lpn as ADON?

DSkelton711 · Aug 11, 2012

Just have to add my 2cents! What it boils down to is this: An LPN cannot supervise a RN in a clinical capacity. I know many LPNs with more experience than I. I ask questions. We work as a team. But the regulations in my state do not allow a LPN to manage a RN in a clinical role. Period.

RN1822 · Sep 6, 2012

This is an interesting thread. I am a new Grad RN but worked as a nurse supervisor at a LTC facility in Massachussetts while I was in school. I have never seen an ADON that was a LPN but have seen several functioning ADONs that were LPN's that were given the title of "House Manager". At the facility I worked in this was a cost savings and also given to a strong LPN that was well liked. She is being taking advantage of financially and because she feels "lucky" to have this post, she is working herself ragged.

I didn't realize how far out of the scope of my LPN practice I was asked to be until I entered the bridge program and got a reminder from a very nice instructor who was concerned for me. I had been an LPN for many years and had slowly started to pick up more and more responsibility as asked by Management. I can tell you that I did more of the admission assessments that any of the RN's, to include patient teaching, etc.. I can tell you that almost all initial assessments of new admissions in to LTC facilities in far western Massachussets are done by LPN's. I brought this up to a friend of mine who is a DNS at a facility where I pick up agency shifts and she said that it is a fine line and covered legally by the way the admission assessment form is worded. She stated that also there is a place at the end of this 9 page document for an additional nurse to sign if necessary.

I think we will see more "House Manger" positions open up as a cost saving going forward.

txwildflower57 · Sep 12, 2012

I know that a lot of LTCs do have LPN/LVN as the ADON. I think it does come down to the money part. I agree, I would have a very hard time having a LPN/LVN supervising me. I really don't think they are ever in "Charge" perse, I think they would have to refer to the Charge Nurse if she were an RN. It is a money thing but let me tell you here and now - I would take an LVN/LPN right now as an ADON because I don't have one and it sucks big time. If I had an LVN/LPN as an ADON she would probably have to answer to the weekend RN because even in the administrative level the scope of practice is limited.

txwildflower57 · Sep 12, 2012

I know that a lot of LTCs do have LPN/LVN as the ADON. I think it does come down to the money part. I agree, I would have a very hard time having a LPN/LVN supervising me. I really don't think they are ever in "Charge" perse, I think they would have to refer to the Charge Nurse if she were an RN. It is a money thing but let me tell you here and now - I would take an LVN/LPN right now as an ADON because I don't have one and it sucks big time. If I had an LVN/LPN as an ADON she would probably have to answer to the weekend RN because even in the administrative level the scope of practice is limited.

katoline · Aug 7, 2015

Wow. I have been a nurse for 28 years. This argument has been going on this long at least. I am on here today after moving to Texas and checking the Nurse Practice Act myself about just these issues.

Making Assignments

The LVN's duty to patient safety when making assignments to others is to take into consideration the education, training, skill, competence and physical and emotional ability of the persons to whom the assignments are made.^{11 12} If the LVN makes assignments to another LVN or UAP, he or she is responsible for reasonable and prudent decisions regarding those assignments. It is not appropriate and is beyond the scope of practice for a LVN to supervise the nursing practice of a RN. However, in certain settings, i.e.: nursing homes, LVNs may expand their scope of practice through experience, skill and continuing education to include supervising the practice of other LVNs, under the oversight of a RN or another appropriate clinical supervisor. The supervising LVN may have to directly observe and evaluate the nursing care provided depending on the LVN's skills and competence, patient conditions and emergent situations. Timely and readily available communication between the supervising LVN and the clinical supervisor is essential to provide safe and effective nursing care. - from the Texas Nurse Practice Act.

Has nothing to do with 'the alphabet' or years of 'experience', it is the scope of practice. In certain circumstances and Lvn/Lpn can supervise and evaluate the care given by another Lvn/Lpn. Anyone with experience can give 'guidance' or 'words of wisdom' to another. An experienced nurse might suggest to a new MD or Advanced Practice Nurse that perhaps 'such and such'? It's all about approach, respect, and the common goal of best outcome for the patient. Often a CNA notices something about a patient because of their hands on care, that a nurse or even an MD might not.

With things going the way they have been in health care for a long time now, more and more practitioners with less 'formal' education will find themselves in charge. The Assistant Therapist as the department manager, with the Licensed Therapist doing the evaluation and writing the plan of care. The Lvn Unit Manager or ADON as department managers, an RN might be needed for a 'comprehensive' patient assessment and initial plan of nursing care. I guess what bothers me at times is more of a 'control' issue and not a team approach. One DON I knew once said 'we (nurses) tell doctors what to do'. That was just so wrong. But often case managers do go over charts and leave MDs notes on what to chart about, what tests need to be run or questions about where things are headed. It's all about reimbursement, what is covered and what is not and in the best interest of the patient to get where they need to go by going about it in the manner required by insurance and/or Medicare and Medicaid guidelines. Not saying I agree with it. I have found myself on the phone with insurance companies about certification actually crying because of some denial and asking 'what if this were your mother??' And the Doctors are left shaking their heads. katoline