Can RN's moonlight as LPN"s?

[haitianrn]

To earn extra $$, can an RN work as an LPN, or is that prohibited?

Thanks.

[pagandeva2000, LPN]

How is that different from a colleague RN who assists a pt to the bathroom or administers a med for a busy colleague and then that pt later has a problem that the assigned nurse didn't notice in a timely manner? Would the helping RN be held accountable to the same degree as if they were the assigned nurse?

I don't quite see how going into a patient room and assisting them in some way means that you as an RN have "accepted responsibility for the patient" - even if they've signed off somewhere in the chart they have been involved in some aspect of the patient's care. The assigned RN has responsibility for that patient from the time they accept report to the time they hand off. Others who help along the way don't automatically assume responsibility for the patient unless it's formally handed over to them. Am I wrong there?

I think that the helper RN would still be liable. In my eye, accepting full responsibility means just that, and patient care has to be done, whether she does it herself or delegates it to a capable person who has the training and ability to perform that function. I don't know if I am wrong or right, but, I really think that a court would see it that way.

Say, I didn't 'accept responsibility' for that patient, but I helped her to the bathroom and the patient fell down and broke her hip. The assigned nurse did not walk her to the bathroom, I did. I should have either asked that RN what the status was with that patient or looked for myself, and made an assessment regarding the patient's ability. Or, if I decided to help out and give insulin for another nurse, just to be nice. If the patient goes under, I am responsible, because I did the deed. I would also like to know, because basically, I understand what you are saying, jjjoy.

[jjjoy, LPN]

I *can* see the liability and responsibility issues regarding any professional patient interaction. But it would seem to only be a problem in the case where the patient was CLEARLY in distress and the RN could CLEARLY see that and didn't do anything about it. And in that case, the RN *should* be held accountable in the same manner as any health professional at their level who had seen/worked with the patient in that condition.

But that RN *shouldn't* be held MORE accountable than any other assistive RN when they never accepted the role of primary RN to that patient, should they?

So I don't quite see why taking the more circumscribed role of an aide or LPN while holding an RN license is often portrayed as SO incredibly risky when it doesn't seem to be any MORE risky than any other kind of assistance with a patient to which you are not the assigned RN.

Is the risk more or less or the same as ostomy nurses, wound care nurses, diabetic education nurses, etc who work with inpatients and might run across a patient whose nurse hasn't caught something crucial? If they inform the patient's nurse of a problem, do they have to follow up on it later and ensure that it was taken care of properly?

[Juwon]

i don't know why the op was asking, but one reason an rn might be considering an lpn role is if there happens to be an opening for an lpn, but not for an rn, with a nearby facility that has just the right hours and is in a preferred environment.

I know i was curious about the same thing when there were lpn openings at a well-run private hospice facility. The facility only hired a few rns as charge. I was interested in working there because i liked the environment and it was well-staffed, but i wasn't comfortable with the idea of starting out there as charge. The charge rn supervised several lpns and took responsibility for all of the patients in facility (eg calls to mds, deciding when to send pts out, etc). I didn't feel i had enough experience for that role. There also were more openings available for lpns there, making for more flexible scheduling as well (compared to the few rns who seemed to have their shifts set in stone). I would've been more than willing to take lower pay to work at this well-staffed (read: Very reasonable patient load) and to not have to be responsible for the charge role. But i was told i couldn't apply to be a non-charge nurse because i had a rn license and all of the non-charge nurse positions required an lpn license.

It was disappointing that i couldn't work there but i had to accept that.

I still don't quite get why an rn working in a lpn or na role is considered "dangerous because you're still being held to rn standards." an rn working the lpn or na role isn't doing anything out of their scope of practice. I don't see why there'd be a substantial increased risk that they wouldn't perform up to rn standards in their circumscribed role as opposed to when they are taking on full rn duties. Is it that an rn might held more liable than an na for missing some vital symptom if a lawsuit were brought against them? But that sounds reasonable and not more risky than working as an rn. Is it that if the supervising rn makes a poor judgement that the rn-in-lpn-role will be held more liable than an lpn in the same situation? Wouldn't it depend upon the rn's experience and if the rn *clearly* knew that the supervising rn's judgement was wrong and didn't follow up with the chain of command? Again, how is that more dangerous than everyday rn liability risks?

i can fully understand why an rn would work as a lpn in ltc facilites. The reason for that being is the overtime. My mom is a registered nurse at a nursing home and when there is an opening available for overtime, it goes to the lpn's first because it is cheaper to pay the lpn's when they do the same job as the rn pretty much except hang blood and start an iv. She always get last picks on overtime. The lpn's are able to make what she bring and much more at times. So yes it is a way to make more money as an lpn in certain situations. Its ok if you are going to be held to the standards of the higher degree(rn)

[diane227, LPN, RN]

You are always held to the standard of practice for the highest license that you hold. You can work as a CNA for CNA pay if you want, but you are still and RN and if something is amiss, you will be held accountable. Why would you want to work at a level below your license?

[mmm333, LVN]

So therefore from the employer perspective you could capitalize on the RN by offering them only LVN work, knowing that you will get RN-level care but pay them the lower rate. Be careful, RNs... this is a slippery slope.

[mmm333, LVN]

If what you say here is 100% true, and it is up to a non-healthcare working jury or judge to decide the case, then I would go along with my nursing school prof's advice to NEVER pick up an LPN or CNA license as an RN due to legal risks and ramifications. I hold CNA & RN and was considering LPN. I knew LPN was pretty risky since it is so close but so different from RN. But I hadn't taken into consideration the idea that the CNA role could pose such drastic risks to the RN. Everything you say makes perfect sense. On the other hand, the poster above makes a good point that without taking report and "accepting full responsibility (to provide RN-level care) for the patient".

This is like many other controversies involving the law- the law is nuanced beyond what lay persons understand or know- beyond what the laws say are many variables such as enforceability, conflict of laws, juries & public opinion, judges views on the matter at hand, and other influential factors. It makes the whole business very uncertain and I think that's why there are so many [inconclusive] discussions about holding multiple licenses.

With RN & Paramedic it is quite clear that EMT-P is prehospital and RN takes over once you step through the glass door- but with LPN or CNA the roles simply collide on the same turf.

[mmm333, LVN]

Dianne I certainly appreciate your response in spirit. I am a new grad with no job 6 months post-graduation. I am now seeking work using my CNA. These are desperate times, so in response to your question I suppose the answer is "I'm desperate to work in healthcare in any capacity so that my RN skills won't fade away to the point where I am old news".

The funny thing is that if I am hired as a CNA and held to RN standards, I should be giving RN care (impossible with CNA patient loads but I guess the "reasonable RN" standard would come into play). Most employers would be confused as to exactly what sort of care I should give and wouldn't be too happy if I started dishing out meds or performing RN tasks. I'm worried that I will be stuck between "overqualified CNA" and "inexperienced RN". I got turned down for a unit clerk job, not by my interviewer who loved me, but by HR after I was told I was "hired". I suspect that HR felt that I was too qualified and would leave the job as soon as I found an RN job. I guess they were right.

If I don't find RN work in the next year or so I'm going to law school. Tough times.