Being the "only RN" in the building.

nurseprnRN, BSN, RN · Jul 19, 2013

You should be clarifying that "only RN in the building" thing. if so, then you are responsible for the works even without the supervisory title, and you should never be the ONLY RN; there should always be two, so one can cover breaks or tend to an emergency and one can watch everything else. LPNs cannot supervise RN nursing practice under every nurse practice act with which I am familiar. Therefore for purposes of licensure, you are the supervising professional.

Perhaps you could see if your state LTC licensing act covers this (I'll bet it says that there has to be RN supervision), and bring a copy to the discussion you're going to have with the DON or administrator. If they are doing something hinky, at least they know you know. Then you can decide what you want to do about it-- report them (and lose your job, probably), try for a raise (in the nicest possible way without mentioning anything that could be construed as asking for a payoff for not reporting), or quit and tell them why. And then report them.

jadelpn, LPN, EMT-B · Jul 19, 2013

The Licensed Practical Nurse in the Charge or Supervisor Nurse Role

Not sure what state you are in, but in Massachusetts, LPN's can in fact take a supervisory role.

"Because you are a new nurse" would perhaps be a better description than "because you are an RN in the building".

Spikey9001, BSN, RN · Jul 19, 2013

AFAIK an RN has to be present in the building for emergencies, falls, etc... And I am in NJ. Also, this isn't an everyday thing, but it happens 2-3 of the 5 days I work.

chrisrn24 · Jul 19, 2013

I work with mostly LPNs and they are always charge, as they've been at my work for years and I'm new.

ToothFairy(5) · Jul 19, 2013

I did that for a while but I was not a new nurse. But as far as my understanding goes, RN can supervise a LPN but not the other way around. I would ask about a pay raise but I would wait till I had been there a little while, like after a 90 days probationary period. But do check as different states my have different rules on this in reagrds to a LTC facility or Assisted Living.

xoemmylouox, ASN, RN · Jul 19, 2013

In most states an LPN can supervise, but cannot manage/evaluate an RN's clinical skills. Many facilities only have 1 RN in the building and sometimes that is only the DON or ADON..

gcupid · Jul 19, 2013

It is too late to expect any changes in pay. Although you are new and would like to gain experience in order to become a strong leader, there is no experienced required by law in order to function as a supervisor in the ltc arena. As the only present Registered Nurse in the building, you are inherently supervisor whether u are paid for the position or not. It's not even your choice or up for discussion. Even if there is a RN on call, you still are responsible for the patients bc you are inside of the building during the time of any incident.

The best approach to your DON in regards to a pay increase is to try & set up a back up RN who actively practices as a bedside supervisor on call should u have any questions/issues and once you feel more comfortable assume the supervising role completely.. I know you want to be safe & kudos to you but never let administration degrade your role..... She is essentially getting two nursing positions filled for the price of one.

school does not adequately prepare RNs (without Lpn experience) the skill set needed to independently practice without the aid/orientation of on-the-job training/mentoring. Something may be worked out in your favor but I'm guessing that either you will start to resent your boss or she will resent you..... Is the market saturated with RNS or new grads willing to accept lower pay?

I'd stay until I'm able to find another job that pays me on par with the competition and that has a track record of retaining new & experienced nurses,

BrandonLPN, LPN · Jul 20, 2013

It's not at all uncommon for there to be only one RN in the building in a LTC facility. In fact, it's not uncommon for there to be no RN present whatsoever. Many, many times (usually on 2nd and/or 3rd shift) the only licensed nurse on premesis is a LPN. The idea that LPNs

work under direct RN supervision at all times in a LTC setting is an enduring myth and patently false.

Note the words I bolded there. The regulations for LTC are different than acute care. The rules for LTC state that there must be a registered nurse on duty 8hours out of every day. For obvious reasons, this 8 hours is usually 1st shift. The rest of the day, there only needs to be "a licensed nurse" (ie RN or LPN) on duty.

Given that the nurse practice act for practical nurses for every state pretty clearly states that LPNs function under the supervision or a RN or physician at all times, this staffing policy seems to be in flagrant disregard of the nurse practice act, right? Well, no, LTC facilities get around this because a physician (or sometimes the DON who is a RN) is always on-call 24/7 for the LPN to consult with should the need arise. Thus, the LPN is technically "working under their direction". And even I'll admit this is an exceedingly "creative" interpretation of the rules.

So, long story short, LPNs do not actually require a RN present to supervise. At least in a nursing home.

With all that said, I think it's a very inefficient use of resources for any LTC facility to utilize a RN as a med/floor nurse while sticking a LPN in the charge role. The simple and indisputable rules of licensure dictate that the RN should be in charge and the LPNs should work the floor.

The problem with this, in the case of the OP, is that the OP is undoubtedly less experienced than the seasoned LPN who was assigned as charge. From a purely functional POV, it just makes more sense to let the more experienced nurse take charge, regardless of licensure. Of course, this clearly isn't supported by the actual, y'know, laws and stuff.

LTC is full of scenarios where the LPNs on duty are simply more experienced than the RNs on duty. This is a natural result of an industry where the RNs jump ship as soon as that coveted hospital job becomes available, while the LPN is more or less "stuck". (broad generalization, but we all know there's a lot of truth there)

Such is the nature of LTC. It's an environment where theory and practice are rarely coincident.

withasmilelpn · Jul 20, 2013

I worked as a weekend supervisor in a LTC/Rehab as an LPN - because I had tons of experience , worked there 6 years and knew their policies forwards, backwards and blindfolded. We did have an RN that refused to be charge, and I would just get her for things out of my scope like TPN, etc.

Supervisory positions do not require an RN, and I was not supervising the other RNs clinical skills in that capacity. (Although I often directed my RN peers to the policies when need be for things like morphine pumps and talked them through it when they had no idea what to do.)

As far as emergencies go, LTC is limited as to interventions - generally its assess (or collect data - :-)) O2, Suction, check blood sugars, vs, CPR - the bare basics, any LPN can do (and you don't need 2 RNs for Green tea) duties were to maintain adequate staffing, deal with complaints, problems, follow up with labs, etc etc. I liked it.

Vishwamitr · Jul 21, 2013

PDMUYOA

(Please don't make up your own abbreviations). How do you feel figuring that out? As far as I know, you had some difficulty. It's OK to use it in within your own clique but not in a nursing forum.

VANurse2010 · Jul 21, 2013

I'm not seeing any abbreviations in this thread that aren't commonly used... unless I missed something.