Being the "only RN" in the building.

Specialties Geriatric

Published

I currently work at a LTC that is staffed by primarily LPN's. I graduated last year and began working here at the beginning of this year. My base pay is about $5 less an hour than what I think it should be based off what local hospitals and other LTC facilities pay. Also, I get a $2/hr bonus so my actual base pay is even lower.

I currently work on the med cart and do not want to supervise until I get more experience. I've recently noticed that they use LPN supervisors and when I asked, they said "because you're the RN in the building." I don't know EXACTLY what this means but it comes off fishy to me.

I was contemplating asking my DON for a raise based off of that fact. Is it justified?

Specializes in Med/Surg, LTACH, LTC, Home Health.
I'm not seeing any abbreviations in this thread that aren't commonly used... unless I missed something.

It's the AFAIK made by Spikey9001. It took me a minute to figure it out but I think it means "AS FAR AS I KNOW". Never seen it before but I like reading the car tags so this was just another 'what does that mean' for me.

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Specializes in Med/Surg, LTACH, LTC, Home Health.
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.

I never would have figured that one out....

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AFAIK has been around on many message boards for a long, long time. It's cool and all, but just sayin'...

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In the facility( LTC) where I used to work on 2nd shift a majority of the time there was no DON or RN in the building and I don't ever recall seeing anyone on the 3rd shift. This is very common in some nursing home settings. The DON or RN is suppose to be on-call just in the case an emergency arises. I can clearly remember one of the RN supervisors telling me "my son has a baseball game today, call me if you need me." I never saw her. So a majority of the time the LPN was in the facility alone. I guess it just depends on the facility's policy. Usually if you are the only RN in the building then you are ultimately in charge and if any emergency or situations occurs your co-workers will probably be coming to you to help with resolution if they are not able to resolve them.

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In the facility( LTC) where I used to work on 2nd shift a majority of the time there was no DON or RN in the building and I don't ever recall seeing anyone on the 3rd shift. This is very common in some nursing home settings. The DON or RN is suppose to be on-call just in the case an emergency arises. I can clearly remember one of the RN supervisors telling me "my son has a baseball game today, call me if you need me." I never saw her. So a majority of the time the LPN was in the facility alone. I guess it just depends on the facility's policy. Usually if you are the only RN in the building then you are ultimately in charge and if any emergency or situations occurs your co-workers will probably be coming to you to help with resolution if they are not able to resolve them.

...and if you are the only RN in the building and they don't come to you and they resolve them poorly, it will still be your fault and your responsibility. Just sayin.'

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...and if you are the only RN in the building and they don't come to you and they resolve them poorly, it will still be your fault and your responsibility. Just sayin.'

With all due respect, that is not always the case. It perpetuates the myth that an LPN works under someone else's license other than their own. If something is resolved poorly, it is on the LPN and their license.

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^^I agree.

It depends on how the assignments are made and the staff is utilized. If a RN in LTC is assigned as a floor nurse to a specific hall (or whatever) of residents, then that's what he's responsible for.

If the RN has his assignment down one hall and the LPN has his assignment down another, there's really no way the RN would be held responsible for a mistake/oversight of the LPN. The said RN was never given report on the LPN's group and never accepted any responsibility for them. It's just not his assignment.

On the other hand, if a particular unit/hallway/whatever is assigned a LPN and a RN, and the RN is the "charge", then of course the RN is the one ultimately responsible for his group of residents. Why wouldn't he be?

But it's simply not true to say that if a RN working his own hall happens to be the only RN in the building at the time, that this makes him de facto responsible for the entire building. Not so. He is responsible for his group of residents, just like any other nurse.

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With all due respect, that is not always the case. It perpetuates the myth that an LPN works under someone else's license other than their own. If something is resolved poorly, it is on the LPN and their license.

They don't "work under someone else's license." They work under their own scope of practice and by law under the supervision of an RN, and if they exceed their scope in the course of their "resolving it," you, as the RN in the building, will be held accountable.

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They don't "work under someone else's license." They work under their own scope of practice and by law under the supervision of an RN, and if they exceed their scope in the course of their "resolving it," you, as the RN in the building, will be held accountable.

Only if said RN were acting in some sort of "charge" capacity. If the RN had his own assignment, separate from those of the LPNs, he would only be responsible for adverse events involving the patients under his care.

I worked at a place that just assigned halls to a mix of RNs and LPNs indiscriminately. Very common practice. If one of the residents in one of the LPN's groups went south, it would be that LPN's responsibility. No one else's. In a scenario like this each nurse is responsible for their own group. There is no charge. Each nurse is "in charge" of whatever assignment they have that night.

On the other hand, the LTC facility I work at now utilizes more of a "team nursing" model. Each unit has a RN and a LPN. The RN is charge and the LPN is the med/tx nurse. In this scenario, the RN is indeed responsible for anything that happens on his unit under his watch.

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What you consider standard practice in your facility may or may not be OK with the BoN if anything ever comes to your attention. They will not listen to you say, "Oh, the LPN's in charge on the floors, we don' need no darned RNs to be in charge, so the only RN in the building isn't liable" and then say, "Oh, okay, no problem."

Word to the wise, but hey, do what you want.

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What you consider standard practice in your facility may or may not be OK with the BoN if anything ever comes to your attention. They will not listen to you say, "Oh, the LPN's in charge on the floors, we don' need no darned RNs to be in charge, so the only RN in the building isn't liable" and then say, "Oh, okay, no problem."

Word to the wise, but hey, do what you want.

What I'm trying to say is that if a RN has his own assignment, then he's not responsible for the other nurses' assignments, be they RNs or LPNs.

It's not the fact that LPNs are sometimes the only nurse present, therefore they "don't need no RN watching over them" when there is one present. That's not what I was tying to say.

What I was saying is that in a scenario where each nurse is "charge" of his own hall, no one nurse can be held responsible for the pts in another nurse's group. That's all.

You seem very knowledgable about the legal aspects of nursing. But I just don't think that it's implicit that a RN is responsible for an entire facility simply because he happens to be the only RN on duty. If said RN is acting in the capacity of a floor nurse, then he's only responsible for the pts in that assingment. It seems to me a very poor judgement call on the part of the BON if they would really punish a RN for something that happened to a group of patients they never accepted responsibility for and never received report on. Such a judgement would reflect very badly on the common sense of said BON.

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What you consider standard practice in your facility may or may not be OK with the BoN if anything ever comes to your attention. They will not listen to you say, "Oh, the LPN's in charge on the floors, we don' need no darned RNs to be in charge, so the only RN in the building isn't liable" and then say, "Oh, okay, no problem."

Word to the wise, but hey, do what you want.

This is why it is imperative that nurses know both their scope and level of responsibility.

In Massachusetts, there is absolutely language that speaks to an LPN in a charge role. Does that mean I would ever take on that role--no thank you. However, I am old and mean.

I would think that if there's a nursing supervisor in charge of the facility, then that is one thing, however, an LPN makes an error, that is on them, not the only RN in the building that is in the postion of the med nurse.

But always check with the BON. And have . And know the policy that would or would not put the "only RN in the building" responsible for the actions or inactions of other licensed nurses. And the UAP's. Cause if, as an LPN, I delegate to a UAP, and something goes awry, then it is on me--

The scope of the LPN varies widely, by state, and there's new statues put in to place all the time. It beehooves anyone to be mindful of them.

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