Documentation as a GN

Nurses New Nurse

Published

Specializes in medical, telemetry, IMC.

I'm currently an LVN, just finished a LVN-RN program, and I just received my GN permit. As an LVN, I always have an RN sign my charting, do I have to do the same as GN or can a GN sign/chart just like an RN?

Specializes in Psych ICU, addictions.

Find out what your facility's policy is, since that's the only correct answer.

Specializes in Critical Care, Education.

Since you are using the term "LVN", I am assuming you are either in CA or TX. In TX, there is no such thing as co-signing for another licensed person. The RN can only sign her/his own documentation. Sometimes, organizational policy will dictate that the RN must indicate that he/she has validated the LVNs observations... usually with a note like "concur with above" or something but never with just a signature.

I would simply ask the NM for the facility policy. I worked behind a nurse who signed her documentation with LVN and RN after her name. The DON didn't like that. I guessed that they never gave her the pay raise!

Specializes in medical, telemetry, IMC.
Since you are using the term "LVN", I am assuming you are either in CA or TX. In TX, there is no such thing as co-signing for another licensed person. The RN can only sign her/his own documentation. Sometimes, organizational policy will dictate that the RN must indicate that he/she has validated the LVNs observations... usually with a note like "concur with above" or something but never with just a signature.

Yes, I'm in TX. Yes, as an LVN, an RN always added "I agree with above assessment" to my nurses notes.

I have been working in my current facility for 5 years and I am one of the most experienced nurses on my floor (IMC). I am going to keep my same spot/job as an RN. I have talked to my unit supervisor and my director of education and nobody quite knows what to do with me. I am not gonna be "in orientation" due to my experience.

I searched the BON website but can't really find an answer to my question "does an RN still have to add "agree with above ..." Same goes for discharge paperwork, as an LVN I always had an RN sign the discharge instructions for the patient. Can I sign the discharge instructions now as a GN??

I'll take the NCLEX-RN at the end of June, so hopefully all this won't be an issue anymore! :)

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