Can a LPN delegate to RN?

[roxs752]

We have a new manager on the LTC unit. She is a LPN. She has been delegating to me and another nurse who is a RN. Is this even legal? How can she delegate tasks that are out of her scope of practice.

[TheCommuter, BSN, RN]

We have a new manager on the LTC unit. She is a LPN. She has been delegating to me and another nurse who is a RN. Is this even legal? How can she delegate tasks that are out of her scope of practice.

LPNs can manage, supervise and oversee RNs in an administrative capacity. LPNs are not permitted to supervise RNs clinically. However, nursing homes allow LPNs to fill managerial roles because the LPN unit manager is working under the licensure of the RN/DON of the facility.

[Daisy_08, BSN, RN]

Wow. Could you please quote the words or phrase in which you detect "bitterness"? I'm at a loss to discern any such intent.

All right, I will retract the statement. I'm sure it was the way I was reading it.

I have worked in a home where the DOC was an LPN. She did 'delegate' to RN's. Nothing done in the home was outside any LPNs scope.

Perhaps you could be more specific as to what she is asking you to do.

[Nascar nurse, ASN, RN]

If the administrator of the facility (who rarely has an RN license) comes up to you & delegates a task to you, will you argue they have no right to delegate to an RN or will you just go follow up as asked? Now fill in LPN manager & you should have the same answer.By the way, I HAVE refused to do what an administrator has asked me to do on a rare occasion, but only because they were trying to play "unsafe" nurse.

[NurseDirtyBird]

In my facility, when LPNs come across something that is outside of their scope of practice, they go find an RN to do it. They aren't delegating, they are making sure the task is completed by someone who legally can complete it. A good supervisor would make sure nursing tasks are done safely and within the law. I don't think this is technically delegation in a nursing sense.

[KRVRN, BSN, RN]

I guess I'm not seeing what the problem is. If it's a task that needs to be done but it's outside the LPN's scope, what is wrong with a RN verifying the order and then completing it? Delegating, asking for help, teamwork...

[nurseprnRN, BSN, RN]

Let's clarify the difference between "delegation," "assignment," and "supervision."

Delegation is handing off a responsibility that you could do yourself but that can be done with someone with a lesser scope of practice. For example, an RN can delegate vital signs to a CNA, or med passes to an LPN (with or without IV meds depending on local nurse practice act, so let's not get into that here). Delegation is often used as a substitute for "making assignments," but this is not accurate even if people accept it as equivalent; it is not the same thing.

Anyone with line authority (nurse of any level, lay clinic manager, etc.) can make assignments of staff per an organizational chart. Persons on that chart could be anyone, including physicians, depending on the organization of the business/work unit. This person may or may not be able to supervise or evaluate clinical practice.

An RN can supervise and evaluate the clinical practice of other RNs, LPNs, CNAs, and HHAs (home health aides), as in, whether tasks are performed correctly.

So yes, LPNs whose position job description includes making assignments can assign RNs. LPNs are not "working under the license" of a DON; they work within their own scope of practice and as such, cannot supervise or evaluate RN-level clinical practice performed in such assignment.

[Asystole RN]

Delegation is not assignment.

From the NCSBN:

Principles of Delegation ƒ The RN takes responsibility and accountability for the provision of nursing practice.

• The RN directs care and determines the appropriate utilization of any assistant involved in providing direct patient care.
  

• The RN may delegate components of care but does not delegate the nursing process itself. The practice pervasive functions of assessment, planning, evaluation and nursing judgment cannot be delegated.
  

• The decision of whether or not to delegate or assign is based upon the RN’s judgment concerning the condition of the patient, the competence of all members of the nursing team and the degree of supervision that will be required of the RN if a task is delegated.
  

• The RN delegates only those tasks for which she or he believes the other health care worker has the knowledge and skill to perform, taking into consideration training, cultural competence, experience and facility/agency policies and procedures.
  

• The RN individualizes communication regarding the delegation to the nursing assistive personnel and client situation and the communication should be clear, concise, correct and complete. The RN verifies comprehension with the nursing assistive personnel and that the assistant accepts the delegation and the responsibility that accompanies it.
  

• Communication must be a two-way process. Nursing assistive personnel should have the opportunity to ask questions and/or for clarification of expectations.
  

• The RN uses critical thinking and professional judgment when following the Five Rights of Delegation, to be sure that the delegation or assignment is:
  

1. The right task

2. Under the right circumstances

3. To the right person

4. With the right directions and communication; and

5. Under the right supervision and evaluation.

• Chief Nursing Officers are accountable for establishing systems to assess, monitor, verify and communicate ongoing competence requirements in areas related to delegation.
  

• There is both individual accountability and organizational accountability for delegation. Organizational accountability for delegation relates to providing sufficient resources, including:
  

1. Sufficient staffing with an appropriate staff mix
   
2. Documenting competencies for all staff providing direct patient care and for ensuring that the RN has access to competence information for the staff to whom the RN is delegating care
   
3. Organizational policies on delegation are developed with the active participation of all nurses, and acknowledge that delegation is a professional right and responsibility.
   

https://www.ncsbn.org/Delegation_joint_statement_NCSBN-ANA.pdf

[RyanCarolinaBoy, ADN, BSN, MSN]

In the state of Nc, it was determined that lpns can not oversee rns so it is outside of their scope to be a unit manager. The state bon clarified is specifically. So check ur state practice act as this varies from state to state. Personally I do not think that lpns should b in a position of authority over rns clinically. Administratively that depends on the situation at hand.

[HR1989]

If the administrator of the facility (who rarely has an RN license) comes up to you & delegates a task to you, will you argue they have no right to delegate to an RN or will you just go follow up as asked? Now fill in LPN manager & you should have the same answer.By the way, I HAVE refused to do what an administrator has asked me to do on a rare occasion, but only because they were trying to play "unsafe" nurse.

Wow what did the administrator ask you to do?

[NicuGal, MSN, RN]

Check your state delegation.

[jadelpn, LPN, EMT-B]

Depends on the state, and the practice act of the state. It is usually a situation of an LPN can't direct an RN in clinical practice. However, most LTC facilities are not acute medical care. A number of them are not skilled care ie: do not do IV therapy (which can in some states be under the scope of an LPN) or any other skilled practice. So if it is a matter of the LPN saying that RN such and so has the whatever hall for the evening, or which RN is on the med cart, or the like--then yes, it usually can be done. And there are even some LTC facilities who are managed by--managers--and not clinical nurses at all.

This is widely different than acute care. LTC residents are not the same as sick patients. The residents are living in LTC as if it were their home.

[smartnurse1982]

Wow,great topic!

i have wondered this myself.

I do not understand when someone says"the lpn is under the Rn's license".

Let me give an example..

Say if i am working for a temp agency and i am the only Rn in the building in a sub acute/ltc setting.

The lpn(whose worked there for 30 years)gave a wrong med Iv push and its fatal, who would be held responsible?

In most facilities,if an lpn has been there long enough will allow them to do things that are out of scope.

Lots of long time lpn's can do things that are now designated "Rn level skills" like Iv push.