nursing care plans.... lvn or rn

[LVNwannaBE2007]

i have a question i got in a heated debate today with my DON over if care planning is a rn or lvn school... (btw she was one of my lvn teachers) yes they teach you how to write a care plan in lvn school but i was also told it was an rn skill...... but lvns follow it for a plan of care for the patient... can someone help me out here?

[joprasklpn]

That is not how we did it at our facility either. LPN's added to the plan of care after admission care plan was in place. Stuff like for falls and skin tears with goals and interventions and outcomes. I think it is a team approach as care plans are always being updated.

[scattycarrot, BSN, RN]

Hmmm...careplans. Huge waste of time and energy in my opinion. As for who writes them? Wouldn't it depend on the resulting task and it being within your scope of practice (thats a question by the way and not a statement!)??

[Rexie68]

i'm an lpn in ltc, and i'm the primary care plan writer for all 139 of our residents. an rn may add one or update one i've written, but, for the most part, i'm it. kind of scary...not the lpn part, but the fact that i'm responsible for so much...and i hope the floor nurses are reading and adjusting the care plans as needed...'cause i sure can't keep up with all of them along with all the medicare and regular mds'....

[fultzymom]

ok i understand that but who initially writes them... rn or lvn?

My facility will use a RN or LPN. It just depends on the MDS nurse. We used to have a RN and a LPN working in MDS and so whoever did that persons admission assessment was the one who did it. So sometimes the LPN initiated the care plan. Now that LPN left about a year ago and I took over the job so there are two RNs so it is always a RN who does it.

[Daytonite, BSN, RN]

Legally, only an RN can write and document a care plan for the patient's medical record. This is stipulated in Title 42 of the federal law for Medicare. However, in most of the nursing homes that I worked LVNs/LPNs were expected to contribute to the care plans that we used. I also find that a lot of LVN/LPN nursing schools are requiring the students to write care plans as well these days. It probably stems from the fact that they are required to be doing them in nursing homes as charge nurses.

[Rexie68]

legally, only an rn can write and document a care plan for the patient's medical record. this is stipulated in title 42 of the federal law for medicare. however, in most of the nursing homes that i worked lvns/lpns were expected to contribute to the care plans that we used. i also find that a lot of lvn/lpn nursing schools are requiring the students to write care plans as well these days. it probably stems from the fact that they are required to be doing them in nursing homes as charge nurses.

are you sure, daytonite? i've been doing it for 3+ years and the surveyors are ok with it. i do the mds' (an rn signs off on the mds, but i sign section v where it says raps were care planned) and the care plans...i also did the care plan meetings and sign the icc sheets and notes...many times an rn never signs them.

[Rexie68]

was also thinking.....activities, dietary, and social services also write care plans...not an rn...perhaps it differs by state??

[CyndieRN2007]

As I stated before, in the state of Texas, an LVN cannot initiate a careplan.

[Rexie68]

from medicare title 42:

405.2137 condition: patient longterm

program and patient care

plan.

each facility maintains for each patient

a written long-term program and

a written patient care plan to ensure

that each patient receives the appropriate

modality of care and the appropriate

care within that modality. the

patient, or where appropriate, parent

or legal guardian is involved with the

health team in the planning of care. a

copy of the current program and plan

accompany the patient on interfacility

transfer.

(a) standard: patient long-term program.

there is a written long-term program

representing the selection of a

suitable treatment modality (i.e., dialysis

or transplantation) and dialysis

setting (e.g., home, self-care) for each

patient.

(1) the program is developed by a

professional team which includes but is

not limited to the physician director of

the dialysis facility or center where

the patient is currently being treated,

a physician director of a center or facility

which offers self-care dialysis

training (if not available at the location

where the patient is being treated),

a transplant surgeon, a qualified

nurse responsible for nursing services,

a qualified dietitian and a qualified social

worker.

well gosh, that doesn't really qualify it to rn for ltc, but some could take it that way. i guess our surveyors consider me qualified to write the darned care plans. guess i'll have to keep doing them!

[LanaBanana]

In my hospital we are to do daily goals sheets for each pt, which is essentially a care plan. My dilema is that forming a care plan is not within my scope of practice as a LPN. So here I am with my own team of pt's and I'm supposed to write the goals and then have a RN sign them all. I finally said this week that I'm not going to write them out if I can't sign them. This means that now my charge nurse has to do all of mine. I think it's kind of ridiculous because the goals for most pt's is "no falls", "no skin breakdown", and getting whatever labs that are out of whack WNL. There are others that are more specific, but how hard is it to see what needs to happen to keep a pt safe and get them home/well?

[ohmeowzer RN, RN]

i am a RN and i just plug them into a computer when i do the admit assesment. i do the first care plans and the LPN's can just add a daily notation.

[Daytonite, BSN, RN]

are you sure, daytonite? i've been doing it for 3+ years and the surveyors are ok with it. i do the mds' (an rn signs off on the mds, but i sign section v where it says raps were care planned) and the care plans...i also did the care plan meetings and sign the icc sheets and notes...many times an rn never signs them.

you are nursing home. that is section 483 of title 42 and may be ok. that is not true for acute hospitals.

title 42, section 482 conditions of participation for hospitals, sec. 482.23 condition of participation: nursing services. the hospital must have an organized nursing service that provides 24-hour nursing services. the nursing services must be furnished or supervised by a registered nurse. (b) standard: staffing and delivery of care. the nursing service must have adequate numbers of licensed registered nurses, licensed practical (vocational) nurses, and other personnel to provide nursing care to all patients as needed. there must be supervisory and staff personnel for each department or nursing unit to ensure, when needed, the immediate availability of a registered nurse for bedside care of any patient. (4) the hospital must ensure that the nursing staff develops, and keeps current, a nursing care plan for each patient.