Difficulties Defining Scope of Practice

[DanidelionRN, BSN, RN]

I posted this in a different forum, but so far no responses, so I figured I'd try here:

So.... In nursing school at the University of Wisconsin-Eau Claire, where i graduated with my BSN last December- I was taught that patient education was one of the things that was specifically within the scope of practice of RNs, and only RNs, because it required evaluation- and that while we can delegate all kinds of things to LPNS and CNAs... we cannot delegate tasks that require evaluation.

So... now I work in Iowa at a nursing home, and it's staffed by some RNs and some LPNs... and I kind of feel like the whole delineation of practice between the RNs and LPNS is thrown out the window. For one thing, while LPNS are required to practice Under the supervision of a Registered Nurse according to the Nurse Practice Act of Iowa... the LPNs at my facility have their own patient loads, and don't really answer to a registered nurse at all, unless you're counting the DON, who might or might not be present. Yes, RNs are in the facility, at least on the day shift... but they don't have any legitimate authority over the LPNS at all.

Further, the LPNs regularly engage in activities that require evaluation of outcomes of patient care- which I was pretty sure was NOT something that was in their job description.

I'm a bit confused I guess, about what the hell they are and are not supposed to do... and a bit concerned about the fact that they're acting without really being under direct supervision of an RN... and in my mind, I now have a question of, "If I'm an RN on the floor while an LPN is working and screws up- whose supervision are they under? Mine? Is it on my head, or someone else's?" If I'm the only RN (and possibly one of only 2-3 BSNs employed at the facility, period- and I've only had my RN license since February) on the floor- am I responsible for the care being provided to all 120 patients in the facility even though I am not directly supervising the care of more than 15 of them?

I read the nurse practice act, but it was kind of unhelpful and did not really include much for specifics other than pertaining to IV therapy, and that LPNs are not to be doing things that "require an RN's skill or level of preparation"....

Please help?

[xtxrn, ASN, RN]

http://www.iowa.gov/nursing/nursing_practice/lpn_functions.html

lpns are the backbone of ltc....they can do a lot- at least in the south...i'm back in il now, and the limits placed are kinda nutty...i haven't met any lpn who didn't have the same ability to learn as an rn- they just had decided to go the lpn route, for whatever reasons....

if someone has a certificate or license, they are responsible for what they do involving that license. if an lpn (or cna for that matter) does something that you have no knowledge of, or instructed not to (if you're in an actual managerial/supervisory position) the lpn sinks his/her own boat. you float :)

and there are fuzzy areas. in tx, it went by different rules between each facility...and depending on the facility they could start ivs, and give iv meds.

[DanidelionRN, BSN, RN]

Thanks. I couldn't find a page like that one for some reason- I had only found a long complicated PDF document of rules that only talked about the IV stuff. That was helpful. I still think my facility is messing things up though, from reading that- in that- "Initial assessment" is required to be done by an RN... and at my facility, that doesn't happen. If an LPN is working a hall that gets an admission, they typically do all of it.

I've definitely met a couple of LPNs at this facility who kind of have me wondering how and why the hell did they ever becomes nurses at all- but overall most of them are pretty excellent. I definitely have learned a lot from some of them.

[xtxrn, ASN, RN]

Thanks. I couldn't find a page like that one for some reason- I had only found a long complicated PDF document of rules that only talked about the IV stuff. That was helpful. I still think my facility is messing things up though, from reading that- in that- "Initial assessment" is required to be done by an RN... and at my facility, that doesn't happen. If an LPN is working a hall that gets an admission, they typically do all of it.

I've definitely met a couple of LPNs at this facility who kind of have me wondering how and why the hell did they ever becomes nurses at all- but overall most of them are pretty excellent. I definitely have learned a lot from some of them.

Yeah, in the LTCs I worked at in TX, the skilled patients got RN assessments, but the floors were also staffed with RNs for the shifts that got admissions. Otherwise, they did everything, including the weekly skin checks. Some had IV certs but weren't comfortable doing them....I had some medication issues that didn't allow for taking call, so I was on IV Patrol when someone on an unskilled wing needed something with an IV after hours.

Here in IL, it's way different. For one, they have enough RNs to staff non-skilled, custodial wings (and complain about staffing). But the LPNs are held back, and it's not necessary. When possible, they're also being chased out of hospital positions where they've oriented most of the RNs in the PICU...not right. Skills aren't dependent on initials. I'm glad you've got some good folks to work with :) I think the duds are universal - LOL