Is it legal to have just two LPN's on a MedSurg floor at night?

Dear Nurse Beth Advice Column - The following letter submitted anonymously in search for answers. Join the conversation!

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Is it legal to have just two LPN's on a MedSurg floor at night with the idea that you could use your telly monitor if an rRN or your house supervisor ,who's an RN .  Is it legal to tie them up like that, pulling an RN away from  telemetry monitoring..  Or depending on house supervisor to do the initial assessments, pushing all the IVP meds, and any blood product. Round in all areas one to two hours and if there's an area, that's busy stay and help them until things settle back down. supervisor has to be at all. Baby births and all codes. Seems like you're over, extending the house supervisor and expecting the telly person to just walk away from the telemetry sounds a little much to be responsible for. I'm just wondering about the safe practice. Of  2 LPN's  on med surge floor at night

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Specializes in Tele, ICU, Staff Development.

Is this legal?

Unfortunately, staffing ratios and staffing mix in acute care are not legally mandated in most states. Only California has legally mandated staffing ratios and staffing mix for acute care. I know you're not in California because California has LVNs, not LPNs, so yes, it is probably technically legal in whatever state you are in.

Although California is the only state with legally mandated staffing ratios, some other states have primarily voluntary staffing regulations, guidelines, or recommendations. 

Please check your state guidelines for any regulations regarding staffing requirements.

If not illegal, what are the governing boundaries?

Instead, governing guidelines relate to the scope of practice for LPNs, facility policies, patient safety, and ethical standards. The situation you describe indicates minimal staffing, with a patchwork approach to patient care and shifting responsibilities. The facility uses alternatives to prevent LPNs from violating their scope of practice. For example, RNs are assigned to administer IV pushes, conduct blood transfusions, and perform assessments. 

Tele Monitoring

Look up the facility's policy for tele monitoring to see if it requires a dedicated RN or monitor tech. If so, they violate their policy to leave the tele banks unmonitored while the monitoring RN is pulled to perform patient care.

If continuous tele monitoring is a standard some of the time, why is it not a standard all of the time? This is a shifting standard of care to say the least.

House Supervisor

It's not uncommon for supervisors to wear multiple hats, but there are limits, especially when too many competing priorities could compromise patient care. Review the job description for the house supervisor as a start. 

Conclusion

I wish I could say there is a simple solution. If the nurses are part of a union, the union representative can raise any concerns. Another option is to review policies and job descriptions and have a conversation with the nurse manager to clarify roles.

Best wishes,

Nurse Beth

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