Do all LTC facilities have RN's?

[cgb937]

Hello,

I am curious to know if all LTC or rehabilitation centers have RNS. I have seen plenty LPNs and CNAS but is it required to have RNs in a facility? This may seem like an obvious answer for some of you, but I honestly have no clue whether it is required or not.

[djh123]

I've never heard the question, nor thought of it. I'm sure, as someone else said, that it varies from state to state. In my state you have to be a RN to 'pronounce', so a LTC facility better have a RN or two for that reason alone. In my facility there are numerous RN's, although many are doing case mgt., management, and currently there are only a few of us actually working the floor.

[CoffeeRTC, BSN, RN]

To CoffeeRTC - are the facilities JACHO?

No. Our company is unofficially pushing it too. Is it better for the QIs? They seem to think there will be better care. I've met my fair share of LPNs that can do circles around the RNs.

[TheCommuter, BSN, RN]

My understanding is that a nurse does have to be on staff to supervise the LPNs and CNAs. As well as take MD orders and/or sign for orders.

An LPN is a nurse...

However they may work behind the scenes more and may not be as visible.

During my years in LTC, some facilities staffed the late shifts (3-11pm and 11-7am) with LPNs/LVNs as the only licensed nurses in the building. If needed, an RN could be reached remotely by telephoning him/her at home.

No RNs were physically present in these facilities working "behind the scenes" during the late shifts, not even a DON, unit manager, case manager, or so forth.

Again, legally mandated RN coverage varies from state to state.

[amoLucia]

If I recall correctly, in some states, there was a certain rule that an RN was absolutely REQUIRED if there was an unlicensed nurse graduate working. A nurse still waiting to take NCLEX or awaiting a license number to be issued was required ''to be under the direct supervision of an RN". The graduate COULD be hired (depending on the state to allow GNs or GPNs) and work a floor but needed the RN present.

Also, might there be a need (???) if a nurse is working under BON stipulations/RESTRICTIONS re narcotic administration? Not sure about this one, though.

Generally, facilities do allow administration of IV meds, particularly IV ABTs. But some places also allow push meds. So it would depend on a state's LPN scope of practice for any LPNs/LVNs to admin those meds as req. PICC line lab draws on 11-7 fall in here too. So an RN supervisor or RN from another unit would have to do the tasks if nec.

I'd have to check out the rules re Death Pronouncement. I don't know that all RNs will actually 'pronounce' - I've worked with some who deferred doing so for personal reasons. I never had a problem doing so but some others have. Some agency nurses wouldn't do it. And that was always a service provided as nec by Hospice Providers. They would be quite put out if they had to come out for pronouncements - like ''oh, you don't have an RN on 11-7?" Nooo, we don't have to.

It's been a rude awakening dilemma for many a newbie RN whose first job is in LTC when they learn about all "other duties as assigned". And then they find out that they have a bit more responsibilities than they expected and from when they interviewed. All because they hold the highest nsg license in the house when they're working. Like isn't there a nsg supervisor or other RN working when I'm on?

Surprise, surprise, surprise!

[kbrn2002, ADN, RN]

That depends on several factors. The most important of which is what the State requires for that type of facility. I work in a SNF and it is required to have an RN on the premises at all times if there is a resident with an IV. We have occasionally gotten around this issue on NOCS if there are no IV meds required on that shift and the off going [or incoming] nurse can do the q shift flush depending on if the PM nurse is staying late or the AM nurse is willing to come in early. For times no RN is scheduled an RN is required to on-call. This is usually the DON or ADON. It is pretty rare but we do occasionally have LPN's working NOCS.

Assisted living and senior living facilities are usually staffed by LPN's with an RN Manager that may or may not be on site regularly. I also know of several group homes that have no licensed staff on site, only care attendants that are not necessarily required to be CNA's. These care attendants can pass any needed medications by taking a very short med administration class. Again there is some sort of RN Case Manager, but they are not scheduled on premises.

Interesting question. I look forward to reading other responses as State BON's rules and regualtions can vary so wildly. I wonder what other states are like?

[CapeCodMermaid, RN]

It's not entirely management. Based on the 5 star rating system, the more RNs the higher star value.

Many insurance companies want RNs on staff. And, at least in my state, LPNs can't assess. Most of what we do other than push pills has to do with assessment.