LPN nurse manager in LTC

[RubyRN,CHPN]

My nursing experience does not include LTC so I hope someone can assist me with me with my question.

I recently ran into an old aquaintance who informed me her DIL, a relatively new LPN with less than 2 years experience, was working in a local LTC as a unit manager of a non-medicare unit. This LTC facility is part of a large corportation in the US. Tell me, how does it work with supervision when a non-RN oversees and supervises the work of an RN. I know there are RN's that work on that unit.

Thank you for your time.

Ruby

[TheCommuter, BSN, RN]

I am in Texas, where having LPN/LVN nurse managers is a common occurrence in the LTC facilities around here. All of my ADONs (assistant directors of nursing) and unit managers have been LPNs/LVNs because it is more cost-effective to the companies.

In my state of residence, the general rule is that the LPN nurse manager can supervise the RN floor nurse only in an administrative capacity. The LPN nurse manager cannot supervise the RN floor nurse in a clinical capacity. In other words, the LPN manager can discipline the RN floor nurse for non-clinical issues such as excessive tardiness, attendance issues, sleeping, profanity, incomplete paperwork, fighting, and so forth.

Here's a situation that arose last year at one of my workplaces. An RN floor nurse was caring for an elderly woman who fell. The LPN unit manager suggested that the RN report the fall to the doctor, and perhaps obtain an order to send the resident to the ER for evaluation. When the RN stated, "I've assessed my resident and she's fine, so I'm not calling the doctor or sending her anywhere," the LPN unit manager had to legally accept the RN's clinical judgment.

Unfortunately, the lady who fell developed a subdural hematoma, and the facility subsequently got into trouble with state surveyors.

[RubyRN,CHPN]

Thank you for this prompt, infomative posting. I appreciate it.

[achot chavi]

here's a situation that arose last year at one of my workplaces. an rn floor nurse was caring for an elderly woman who fell. the lpn unit manager suggested that the rn report the fall to the doctor, and perhaps obtain an order to send the resident to the er for evaluation. when the rn stated, "i've assessed my resident and she's fine, so i'm not calling the doctor or sending her anywhere," the lpn unit manager had to legally accept the rn's clinical judgment.

unfortunately, the lady who fell developed a subdural hematoma, and the facility subsequently got into trouble with state surveyors.

i don't understand , why couldn't the lpn unit manager call the doctor herself and send the pt for a ct scan or er eval?

[kermitlady]

I agree with the previous poster. I've been a unit manager with RN's working under me and I would've called the doc myself!

[Callinurse]

I am not sure but I have heard if the facility is less than 99 beds they are not required to have 24 hour RN coverage in the building.

Calli

[achot chavi]

Depends on the state

[debRN0417]

I am in Texas, where having LPN/LVN nurse managers is a common occurrence in the LTC facilities around here. All of my ADONs (assistant directors of nursing) and unit managers have been LPNs/LVNs because it is more cost-effective to the companies.

In my state of residence, the general rule is that the LPN nurse manager can supervise the RN floor nurse only in an administrative capacity. The LPN nurse manager cannot supervise the RN floor nurse in a clinical capacity. In other words, the LPN manager can discipline the RN floor nurse for non-clinical issues such as excessive tardiness, attendance issues, sleeping, profanity, incomplete paperwork, fighting, and so forth.

Here's a situation that arose last year at one of my workplaces. An RN floor nurse was caring for an elderly woman who fell. The LPN unit manager suggested that the RN report the fall to the doctor, and perhaps obtain an order to send the resident to the ER for evaluation. When the RN stated, "I've assessed my resident and she's fine, so I'm not calling the doctor or sending her anywhere," the LPN unit manager had to legally accept the RN's clinical judgment.

Unfortunately, the lady who fell developed a subdural hematoma, and the facility subsequently got into trouble with state surveyors.

I can understand the LPN not wanting to call the doctor over the RN, but she should have called the DON and reported this immediately, especially if the facility protocol was to notify the doctor of resident falls. The RN should have respected the LPN's position as the Charge Nurse and acted accordingly.

[CapeCodMermaid, RN]

At none of the facilities I've worked in would there have been an LPN as the ADON. In Massachusetts the ADON stands in for the DON in his/her absence and an LPN can not.

[Nurselacey]

I was just offered a job at a LTC/rehab facility and they have a LPN as charge..I was told that she can call doctors and do admissions and is not necessarily my supervisor but is considered the charge. It makes me very uncomfortable considering I would be left out of the loop so to speak and yet wouldn't I ultimately be the one who gets in trouble if she makes a mistake as I am the one with the RN license. I really would like to work at this facility but I do not want to jeopardize my license. Any advice would be appreciated.

[CapeCodMermaid, RN]

You are responsible for your own practice. You are responsible for the CNAs who work 'under' you. If someone else is in charge, I don't think you'd be responsible for her.

I'm sure I'll get flamed, but as an RN, I wouldn't feel comfortable having an LPN as my supervisor...call it whatever you want. I know some wicked (Massachusetts talk for very) smart LPNs but that doesn't negate the difference in education and scope of practice.

[Nurselacey]

Thanks for your input..It is the hours that I liked about the job 16 hr days two days in a row then off for five days..I am just very uncomfortable about having an LPN as "Charge" If i was an LPN I would be fine but it is sooo easy to lose your license..I just got it in June ..probably being paranoid but...Thanks again.