Do RN's co-sign assessment sheets at your hospital? What does it mean to you?

NursesRmofun, ASN, RN · Apr 20, 2004

I work on a surgical floor and our hospital just began requiring RN's to co-sign the LPN's assessment papers. The hospital says it does not mean that we agree with there assessment. We have talked to a representative from the state board who says that this is not a requirement of the state but that the meaning is outlined specifically by the hospital. Do any of you guys do this? What does it mean at your facility? We dont do team nursing...I trust the LPN's I work with but just dont like my name on a sheet of paper if I have not assessed that patient myself.

We did at the hospital I last worked for. I understood it to mean that we actually did an assessment ourselves and agreed with the assessment the LPN wrote.

Anniekins · Apr 20, 2004

I would never co sign anything that I did not agree with. :rolleyes:

What is their rationale?? If you don't agree....whats the point in signing??

Repat · Apr 20, 2004

We do not co-sign - the hospital requires that a patient have at least one assessment per 24 hours by an RN (so RNs always follow LPNs, if possible, since we work 12-hour shifts). I would never co-sign anything. I even add "witness to signature only" on consent forms, because I am never in the room when the MD discusses whatever test or procedure I am getting a consent for.

RNPATL, DNP, RN · Apr 20, 2004

It means that you agree with the assessment and in your professional opinion as a Registered Nurse, the patient presents as it says on the assessment form you co-signed. If you were taken to court, you would be held to a level of responsibility for that patient because you signed the assessment as an RN. Be careful.

mattsmom81 · Apr 21, 2004

I agree with Patrick. Never cosign unless you are in agreement with it. Your facility is not being honest with you...you ARE legally responsible for what you sign.

purplemania, BSN, RN · Apr 21, 2004

co-signing is not allowed by the Nurse Practice Act in Texas. The RN must make the assessment and chart it. The LVN evaluates throughout the shift and notifies the RN of changes that may require another assessment.

Tweety, BSN, RN · Apr 21, 2004

So what does your signature mean if it doesn't mean that you agree with their assessment?

Sounds like they are trying to prove to JACHO or a state agency that all patients are receiving and RN level of care.

I'd be cautious about this.

allnurses Guide · Apr 21, 2004

The RN does the initial assessment. The LVN then can do patient care, pass meds, etc. At the end of the day I look over the notes charted by the LVN and if I agree, which means I've assessed the situation, then I write "agree with above".

In my state, LVN's can't do the full nursing assessment. They can chart about meds they give or dressings they change or foley's they place. Yes, stupid but that's the law.

steph

bukko · Apr 21, 2004

In my state, LVN's can't do the full nursing assessment. They can chart about meds they give or dressings they change or foley's they place. Yes, stupid but that's the law.
steph

The trouble with laws, Steph, is who really knows what they are? Unless you sit down and read every line of a state's nurse practice act, which I haven't, you have to assume that the way things are done in your hospital are according to the law.

At my hospital, also in California, LVNs are allowed to fill out the entire shift assessment part of the nurse's notes. No RN co-signature required. But RNs have to sign that they've read the care plan for each LVN's patient they cover. (For you non-Cali nurses, each LVN has an RN assigned to "cover" -- do the things LVNs aren't allowed to do, like hang antibiotics and push IV meds.) LVNs can sign the square on the care plan sheet that certifies they've done the dressing change.

The only place where my hospital is strict is the assessment of new admits. RNs MUST do it and fill out the form, even though an LVN might be assigned to do the patient care. When I used to work as an LPN in Florida, RNs were supposed to do the admission assessments, but LPNs would fill out the sheet and sign it with no counter-signature. Legal oversight was so lax there that nobody got busted.

I want to do what I believe is legal. There's such a hodge-podge of hospital practices that it's hard to know, though. Unfortunately, the hard legal truth of a matter frequently doesn't come out until there's a hard legal case about it.

Burnt Out, ASN, RN · Apr 21, 2004

At the hospital where I work at, we as RNs do have to sign the assessment sheet. We also have to do the initial assessment of a patient; we also have to assess and sign behind our LPNs-don't get me started here :rolleyes:

When the LPN I am assigned to follow behind gets a new patient, and if I am caught up at that moment, I go in there with him or her and do my assessment while she/he interviews the patient. That way I can immediately sign and everyone is happy. If I am busy, I will take the assessment sheet and just briefly review with the patient about their meds, allergies, surgical hx and medical hx, as well as anything else that I feel I need too. Waste of time...yes. I trust the LPNs I work with....but it is my license on the table too.

gwk · Apr 21, 2004

I work couplet care ..all new pts(mom and baby) have an initial assessment by an RN and every 24 hour thereafter..I would never sign someone elses assessment without doing it myself and if thats what needs to be done why even assign the LVN the pts????