LPN as Charge??

Nurses General Nursing

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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??? :confused:

Thanks in advance for opinions and answers :)

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
I think ya both need to move out of the states your in.....I dont answer to anyone but the Supervisor or DON ! I am a Charge nurse on my unit with yes another charge nurse. we are both responsible for the unit (split into 2 wings) Did I mention that we are both LPNS.....Wait, my supervisor is an LPN.....I delegate the cna's, I do the assesments, I do the md orders and oh my god.....I do my own admissions! I have been a supervisor of a 150 bed SNF/LTC facility....And I have known plenty of Unit managers that have been LPN's ....LPN's have come a long way in nursing, I think its time to get rid of the RN-"itis". !!!!!!!!!!! Were all in nursing for one reason and it comes down to caring for the pts!

It's not a matter of RNitis and I hope I'm not coming across that way. It's what the board of nursing states, here in Florida. :)

Here's what the Nurse Practice Act in Florida states about practical nurses. " "Practice of practical nursing" means the performance of selected acts, including the administration of treatments and medications, in the care of the ill, injured, or infirm and the promotion of wellness, maintenance of health, and prevention of illness of others under the direction of a resgistered nurse, a licensed physician, a licensed osteopathic physician, a licensed podiatric physician, or a licensed dentist. "

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It's not a matter of RNitis and I hope I'm not coming across that way. It's what the board of nursing states, here in Florida. :)

Here's what the Nurse Practice Act in Florida states about practical nurses. " "Practice of practical nursing" means the performance of selected acts, including the administration of treatments and medications, in the care of the ill, injured, or infirm and the promotion of wellness, maintenance of health, and prevention of illness of others under the direction of a resgistered nurse, a licensed physician, a licensed osteopathic physician, a licensed podiatric physician, or a licensed dentist. "

And that's exactly what the BON says in most states I have worked in. However, I believe you are reading more into than there is. "under the direction of" does not mean if there is an RN within shouting distance, that RN is allowing an LPN to work "under" his/her license.

It means that an LPN works under the direction of an .....

It does not say every RN in the building and in the case of LTC the MD, RN doesn't have to be in the building.

By the way, that includes Florida, where I worked many years ago as the supervisor in a LTC facility.

Y'all are reading way too much into "at the direction of"

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
And that's exactly what the BON says in most states I have worked in. However, I believe you are reading more into than there is. "under the direction of" does not mean if there is an RN within shouting distance, that RN is allowing an LPN to work "under" his/her license.

It means that an LPN works under the direction of an .....

It does not say every RN in the building and in the case of LTC the MD, RN doesn't have to be in the building.

By the way, that includes Florida, where I worked many years ago as the supervisor in a LTC facility.

Y'all are reading way too much into "at the direction of"

I'm sorry I missed your post above where you said essentially the same thing I did. I'm sorry.

I'm sure then you know that the RN is responsible for the outcomes of those under his/her direction. While you rarely, if ever here of the actions of an LPN getting an RN in trouble, it's still a responsiblity that shouldn't be taken lightly. And the original poster needs to know who the RN she is under the direction of, and I agree that it is the DON. And I've never heard where the RNs are under the supervision of the LPN (but I don't know everything, just what the act says as it relates to me and the people I work with in the hospital here). Although in some cases where experience matters, it seems like that should be the case. :)

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Specializes in Trauma, Teaching.

In my hospital, charge duties include making the assignments, monitoring the flow of care, rarely taking a patient assignment; and is responsible for knowing that the assignments are appropriate. As charge, I am responsible for overseeing the rest of the crew, and act as the liason between the house super. and the MDs being called. Different than LTC, I know. How as an LPN can you be expected to over see an RN, who technically out ranks you? (I know a great many LPNs who "outrank" RNs when it comes to skill, but that's not the question here. :chuckle ).

If by being charge, you are responsible for knowing an RN has completed her duties appropriately, I think you may have grounds for objection to being placed in that role. On the other hand, if you are really in charge, you can delegate tasks, such as "YOU need to call the MD about YOUR patient, I'll cover the lights so you can" :rotfl:

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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 :o
I HAVE READ MANY OF YOU ALL ANSWERS I AM A LPNWITH 15 YEARS EXP I HAVE BEEN UM,SUPERVISOR ,MDS COOR,STAFFING COOR,STAFF DEV COOR,WHY IS IT A PROBLEM BEING A LPN OR RN TE FOCUS SHOULD BE ON GOOD PT CARE.I'M A NURSE I TAKE THE RESPONSBILITY OF MY OWN CON'T EDUCATION I STILL READ AND KEEP UP WITH STATE LAWS.I ALSO HOLD ADMINSTRATION AND TEACHING LICENSES. SOME NEW RN SCARE ME WE HELP EACH OTHER .IN A CODE NO ONE IS ASKING ME IF I AM A R.N OR LPN.I AM A NURSE THERE TO DO MY BEST IN SAVING A LIFE USUALLY I'M THE ONE RUN THE CODE.I HAVE DECEIDE TO GO GET MY PA GUESS WHAT I STILL WILL BE A NURSE.JUST A PA.
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i have read many of you all answers i am a lpnwith 15 years exp i have been um,supervisor ,mds coor,staffing coor,staff dev coor,why is it a problem being a lpn or rn te focus should be on good pt care.i'm a nurse i take the responsbility of my own con't education i still read and keep up with state laws.i also hold adminstration and teaching licenses. some new rn scare me we help each other .in a code no one is asking me if i am a r.n or lpn.i am a nurse there to do my best in saving a life usually i'm the one run the code.i have deceide to go get my pa guess what i still will be a nurse.just a pa.

amen nursepa !!!!!!!! well said ! i also can teach, have done mds's and so on...... theres alot to be said for lpn's !!

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Specializes in ICU, PICC Nurse, Nursing Supervisor.

This is a thread that will go on forever :deadhorse , there is always going to be a LVN -RN tug of war:smiley_ab . But isnt the ultimate goal good patient care. Who cares who is charge, just do your job and take care of the patients . I have been the charge nurse and believe me it's not that great. I am willing to give that responsibilty to anyone who wants it. I am greatful when I work with an RN:bowingpur , whether I know the patients better or not ,I give her the keys and let her drive. I know what my job is and I do it. We work as a team do what needs to be done. We pass meds together ,do treatments together and who ever gets the abnormal lab calls the doctor. In my facility the RN DON was trained by a LVN to do her job. The RN did not have any experience and the LVN had been a ADON for many years, it works out great. What is all comes down to is patient care and TEAMWORK ,TEAMWORK, TEAMWORK:yeah:

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
I HAVE READ MANY OF YOU ALL ANSWERS I AM A LPNWITH 15 YEARS EXP I HAVE BEEN UM,SUPERVISOR ,MDS COOR,STAFFING COOR,STAFF DEV COOR,WHY IS IT A PROBLEM BEING A LPN OR RN TE FOCUS SHOULD BE ON GOOD PT CARE.I'M A NURSE I TAKE THE RESPONSBILITY OF MY OWN CON'T EDUCATION I STILL READ AND KEEP UP WITH STATE LAWS.I ALSO HOLD ADMINSTRATION AND TEACHING LICENSES. SOME NEW RN SCARE ME WE HELP EACH OTHER .IN A CODE NO ONE IS ASKING ME IF I AM A R.N OR LPN.I AM A NURSE THERE TO DO MY BEST IN SAVING A LIFE USUALLY I'M THE ONE RUN THE CODE.I HAVE DECEIDE TO GO GET MY PA GUESS WHAT I STILL WILL BE A NURSE.JUST A PA.

Excellent post. I don't know how say this without sounding arrogant or insincere, because I'm an RN, and someone is going to think that, no matter what I say.

I have a great respect for LPNs and what they do. It was LPNs on my first job that took me under their wing and taught me how to be a nurse in the real world, and we weren't worried about who was the RN and who was the LPN. Technically speaking, as far as administration and the state was concerned, however, I was "directing" them, which was a joke. So in addressing the original post, which was not concerned with the old RN/LPN battle, ultimately there is someone in charge (her DON, not the RNs who happen to be there), and it would behoove the original poster to know who that is. Same with me, I'm under the direction of a charge nurse, a manager, an house supervisor, etc., none of whom can be an LPN. I sometimes think LPNs are taken advantage of this system, doing all they do without proper compensation. On the floor I work, the LPNs work the same assignment and do the same thing as I do, for about $200.00 a week less.

With that, I'll bow out of this conversation, so I don't sound too defensive or insincere, or be accused of having RNitis. :rotfl:

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Having seen both sides of the coin...here's my two cents.

I have been an LPN for a decade and have just completed an associate degree RN program. What I have observed at a hospital I just started doing some pool work for is simply what I deem inappropriate. The staff on this busy med/surge floor consist of 5 LPN's and 2 RN's plus a charge RN who does not take patient assignments. The LPN's must have a "cover" RN to co-sign all admit/discharge paperwork and assessments (LPN's can't do initial admit assessing), blood transfusions, and IV pushes. The patient load is 6 patients per nurse. The RN must do her assignments plus all the coverage work...and there were plenty of IVP meds and transfusions going on. To me that really puts a strain on the RN trying to complete her assignments and the coverage stuff. I oriented with an LPN who's assessments consisted of 3 seconds...she checked pedal pulses with the patient wearing thick socks and listened to the lungs in areas over bone. Hmm! Now I know that all LPN's are NOT like this because as an LPN I never did this (and many great LPNs I have worked with wouldn't have done this). The problem is, if the RN doesn't recheck the assessments and someting becomes of it later...the RN is then ultimately responsible! With that said, while I admire and respect LPN's (especially having been one for 10 years!), I really think the LPN should NOT be supervising other RN's in any situation. The scope of practices are different as well as education level. With the level of acuity and responsiblity on the rise in patient care I tend to agree with what seems to be a shift to all RN's in the hospital setting. I know there are great LPN's who are more than capable, but unless I have assignments that allow time to check what I am to sign for, then I prefer to only be responsible for my charting and patient care. We must all try to see things from other peoples eyes--I always thought the LPN can do the same thing just paid less! This is true to an extent--but when the RN can only do certain things and must co-sign for LPN's, it is a different story. I realize my opinion may not reflect that of others but consider yourself in the situation I described. To the origanal poster--No I do not think LPN's should be in charge if an RN is present--most nurse practice acts state the LPN works under the supervision of an RN, MD, etc.

Karen

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I agree with Tweety.

This isn't about "RNitis". It's about you knowing and abiding by the scope of practice mandated by your state. There are some states that mandate that LVN/LPN's are not allowed to assess. And I don't know of any that state that LVN/LPN's are not under direction of an RN. And if push comes to shove and the care of an LVN/LPN goes bad, you BET the RN on the shift will be pulled into legal proceedings in a heartbeat. They may or may not suffer repercussions (sounds like the RN you described got very very lucky), but they will be involved. I'd rather not stake my practice on luck or the goodwill of an attorney in a courtroom or, worse yet, the BON where you are GUILTY and must prove yourself innocent. I think I'd rather go into a courtroom, come to think of it, but I digress!

I think what someone was trying to point out is that, while your LTC facility may *want* you do things (or the RN's there try to talk you into doing certain things), it doesn't mean that if you follow their directions/expectations/written/unwritten policies this will save you from legal action should it ever come to that for whatever reason. Ignorance is never an excuse for breaking the law in any courtroom, for anything or anywhere.

Someone mentioned that they are staffed mainly with LVN/LPN's in their LTC and have come through many inspections with flying colors. This is not to detract from the great work you all do, but we all know how inspection days are----administrators kissing butt, passing trays, yada yada. :rotfl:

Having said that, I agree with the posters above that most LVN/LPN's out there are incredible and can be my nurse anyday.

IMBC

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