Just recently started at a new facility. This facility has one LPN whom only comes in to work to give out all the medicines to all the patients on the floor. My question is, am I, the RN, responsible for making sure that my patients medicines are given; and if and when to hold certain meds such as BP meds, etc. Is this setup a delegating process. In other words, if the LPN went ahead and gave a BP medicine without checking a persons blood pressure on graphics, before you could tell the LPN to hold the BP med verbally (probably because as soon as the LPN comes in to work, they automatically start giving out am meds before the RN has even entered the room to do pts vitals, assessment, etc.) Am I responsible as the RN if a pts. BP is bottomed out because the LPN didn't check the graphics or know that pts BP beforehand? Of course I think I am. In other words, the LPN is not using their nursing skills by not checking BP. And if you so happen to be checking BP after the LPN has already given it while making your rounds, and you realize that there needs to be a med put on hold and you go to your MAR - guess what the med was already given before you could even delegate not to give this so and so med.
Specializes in A little of this & a little of that.
The language regarding delegation and assignment in varies. In most states LPN's can delegate to other LPN's or UAP's. To delegate is to pass a task that is your responsibility to another teammember. For example, you work with a PCT on your assignment- some nurses will have the PCT do vitals or glucometers on their patients, that is delegating. An RN works with an LPN as a partner instead of a PCT so the LPN can be delegated to do treatments, check IV sites, give meds, etc. In a clinic the nurse may delegate to the MA things like setting up a procedure tray. Delegation must be within scope of practice and is a direct action between the nurse assigned to the patient and someone working along with her but not having responsibility for the patient. Unless an LPN is working in what is essentially a PCT role, jointly assigned with an RN, delegation is not involved. An LPN assigned to a patient is accountable under his/her own license for all care and suubsequent delegation of care. The LPN is not working "under the license" of an RN. The RN who made the assignment is only responsible that the tasks involved are within the LPN scope of practcie. If there is something not in the LPN scope (ie TPN) the RN making the assignment is responsible to arrange for an RN to do that care. This is supervision which is all that laws generally require of RN's in relation to LPN's.
Assignment, done by supervisors or charge nurses, must be appropriate to the scope of practice of the assignee. Assignments given to an RN or LPN make that nurse accountable under his/her own license for all care given. The LPN is held responsible for any errors in judgement. If the LPN fails to inform the supervisory RN of a patient condition requiring further assessment or care beyond the LPN scope, the LPN is responsible for any problem arising.
In the "old days", it was common to use the "team" approach in hospitals. Depending upon the acuity of a unit, only the charge nurse might be an RN. The unit would be divided into two or more "teams". Each team would have a med nurse (RN or LPN) who was responsible for all monitoring associated with giving meds, such as BP's. The patient assignments would be given to RN's or LPN's, usually with a PCT or CNA as "helper". Sometimes you would see a PCT with an assignment and no nurse assigned, if it was a low acuity unit. If a particular patient in an assignment was considered more acute, a switch was made so that an RN was assigned that patient and the helper might be an LPN or PCT. This method was designed to utilize resources efficiently in a time when there was a real shortage of RN's. The idea was to have the RN's in positions that would best utilize their more advanced training while leaving the more routine care to those whose training had been geared towards bedside care and medication administration. The philosophies behind LPN training (actually the very existence of LPN's) is based on this model. Most Nurse Practice Acts were also written based on this model. "Delegation" came into play when dividing tasks between the pair of workers on one assignment.
With the adoption of the "primary care" model, the delegaion issue is mostly confined to out of hosptal environments. In LTC or Sub-acute, an LPN may be "assigned" charge. They "assign" patient care to CNA's. The supervisor may "delegate" certain tasks such as care plan updates, condition changes and assessments to the LPN. If they were the supervisor's responsibility (many states limit or exclude LPN's in these tasks), the supervisor is responisble for the delegated care and may later have to co-sign. The LPN may delegate a routine treatment such as applying diaper cream to the CNA, but she is the one responsible for signing that the treatement was done and is accountable for the outcome.
BTW, the "primary care" model was also promulgated by the ANA as part of their position that all "professional nurses" have BSN's and that anyone less would not really be nurses. All of the ADN RN's who don't consider LPN's to be nurses should consider this fact. The ANA wanted the ADN to be a "technical nurse". Had they used the familiar language, Registered Nurse and Practical Nurse, they might have succeeded.
"Delegation" has become another term like "assessment" that is often more a matter of semantics than actual practice. Though it did once have a more defined meaning. I know this is long, but I hope that it helps.
i don't think that djb727 meant her statement to sound like lpn's are not qualified. i think she meant that since the rn is the primary nurse taking care of the patient that she feels responsible to make sure that the patient is properly taken care of. since the lpn is only giving meds that day, she was unsure if she (the rn) was responsible to verbally notify the lpn to hold the med. if you think about it the roles can be reversed. if the rn was giving meds and the lpn was the primary care giver, the lpn may wonder the same thing. this is just a matter of what needs to be communicated than a rn vs lpn issue.
Specializes in Community Health, Med-Surg, Home Health.
i don't think that djb727 meant her statement to sound like lpn's are not qualified. i think she meant that since the rn is the primary nurse taking care of the patient that she feels responsible to make sure that the patient is properly taken care of. since the lpn is only giving meds that day, she was unsure if she (the rn) was responsible to verbally notify the lpn to hold the med. if you think about it the roles can be reversed. if the rn was giving meds and the lpn was the primary care giver, the lpn may wonder the same thing. this is just a matter of what needs to be communicated than a rn vs lpn issue.
if i sounded like i was upset, please allow me to render my apologies to the op and everyone else that took it as such because that was not the message i intended to send; it was more to enlighten. i think i should express myself a bit clearer in what it means, because as you see, it does cause confusion, this is mentioned often. the lpn has a license of his/her own and is accountable and responsible for their practice, and it seems that many rns don't know this; including my don. when administering medications (using this example because this is the topic of the thread), the lpn was trained to comply with the 5/6 (however one was taught) rights of medication administration, which includes knowing what you are giving, why, what parameters are there, side effects and contraindications.
i have had many rns say that they are responsible for the actions of the lpn, so to speak (again, i don't say this out of being petty, but maybe some are not taught this). many times, this misconception has led to insane policies and procedures that eventually frustrate both, the lpn and rn out of fear and miscommunication that came out of it. for example, what is happening at my job right now is that lpns are not allowed to administer flu or pneumococcal vaccines ordered by a physician without an rn screening it first. meanwhile, the state (which is supposed to supercede policy) says that as long as there is a patient specific order from a physician, the lpn may administer, provided that it is deemed safe. lpns in my state cannot honor non-specific patient orders (say for example, a walk in flu clinic) because we do not have assessment priviledges...then, screening must be done by an rn (but after the screening, she can then delegate an lpn to administer). now, my job is saying that even with the order of a physician, we still cannot give without an rn screening, so, it is double work for the lpn...and the doctor's order alone for these two specific vaccines means nothing to the lpn based on this, because we still have to obtain an rn screening. now, even with a doctor's order, does the lpn just blindly administer without asking specific questions? any lpn...any nurse that does this is wrong. but, our don feels we are not able to do this. do you see what i mean about silliness? clearly, the state made their determination. any lpn that deviates past that is wrong, and is responsible for herself...not the rn, the doctor or the don. but, these are things that lpns face in varying degrees.
Specializes in A little of this & a little of that.
I absolutely didn't think the OP questioned whether LPN's are qualified to be med nurses. I got the impression she hasn't worked with the system before. I also had the impression, possibly wrong, that she thought that everything an LPN does is "under the RN's License". This is a common misconception that creates a lot of unnecessary problems as pagandeva points out.
Any med nurse should be checking all parameters before giving meds. If the med is held or refused, the primary nurse must be informed. If the med nurse doesn't do this, she is at fault, not the primary nurse, regardless of whether she is an RN or LPN. She should also inform the primary nurse of any other pertinent observations, for example high/low sugars, difficulty swallowing or change in mental status. Unless informed otherwise, the primary nurse should consider the meds as given. That said, if i was working with a med nurse I didn't know, I'd be discreetly checking to make sure that policies and parameters were followed for the sake of my patients. The primary nurse is responsible to inform the med nurse of any new orders or changes in a timely manner. If she took an order and didn't tell the med nurse in time to prevent a med error, that is the primary nurse's fault.
Also, everywhere I've worked, med nurses were given report on the patients in their assignment. Sometime listening to the entire report or sometimes being "briefed" be the charge nurse or even reading a report sheet. It is irresponsible to have someone passing meds when they haven't been informed about the patients. I would also be uncomfortable with a med nurse that just starts the med pass with no report. I am not certain what setting the OP is working but I have done it this way in both hospital and LTC settings. The issue here really is not the level of licensure the med nurse has, it's that the set-up is asking for trouble.
thankyou all for your replies. They were all very helpful. Please do not interpret that this was about LPNs being incompetent because believe me, I think some LPNs I have worked with in the past could be MDs due to their competencies. We are all in this together.
I just was not familiar with this setup. This is my second facility that I have worked at since graduating nursing school about 3 yrs ago. I still feel like a "nursling" and instead of asking other coworkers, I asked you guys because I did not want to get sneared at from my coworkers for asking what might have been either a "stupid" question to them, or as one replier to this thread thought - LPN incapable than a RN. which is definitely not where I was going. Once again, thank you all.
Just recently started at a new facility. This facility has one LPN whom only comes in to work to give out all the medicines to all the patients on the floor. My question is, am I, the RN, responsible for making sure that my patients medicines are given; and if and when to hold certain meds such as BP meds, etc. Is this setup a delegating process. In other words, if the LPN went ahead and gave a BP medicine without checking a persons blood pressure on graphics, before you could tell the LPN to hold the BP med verbally (probably because as soon as the LPN comes in to work, they automatically start giving out am meds before the RN has even entered the room to do pts vitals, assessment, etc.) Am I responsible as the RN if a pts. BP is bottomed out because the LPN didn't check the graphics or know that pts BP beforehand? Of course I think I am. In other words, the LPN is not using their nursing skills by not checking BP. And if you so happen to be checking BP after the LPN has already given it while making your rounds, and you realize that there needs to be a med put on hold and you go to your MAR - guess what the med was already given before you could even delegate not to give this so and so med.
It doesn't matter whose patient it is, the person giving the med is responsible for knowing when and how to give, when and why to hold it, what side effects and interactions to watch for, how to chart it. If the charge nurse or anyone else ask me to give a med I would only do so after checking to see if it is appropriate and I would chart it myself. If the LPN gives the med because you delegated it, that LPN is responsible to know whether giving that med is within their scope of practice and all the other stuff involved in giving meds. (ex: in Calif, LVNs don't give IV meds...)
Thornbird
373 Posts
The language regarding delegation and assignment in varies. In most states LPN's can delegate to other LPN's or UAP's. To delegate is to pass a task that is your responsibility to another teammember. For example, you work with a PCT on your assignment- some nurses will have the PCT do vitals or glucometers on their patients, that is delegating. An RN works with an LPN as a partner instead of a PCT so the LPN can be delegated to do treatments, check IV sites, give meds, etc. In a clinic the nurse may delegate to the MA things like setting up a procedure tray. Delegation must be within scope of practice and is a direct action between the nurse assigned to the patient and someone working along with her but not having responsibility for the patient. Unless an LPN is working in what is essentially a PCT role, jointly assigned with an RN, delegation is not involved. An LPN assigned to a patient is accountable under his/her own license for all care and suubsequent delegation of care. The LPN is not working "under the license" of an RN. The RN who made the assignment is only responsible that the tasks involved are within the LPN scope of practcie. If there is something not in the LPN scope (ie TPN) the RN making the assignment is responsible to arrange for an RN to do that care. This is supervision which is all that laws generally require of RN's in relation to LPN's.
Assignment, done by supervisors or charge nurses, must be appropriate to the scope of practice of the assignee. Assignments given to an RN or LPN make that nurse accountable under his/her own license for all care given. The LPN is held responsible for any errors in judgement. If the LPN fails to inform the supervisory RN of a patient condition requiring further assessment or care beyond the LPN scope, the LPN is responsible for any problem arising.
In the "old days", it was common to use the "team" approach in hospitals. Depending upon the acuity of a unit, only the charge nurse might be an RN. The unit would be divided into two or more "teams". Each team would have a med nurse (RN or LPN) who was responsible for all monitoring associated with giving meds, such as BP's. The patient assignments would be given to RN's or LPN's, usually with a PCT or CNA as "helper". Sometimes you would see a PCT with an assignment and no nurse assigned, if it was a low acuity unit. If a particular patient in an assignment was considered more acute, a switch was made so that an RN was assigned that patient and the helper might be an LPN or PCT. This method was designed to utilize resources efficiently in a time when there was a real shortage of RN's. The idea was to have the RN's in positions that would best utilize their more advanced training while leaving the more routine care to those whose training had been geared towards bedside care and medication administration. The philosophies behind LPN training (actually the very existence of LPN's) is based on this model. Most Nurse Practice Acts were also written based on this model. "Delegation" came into play when dividing tasks between the pair of workers on one assignment.
With the adoption of the "primary care" model, the delegaion issue is mostly confined to out of hosptal environments. In LTC or Sub-acute, an LPN may be "assigned" charge. They "assign" patient care to CNA's. The supervisor may "delegate" certain tasks such as care plan updates, condition changes and assessments to the LPN. If they were the supervisor's responsibility (many states limit or exclude LPN's in these tasks), the supervisor is responisble for the delegated care and may later have to co-sign. The LPN may delegate a routine treatment such as applying diaper cream to the CNA, but she is the one responsible for signing that the treatement was done and is accountable for the outcome.
BTW, the "primary care" model was also promulgated by the ANA as part of their position that all "professional nurses" have BSN's and that anyone less would not really be nurses. All of the ADN RN's who don't consider LPN's to be nurses should consider this fact. The ANA wanted the ADN to be a "technical nurse". Had they used the familiar language, Registered Nurse and Practical Nurse, they might have succeeded.
"Delegation" has become another term like "assessment" that is often more a matter of semantics than actual practice. Though it did once have a more defined meaning. I know this is long, but I hope that it helps.