had a meeting with some of the supervisors and said that it was outrageous that I was put on that assignment. They then put me on one of the easier assignments that the other nurses seemed to always be fighting for. I eventually left because they continued to bounce me around the halls and my PRN job was just too tempting.

I definitely see the error of my ways and my ignorance in the mistakes that I made that day. I have certainly grown as a nurse. However I look back at this day and definitely see it as two nurses that were eating their young. I vow to never treat a new nurse the way those two treated me.

I have been working at the ALF memory care unit for the last 7 months and I feel much more prepared to return to the rehab setting. At the time I was so overwhelmed by everything that I was just trying to make sure that I wasn't giving medications 4 hours late. I will need to brush up on my skills but I now have a better sense of care prioritization and patient needs.