California LVN Scope of Practice

[fulitarn, BSN, RN]

My friend works for a mental health resource center in California. They haven't been able to hire an RN because they cannot offer competitive pay.  She is wanting to know if an LVN can preform the duties without an RN or MD supervising. 

The main duties are meeting with clients, completing a nursing assessment, and then based on the assessment , linking the client to a PCP, Urgent care or ER. 

They would also coordinate the clients medications are ready for pick up from the pharmacy, and possible coordination of care such as helping the client make medical appointments.

Thanks so much for your help. 

[NRSKarenRN, BSN, RN]

CA regulations

Vocational Nursing -- Business And Professions Code

Psychiatric Technicians

License Requirements for Psychiatric HealthFacilities (PHFs)  requires ONLY 40 hours of Registered Nurse coverage with LPN or Psych Tech "awake" staffing 24 hrs/day.

CA LVN regs do not state assessment in their  scope of practice. What is being asked is to TRIAGE clients --not in LVN scope. There should be a physician on call as resource person to discuss symptomatic persons for appropriate triage and indirect supervision -which is permitted.

CA Registered Nurse do have Assessment as part of scope of practice.

Quote

 

(a) A health facility licensed pursuant to subdivision (a), (b), or (f), of Section 1250 of the Health and Safety Code shall not assign unlicensed personnel to perform nursing functions in lieu of a registered nurse and may not allow unlicensed personnel to perform functions under the direct clinical supervision of a registered nurse that require a substantial amount of scientific knowledge and technical skills, including, but not limited to, any of ithe following:

(1) Administration of medication.

(2) Venipuncture or intravenous therapy.

(3) Parenteral or tube feedings.

(4) Invasive procedures including inserting nasogastric tubes, inserting catheters, or tracheal suctioning.

(5) Assessment of patient condition.

(6) Educating patients and their families concerning the patient's health care problems, including postdischarge care.

(7) Moderate complexity laboratory tests.

Psych Facilities are required to have nursing practice standards; I would want to see the job requirements specifications to see license requirements for position.  Just because they can't offer competitive pay doesn't make it OK to substitute an LPN in position.

LVN Malpractice coverage highly recommended to CYA.  One can also query LVN Board regarding situation. Many red flags here...proceed with caution.

[fulitarn, BSN, RN]

NRSKarenRN said:

CA regulations

Vocational Nursing -- Business And Professions Code

Psychiatric Technicians

License Requirements for Psychiatric HealthFacilities (PHFs)  requires ONLY 40 hours of Registered Nurse coverage with LPN or Psych Tech "awake" staffing 24 hrs/day.

CA LVN regs do not state assessment in their  scope of practice. What is being asked is to TRIAGE clients --not in LVN scope. There should be a physician on call as resource person to discuss symptomatic persons for appropriate triage and indiret supervision -which is permitted.

Thank you so much. She has already stopped the LVN from assessing. 

[hppygr8ful, ASN, RN, EMT-I]

Under the California Nursing Practice Act, only the RN can perform assessments, which includes analysis and formulation of a nursing diagnosis. This responsibility cannot be delegated or assigned to an LVN.

[NRSKarenRN, BSN, RN]

fulitarn said:

thank you so much. She has already stopped the LVN from assessing. 

Great--- glad you asked!  allnurses here to assist with practice concerns.

 

[CNAinquire]

Certainly, the intricacies of your friend's situation at a mental health resource center in California offer a glimpse into the larger, often convoluted, landscape of healthcare regulation and staffing. In many cases, Licensed Vocational Nurses (LVNs) can perform a wide range of tasks, such as client meetings, nursing assessments, and care coordination. However, the scope of practice for LVNs in California is generally circumscribed by the need for supervision by an RN or a physician.

This limitation on LVNs is somewhat reminiscent of the broader efforts by physicians to curtail the scope of practice for Advanced Practice Registered Nurses (APRNs). Physicians have frequently lobbied to restrict APRNs from practicing independently, justifying their stance by citing the need for high-quality care and patient safety. However, such lobbying can be interpreted as a strategic move to maintain control over lucrative aspects of medical practice rather than an altruistic effort to safeguard public health.

In both instances—whether it's LVNs desiring more independence in their roles or APRNs striving for a wider scope of practice—these regulations serve to channel financial resources away from patients and the broader society. They essentially prop up a medical-industrial complex comprised of accrediting bodies, lobbying organizations, and healthcare institutions, thus perpetuating anti-competitive behaviors that can hinder the efficient delivery of healthcare services.

[Books_Coffee, LVN]

I'm an LVN in CA, about to transition to RN, and I worked most recently in community health. CA scope of practice for LVNs includes focused assessments, such as taking vitals, counting respirations, etc., and reporting findings to an RN or a provider. LVNs cannot do a comprehensive assessment nor refer patients to ER, urgent care, etc., as that is outside their scope of practice. LVNs are not allowed to interpret or analyze data from focused assessments.

LVNs can help patients make appointments and coordinate with the pharmacy, as that falls under more case manager-type work; she would not need a provider or an RN supervising.

I would tell her to be careful about protecting her license by making sure that she is working within her scope of practice. 

See the attachment below, "Patient Assessment: Roles of RNs and LVNs," from the CA Nurses Association

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rn-lvn-role-assessment.pdf

[Nurse Beth, MSN]

Unfortunately, employers can push LVNs to practice outside their scope to benefit their bottom line. Good for you for looking into it yourself.

[SunDazed, BSN, RN]

I was an LVN in California before I was an RN. I definitely did things like document findings in wound care assessments, though I could not change the plan of care for the wound treatments. I did do some acute care full assessments, but they had to be signed off by an RN on the same shift. In SNFs LVNs can have leadership roles in management. And lately, a lot of the SNFs around here will not have any RNs on the night shift, and only administrative RNs on day shifts