LPN as Charge??

Nurse Hatchett do me a favor and pull your job description and tell me ultimately who do you answer too?

Just a quick question......I'm an LPN and the charge nurse on my hall (LTC). I often work with 2 different RN's, even when I work with them I am still charge. One doens't want to be charge, she just does her own thing on the hall, no teamwork with her. The other one just recently got her RN and since I work the hall all the time and families/res relate to me I am charge. My question is who is ultimately responsible the RN or LPN in charge???

Thanks in advance for opinions and answers :)

They can call you charge all day long. The RN is responsible for the patients he/she has assigned to him/her. If the facility has put you in charge of managing the facility, that's fine. The RNs know full well that when it comes to apporpriate and safe care of their patients in that facility; they are on their own with the MDs orders, the BON scope of practice, and the facility policies. They may come to you with their time card corrections, but they would be ill advised to come to you with a question like "Do you think I need to call the MD about this or that?"

The Veridican

I think you have misunderstood what I meant. I am not in charge of the facility, just my hall. What I mean by this is I do the desk ( talk to dr;s, do rounds, assess, tube feeds, Iv's, etc) while the Rn in question does an end of meds and her treatments. I'm not saying I'm above the Rn or anything. On our schedule we have a charge nurse, then two RN, LPN or QMA who does the meds on the end they are assigned. Except if it is a QMA, then I have to do any tx that is staged. Hope this clarifies what I'm asking. Thanks

They can call you charge all day long. The RN is responsible for the patients he/she has assigned to him/her. If the facility has put you in charge of managing the facility, that's fine. The RNs know full well that when it comes to apporpriate and safe care of their patients in that facility; they are on their own with the MDs orders, the BON scope of practice, and the facility policies. They may come to you with their time card corrections, but they would be ill advised to come to you with a question like "Do you think I need to call the MD about this or that?"

The Veridican

And actually the sad thing is one of the particular RN's in question does come to me with any situation that is occuring, and will tell me You're the charge nurse, you need to call the Dr, etc. Hence discussing this at work we wondered who is ultimately responsible.

I think you have misunderstood what I meant. I am not in charge of the facility, just my hall. What I mean by this is I do the desk ( talk to dr;s, do rounds, assess, tube feeds, Iv's, etc) while the Rn in question does an end of meds and her treatments. I'm not saying I'm above the Rn or anything. On our schedule we have a charge nurse, then two RN, LPN or QMA who does the meds on the end they are assigned. Except if it is a QMA, then I have to do any tx that is staged. Hope this clarifies what I'm asking. Thanks

Also keep in mind this is LTC and we only have 2 Rn's who work the floor. :uhoh21:

I work LTC in Minnesota. LPN are considered charge nurse for their hall, but the LPN cannot delgate, supervise other employees. If they are putting you in that role you may want to check with your BON to see if they are putting you in a position that would be out of your scope of practice. If there are 2 RN in the building, not matter which wing they are on, one of them should be the charge for the building. We have had RN's ask an LPN for advice about a resident especially if they are not as familiar with that resident as another nurse, because sometimes they do not work that hall and just want some advice from someone who is more familiar with the resident. The RN IMHO is out of line be asking/requiring you to contact physician for her resident.

I work LTC in Minnesota. LPN are considered charge nurse for their hall, but the LPN cannot delgate, supervise other employees. If they are putting you in that role you may want to check with your BON to see if they are putting you in a position that would be out of your scope of practice. If there are 2 RN in the building, not matter which wing they are on, one of them should be the charge for the building. We have had RN's ask an LPN for advice about a resident especially if they are not as familiar with that resident as another nurse, because sometimes they do not work that hall and just want some advice from someone who is more familiar with the resident. The RN IMHO is out of line be asking/requiring you to contact physician for her resident.

But see we really don't consider it yours and my res. we just (for the most part) all work together and if my fellow nurse has a res who needs something and she is busy, they I just do it. In Minnesota, do you LPN's supervise your NA's and if not then who does? I have a lot of good NA's, but also have some who without direct supervision, then nothing would get done

I think you have misunderstood what I meant. I am not in charge of the facility, just my hall. What I mean by this is I do the desk ( talk to dr;s, do rounds, assess, tube feeds, Iv's, etc) while the Rn in question does an end of meds and her treatments. I'm not saying I'm above the Rn or anything. On our schedule we have a charge nurse, then two RN, LPN or QMA who does the meds on the end they are assigned. Except if it is a QMA, then I have to do any tx that is staged. Hope this clarifies what I'm asking. Thanks

Actually, I don't understand what you are saying, and I mean that sympathetically. I doubt I would understand the situation even if I was working there. The bottom line is that facilities especially LTC facilities can try whatever they think they can get away with, and RNs and LPNs can do surgery if they never get caught and the patient doesn't complain (I knew an LPN that wanted me to help her re-insert a peg tube once when I was an aid--I refused.)

Anyone can do anything they are physically capable of doing--so long as some other force doesn't stop them (i.e., courts, BON, JACHO, State Health Department, etc.) If gross neglect can be tollerated, as I often saw at the LTC facility where I worked, what's wrong with the janitor calling the MD to get an order for a narcotic?

I'm sure, if you are doing a good job in charge of your hall, that everyone is in good hands, especially the patient. After all, you are a nurse.

The Veridican

Nurse Hatchett do me a favor and pull your job description and tell me ultimately who do you answer too?

I answer to my House Supervisor, ADON or DON according to job description

I answer to my House Supervisor, ADON or DON according to job description

No, anywhere you work anywhere as an LPN you answer first to the RN. As was said earlier you can call yourself charge all day long if you wish too. Something can happen down the hall it might not even be your pt but if you're the only RN on duty you take the fall. Just ask the judge!

No, anywhere you work anywhere as an LPN you answer first to the RN. As was said earlier you can call yourself charge all day long if you wish too. Something can happen down the hall it might not even be your pt but if you're the only RN on duty you take the fall. Just ask the judge!

What about the days that there isn't an RN if the facility?? I'm not "calling myself charge" as you put it, that's the way it is on the sched. Whom ever does the "desk" is the charge nurse, that's just the way it is. I answer to my house supervisor LPN, ADON LPN then DON RN. I didn't ask the question to stir up a big controversy over LPN/RN. I realize that an RN is over me, not question about that, She went to school longer and deserves that recognition. Like I stated prev. remember this is LTC and not a hospital, which I understand then it wouldn't even be an issue, as far as I am aware, they don't have LPN's do charge at a hospital and have a lot more RN's then we do in LTC. As I also stated prev. we only have 2 RN's who work the floor. All other RN's are DON, MDS and one 3rd shift RN every other weekend.

I am working in a situation somewhat similar to yours. I am an LPN. There are two subacute units at night. Each one has an LPN. There is supposed to be an RN on duty as well, however, they have no specific duties, unlike the LPNS who have full responsibility to get everything done. My unit is very busy, and it is up to the whim of the RN whether or not they will pitch in, or sit and read a magazine. Most nights there are no RNs to assist, and the LPN is on their own anyway.

On my unit, I am in charge of my unit, because if something doesn't get done the RN has no responsibility for the work. They are there - just in case. I would like to know what just in case is, because many of the RNs, when present never find anything labeled just in case, while the LPN is working without breaks in order to get the work done.