Lpn in ltc assessment

  1. I am a RN nurse manager/ADON I have been informed that LPNs can not assess a resident condition or change of condition, it must be done by an RN. However, if the lpn does assess a chg of condition and if the RN agree's with the assessment and willing to co-sign that is satisfactory. This can be risky for the RN, if she doesn't reassess the resident. So, the point is what can an LPN do these days. We have some great LPN'S do good assessments, we have RN's that do terrible assessment.

    50% of our nurses are LPN's, only LPN's on the dementia unit. This seems like another responsibilty for the RNs, to cover. We always have a RN and LPN working each shift except noc's. Is charting, wound care an assessment? What about lung sounds etc?

    Does anyone have the same concerns?? I have learned the the state surveyers are handing out (IJ's) like candy and this is one of the things they are looking at, so god help us if they find an issue where an lpn assessed and not an RN.

    Your thoughts, maybe i'm getting paranoid or reading into this;
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    About violetrose

    Joined: Feb '02; Posts: 23; Likes: 4
    Registered Nurse/Charge
    Specialty: nuring assistant instructor

    8 Comments

  3. by   Be_Moore
    Definitely not, and as an RN I disliked working with LPN's at my previous job...not because I dislike LPN's, but because my license was on the line every time I had to cosign an assessment or give an IV push medication. Legally to protect oneself, to cosign the assessment the RN would have to do an assessment of the patient in question. "Trusting" the judgment of the LPN is risky business. At my old job, giving IV boluses for an LPN would mean that I would have to do an entire chart check for that patient as well. Having them show me an order is not necessarily good enough because how can I verify there isn't a cancellation order?

    Perhaps the best course of action for your unit would be to reorganize the system into a team approach. Instead of RN's having some patients and LPN's having some patients, have an RN/LPN team that has all of the patients. The RN can then do assessments and the LPN can do medications. Best option I can think of.

    And yes, you are definitely paranoid. But it's not undeserved. I was paranoid of the same things when I had to work with LPN's.
  4. by   chase4myheart
    It has always been my understanding that the LPN cannot do the initial assessment when a person is admitted to the facility without an RN cosigning. Where I work at, LPN's are constantly assessing the patient. This is a part of nursing care that they give. If an LPN couldn't auscultate lung sounds or determine when someone is circling the drain, then they wouldn't be much more than a tech. I do know that LPN's are giving more privileges in LTC than in hospitals. Hope this helps some. Contact your state BON if you are still unsure of the LPN's scope of practice.
  5. by   CoffeeRTC
    I think this will all depend on the state and the nurse practice act for that state. It is impossible in LTC to recheck everything an LPN did. The bulk of LTC is CNAs and LPNs with fewer RNs. I've never co signed for an LPN in the state of PA. I do give the IV pushes, etc, but everything else..they do on their own.
    I'd like to see the rules in writing too.
  6. by   Sherriblu
    The thing that is always forgotten here is that LPNs are licensed also and they are responsible and liable for what they do. You are not liable for everything they do. Maybe you should aquaint yourself with the scope of practice for the LPN.If you dont trust your LPNS to report changes and collect data then you are not a good DON. Take a turn at pushing the med cart and work with your LPNs and get to know them.You might be surprized to know there are very good LPNS out there..
    Last edit by Sherriblu on Apr 16, '09 : Reason: Spelling
  7. by   kermitlady
    Quote from Sherriblu
    The thing that is always forgotten here is that LPNs are licensed also and they are responsible and liable for what they do. You are not liable for everything they do. Maybe you should aquaint yourself with the scope of practice for the LPN.If you dont trust your LPNS to report changes and collect data then you are not a good DON. Take a turn at pushing the med cart and work with your LPNs and get to know them.You might be surprized to know there are very good LPNS out there..

    THANK YOU! This is exactly what many of us have been trying to get some (not all) RN's to understand. We do have a NURSING license; not everything has to be cosigned.
  8. by   achot chavi
    Quote from sherriblu
    the thing that is always forgotten here is that lpns are licensed also and they are responsible and liable for what they do. you are not liable for everything they do. maybe you should aquaint yourself with the scope of practice for the lpn.

    [font="comic sans ms"]lpn's are wonderful and fulfill an important function. depending on the state and facility they have various responsibilities. i didn't hear anything in the op that says she has forgotten anything. however she is obviously responsible to sign off on her lpn's assessments and that is always risky, no matter what. by signing off, she becomes liable if the assessment is sloppy or mistaken.


    if you dont trust your lpns to report changes and collect data then you are not a good don.

    [font="comic sans ms"]where do you jump to that conclussion???


    take a turn at pushing the med cart and work with your lpns and get to know them.you might be surprized to know there are very good lpns out there..


    [font="comic sans ms"]again, what makes you think that she doesn't know what it means to push a med cart, or know her nurses, and she never said that there aren't good lpn's out there,
    please reread her op...she complimented the lpn's!!!
    i don't understand the animosity lpn's have towards rn's we are all in this together and have bigger problems that need our attention than the struggle between us.

    for the record: rn's appreciate and enjoy working with lpn's in a healthy , respectful manner that encourages cooperation and not competition.

    no one enjoys taking responsibility for other people's work, its risky and could blow up in your face. lpn's should take responsibility for their own work and rn's should not have to cosign on the assessments from an lpn, and i think that is all that the op meant.

  9. by   bluegeegoo2
    In Indiana, (or maybe just my facility?) LPN's do all the assessing for their pt load, and contact MD's and whoever else depending on the findings without a RN. The only exception is for GIP hospice pts, who must be assessed q shift by a RN. LPN's can't do the initial assessment of a new pt in a hospital setting, but may assess them after that. Since you are in a position to do so, maybe you could develop a checklist of assessment data for LPN's to use to be sure they are doing a full, complete assessment? I'm sure some LPN's would balk at the idea, and take offense, but if you and your other RN's have to sign-off behind them, a checklist may help you guys feel a little more secure in doing so. Plus, you would have the full assessment laid out nice and tidy right there in front of you to ask questions from to further ease your mind, and to steer your LPN's in the right direction if their assessments are lacking. I dunno. Just an idea...
  10. by   nursekara78
    We don't have that tension between titles in my facility. We are all NURSES, we all worked hard for our license. All of the nurses are a TEAM. However, it is against the NYS regs for LPN's to assess. They can collect data. I don't agree with this reg. there are some LPN's that do an amazing assessment and RN's that just can't do it. Anyhow the RN's have to do all of the assessments....admission/falls/wounds etc.

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