Can a LPN delegate to RN?

Nurses Relations

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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.

I wonder if i was delegating when i was an Lpn working in ltc?

i would ask the Rn on the other hall to hang the Iv's of my pts.

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Specializes in Home Health (PDN), Camp Nursing.
Wowgreat 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? .[/quote']

I think this is by far the worst misunderstanding that a lot of RNs have. As an LPN I have my own license, I do not function under yours. A condition of my license is that a RN, MD, DO, or DDS be available to supervise. This doesn't have to be direct supervision. Often it is provided via phone. If a case of malpractice happens the lawyer will name everyone he possibly can in the suit, this would include the RN and MD. however the LPN is ultimately responsible for their own actions and judgement.

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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.

It is interesting, because some state's wording of the LPN scope is "whatever the facility allows them to do and they show compentency in" with a constant being not directing RN's clinically. LPN's work under their own licenses, therefore, are held to their own practice standard. Most facilities do not allow an LPN to do IV push meds, however, depending on the state practice act, it is not unheard of.

Any medication error that an LPN makes is on the LPN. Would be a completely different scenario if the RN (or LPN) delegated a non-licensed person to give IV push medications. Because the RN or LPN is the licensed person in the building, they are responsible for what they delegate to unlicensed persons.

But again, this all varies by state and practice act on what is allowed, what the facility allows, and if a facility has an LPN policy that they are not to do IV pushes, and they do, then they could get in trouble for this.

The OP was discussing LTC, which is far different than acute or skilled care.

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I always though Ltc was skilled care,otherwise Medicaid would not pay for it?

All the Ltc facilities i have work at had feeding tubes and trachs,snd they were on all floors.

Maybe you mean assisted living?

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I also think that naybe the Lpn has an degree in Healthcare Administration?

I forgot about that one,as many have degrees outside of nursing.

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I always though Ltc was skilled care,otherwise Medicaid would not pay for it?

All the Ltc facilities i have work at had feeding tubes and trachs,snd they were on all floors.

Maybe you mean assisted living?

If I'm not mistaken, what you appear to be referring to is termed 'Subacute'. It's an interesting moniker that allows pts with complex medical situations to reside for set periods of time. Because they are considered to be stable. Stable - you know (vented/trached/tube fed/foley/multiple iv's).

It's an interesting spin on things. Many patients I encounter these days in units like these are actually more complex, and require more or equal work to Med Surg, Ortho, or Trauma Stepdown.

I usually chuckle and say it's their insurances having their way with us. I mean, I've only got 18-30 of them...

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

This is completely state dependent. Page 2 for MA....http://www.mass.gov/eohhs/docs/dph/regs/244cmr003.pdf

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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.

and

I wonder if i was delegating when i was an Lpn working in ltc?

i would ask the Rn on the other hall to hang the Iv's of my pts.

In the first instance, the LPN is responsible, because s/he has exceeded LPN scope of practice (assuming that LPNs cannot give IV meds in that jurisdiction). It does not matter how long an LPN has been in practice; time in grade, in this instance, does not automatically confer increase in licensed scope of practice. Even if the LPN scope of practice allows the LPN to give the med, if something untoward occurs due to nurse error, it's on the LPN, not on the RN.

In the second, if you are an LPN and ask an RN to hang your IV med, you are not delegating. You are acknowledging your scope of practice, and the RN is assuming the responsibility for RN-level practice for the patient.

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There is a difference between LTC/SNF and Sub-Acute. In the facility I was in, LTC/SNF was full of the LOL's LOM who couldn't care for themselves in assisted living anymore and required around the clock nursing as well as PT/OT/ST/RT as insurance allows. The SNF side also got those who were not acute care anymore after joint replacement, major fractures, etc. but couldn't return to an independent living situation because they still needed too much care including nursing (maybe on IV abx still, getting blood thinners, etc) and aggressive PT/OT 5-6 days a week, which would not be covered by home health (usually 3 days a week max). The SNF side could also get pt's who were GT dependent or in need of wound care.

The Sub-Acute side of the building was those who were trached/vented, TBI, stroke, chronic vegetative state, etc. and needed the continuous high level of care similar to ICU/Step Down for extended periods of time. Once they got to a stable/chronic state and did not need gtts titrated and such they could be transferred to Sub-Acute. They could get IV therapy as necessary, though most were not on IV's long term (most hydration was through GT if they were restricted orally).

Anyways, LTC/SNF is not = to assisted living and Medicare/Medicaid pays for LTC/SNF because of the need for ATC nursing care.

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Specializes in critical care, ER,ICU, CVSURG, CCU.
I always though Ltc was skilled care,otherwise Medicaid would not pay for it?

All the Ltc facilities i have work at had feeding tubes and trachs,snd they were on all floors.

Maybe you mean assisted living?

skilled care is paid by medicare, not medicaid.... medicaid pays according to adl, RUG documented level of care
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Specializes in ER.

Is she actually delegating or assigning tasks?

In my state, a nurse never delegates to another nurse. This includes LPNs. So a RN in my state cannot delegate anything to a LPN. The law is written to specifically say unlicensed personnel when discussing delegation. However, this is not the standard in most states I think.

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skilled care is paid by medicare, not medicaid.... medicaid pays according to adl, RUG documented level of care

I might be getting ltc and home care mixed up,because a gt and trach pt,even if stable,are considered skilled care in homecare.

Medicaid also pays for skilled care in the home.

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