How can LPN/LVNs supervise RNs? WE

[downsouthlaff, LPN]

This post is to shed light on a frequently confusing topic to many nurses. Let me start out by saying that in no state is it permitted for an LPN to supevise or delegate nursing practice to an RN. Many Registered Nurses' first reaction (not all) is to take some offense or have concerns about learning that in some nursing specialties LPNs serve as charge nurses, managers, ADONs, etc. In my experience, they often question how can LPN hold such a position when there work must be supervised by RNs or physicians?

The role of a bedside nurse in long term care settings often do not require the skills that most BONs restrict LPNs from. For instance, administering medications, documentation, taking verbal orders from APRNs or MDs, wound care, basic first aid. While you will see both RNs and LPNs employed as bedside nurses in these environments, you will often see that in these environments, when this is the case, there will be almost no difference in there job duties or role despite the different letters behind there name. But how do facilities get away with allowing LPNs to work independently with no RN on duty? That's just it, they don't. The BON in my state for instance states that an LPN can be in a LTC facility without a supervising RN, as long as there's an RN available by phone. Many facilities use the services of an on call APRN 24/7 for both RNs and LPNs to contact either by call or text. Therefore the LPN is not truly making independent assessments or decisions, just gathering assessment data and reporting it to the on call RN supervisor or provider by phone.

Assessment in my opinion is a fluid term. It's hard to regulate assessment. For instance some could say that an LPN working independently during the night hours at an LTC facility auscultates lung sounds and notes crackles, and then measures temperature and notes pyrexia then calls the 24 hr APRN service and reports this, and is then given orders to adress this. It could be argued that the LPN performed an assessment and made a decision wich BONs restrict in some states, but it could also be compellingly argued that the LPN gathered data, and reported it to an APRN using methods that are acceptable per BONs in some states.

With that being said, this brings me to my next point. How can LPNs be in charge or hold titles like charge nurse or ADON or evaluate the work of RNs? The answer is admistratively. Can a nursing home administrator who has a degree in education or finance perform an evaluation on an RN? The answer is yes. While it is true that an LPN cannot clinically supervise an RN, again the actual role of a bedside nurse in many LTC settings doesn't change with the nurse being an LPN or RN. There are rarely advanced level skills being used in LTC. There far in many LTCs a beside RNs and LPNs will do the same job. It is very different from acute care.

Therefore, an LPN who was experienced bedside nurse in a supervisory role would be a good candidate to supervise the work administratively of less experienced nurses be it LPNs or RNs in these settings. Scenario, "Jane is the LVN/ADON at Green Leaf Retirement Center. Jennifer is a new RN floor nurse at Green leaf. It has been brought to Janes attention that Jennifer has not been completing Medicare nurses notes, or reordering medications per facility policy. Jane being Jennifer's administrative supervisor serves Jennifer with a verbal warning and written infraction form,”

In this scenario, Jane did not delegate to Jennifer or supervise clinical nursing practice or judgement. She simply administratively supervised and evaluated Jennifer based on the policy of the facility. And Administrator who is a not a nurse could have legally taken the same action.

So while an LPN can't clinically supervise an RN, in almost all states anyone who owners of a business such as nursing facilities appoint can supervise anyone administratively no matter what the lettere are behind there name. I hope this thread helps RNs who really haven't worked in these long term care settings understand why LPNs and LVNs are able to hold these positions.

[Horseshoe, BSN, RN]

Yes, as you point out above, in my state LPNs can supervise RNs from an administrative standpoint, but they cannot supervise the clinical practice of RNs in my state. Also, in my state, LPNs most certainly can perform assessments-"focused assessments,"-but not "comprehensive assessments." It seems really absurd that some states would prohibit LPNs from making focused assessments.

These things can get tricky indeed. I also suspect that in some facilities, LPN DONs do supervise the clinical practice of RNs (particularly new RNs), which technically is a violation of the Nurse Practice Act. Some of them may not even realize this is out of their scope, especially when they see a new RN making clinical mistakes-it would seem to make sense to teach/demonstrate/correct these practices. But according to the law, this is not permitted.

[downsouthlaff, LPN]

Horseshoe, in my state LPNs can perform focused assessments as well, we can also perform new admission assessment with an RN co-signature. I think the lines are very blurry, I’m which what constitutes admistrative supervision and clinical supervision. I believe that as long as the LPN is supervising that all nurses in the facility or completing all there duties d/t what the facility outlines is required of them, like completing all the charting, clearing mars, transcribing physician orders per facility protocol, making sure they have the right color uniform on, it could be argued that all this still constitutes administrative supervision, in the same capacity that a Nursing Facility Administrator would supervise a Nurse. Now if an LPN were to tell an RN how to assess there resident, or give guidance as to what to do via a residents change in condition, this is violating the practice act. But I also think that it would be perfectly okay for an experienced LPN/LVN to contribute there knowledge to an RN in this given situation, but not supervise which means telling the RN which action to take.