RN signatures after LPN's

**canoehead, BSN, RN** · Aug 5, 2002

LPNs by licensure can collect information (ie lungs have wheezes) but cannot use that information to draw an assessment conclusion (pt is worse, need to notify MD, or pt had wheezes before is stable, no biggie). Of course it is a fine line, but the Assessment is what you are signing you did, not the data collection. You are also making sure that if more info/assessment was appropriate (O2 sats, vitals) that it was done, that the total picture was "assessed" and not just tasks done and charted.

Most of the LPNs I work with have been doing their thing for >15 years and can assess as well as or better than I can, but they key is that their license will not allow them to take that much responsibility. If I am concerned I ask them more questions or walk in and take a look myself but they usually know exactly when something needs to be done (of course).

SherRN · Aug 5, 2002

In our hospital we do not have to co-sign an LPN. They have an assignment just like we do. We have to do their IVP and flush their central and pic lines. We have to do the blood draws from lines hand chemo and any and all blood products.

The strange thing is I just found out that the oher two hospitals in this county have the RNs cosigning the LPNs just as you describe.

BadBird, BSN, RN · Aug 5, 2002

I would not be comfortable signing anything that I did not witness, does signing mean that you agree with their assessment when you did not have a chance to assess the patient for yourself? Is this a management ploy for someone to blame if there is an error?

midwestRN · Aug 5, 2002

We do not co-sign daily assessments for LPN's. The initial admission assessment has to be done by an RN. They have said an LPN can do the initial assessment if an RN co-sign's, but I have never done that. If something is missed, I'm sure it would be my license on the line.

Mattigan, RN · Aug 5, 2002

Canoehead is 100% correct.

Brownms46 · Aug 5, 2002

Originally posted by BadBird
I would not be comfortable signing anything that I did not witness, does signing mean that you agree with their assessment when you did not have a chance to assess the patient for yourself? Is this a management ploy for someone to blame if there is an error?

I won't comment of what the co-signing an assessment means...because I have never understood the neccesity to do this. But I do believe it is a ploy of managment to have someone to blame! And I don't blame any RN for being uncomfortable in this situation!

I have NEVER been in facilities where I had to have my notes co-signed...that i can remember. But I have been in places where initial assessments on admission, were required to be done by an RN. Where I am now...that is not the case, and no one co-signs my notes. I do my own initial assessment, and call the MD if I feel there is a need to! While in orientation, the RN doing the orientation was asked this question, about co-sgining LPN's notes. She expressed the feeling, that there was NO need to have this done.

So I guess again...it depends on where you are, and what the faciltiy, and or state requires.

Nurse Ratched, RN · Aug 5, 2002

On my unit, LPNs do not process admissions because RN's must perform or co-sign the initial assessment and medical hx (and to me co-signing means agreeing with it, so I have to perform one anyway, so why have two people do it?) RN's do admissions and then pass the pt to an LPN if necessary.

RN's have to assess pts once q 24 hours, so we avoid assigning pt's to an LPN over three shifts so we don't run into the co-signing dilemma. Again - this is not bashing anyone - I just happen to be a very anal-retentive person and I won't put my name to anything I haven't witnessed myself no matter who it is.

On nights, I was frequently paired with a wonderful LPN (2 is our max for nurses on nocs.) We had an excellent teamwork process for admissions - she might start the IV and draw blood while I initiated the care plan and did the assessment, database, etc. We could crank out an admit in no time flat :).

Brownms46 · Aug 5, 2002

Good post Nurse Ratched, and I see nothing in it...that should spur any kind of bashing!

Sounds like great team work on the part of you and the LPN working with you!

deespoohbear · Aug 5, 2002

About the only thing an LPN can't do in our med/surg unit is retrieve blood from the blood bank. Also at a death (expected of course) there has to be at least one RN to pronouce death. Other than that, our LPN's take a full load, do IVP's, start IV's, take verbal orders and such. We are really fortunate that our LPN's are able to do such things. I just don't get the co-signing of the admission assessment sheet though. It seems strange that the LPN is allowed to do all that stuff, but their assessment skills aren't good enough for an assessment? I have worked with some LPN's who assessment skills put me to shame. I think it should be based on compentency instead of what initials are behind your last name. I have (and still do) work with a couple RN's who could tell me the sky is blue and grass is green, and I would still go and check. I appreciate all the responses on this subject.

Wgtks · Aug 5, 2002

Hey everyone,

Once again it comes down to your state Nursing Practice Act and your facility guidelines. I feel fortunate to live in Nebraska where an LPN can do an assessment and it does not have to be cosigned, However Joint Commission requires it on inital admission for their facilities. You know in all reality if time where not a factor would it really be that bad of practice to have to Nurses RN or LPN assess a patient during the shift or on admission.

Thanks for Listening

Wgtkss

Love-A-Nurse · Aug 5, 2002

i am not an rn yet, but as an lpn, i just wanted to say, i do not personally feel bad to read this thread because you as an rn want to provide safe care for our patients and protect your license too. thanks to the rns who are there for us and let us be as independent as we can and be there when we need you so we can all work together for the betterment of all.

i promise you, it is just as or more frustrating as an lpn for you to "come behind" me than you will ever know. yet, i understand and i welcome it for more than one reason, yes, even when i am pondering of the things i can do independently.

i do enjoy working with those (rns) who love to teach even though i can't do somethings as an lpn. you are appreciated and thanks for listening! :kiss