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.
Specializes in Gerontology, Med surg, Home Health.
I had the unfortunate task to report a nurse once to the BON. A representative came to the facility. She told me it's not that easy...at least in this state...to lose your license. When nurses who steal drugs from residents or come to work 'impaired' don't lose their licenses it can't be all that easy.
That is true..I have also been offered a job on an oncology unit at a hospital so I am struggling with which job to accept. I just graduated in June and have been working as a Psych nurse. I love geriatric nursing but there are not a lot of openings for RN's in LTC. I am 49 and I am not sure I want all the stress of working in a hospital..
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.
I was just offered a job at a LTC/rehab facility and they have a LPN as 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.
I think you have a legitimate dilemma,. I would double check with the facility as to how much responsibility you will have in the event that the LPN manager makes a mistake in judgment. I would get this in writing. If you have a lawyer friend I would check what local laws apply..
Specializes in ICU, PICC Nurse, Nursing Supervisor.
it is very common in ltc to have a lvn as a supervisor ( i was one many years) . lvn's have their own license and do not work under the license of the rn.
it is very common in ltc to have a lvn as a supervisor ( i was one many years) . lvn's have their own license and do not work under the license of the rn.
i hate to be sucked into this but if you look up the definition of lvn you will get:
"an lvn is a licensed vocational nurse which is a nurse that is licensed by the state to provide routine patient care. some states use the term lpn or licensed practical nurse rather than lvn. an lvn can work in a hospital, long-term care facility, convalescent home, doctor's office or surgical center, providing many of the same services also performed by registered nurses (rns).
the lvn, however, must be supervised by rns or doctors, and cannot do everything an rn does the lvn is usually trained for a year to two years in anatomy, physiology, and patient care, differing from the rn, who has several more years of advanced science and frequently a four-year education. once education is completed, the lvn must also do supervised work prior to applying for licensure. many would argue that the lvn is one of the hardest of workers, though most receive about half the salary of an rn, approximately 24-48,000 us dollars (usd) per year. many lvns decided to achieve their rn after a few years of work, to take on more challenging work or to have the salary to which they are richly entitled"
another site(state of california board of consumer affairs) gave this:
" licensed vocational nurses (lvns)
1. what is a licensed vocational nurse (lvn)?
an entry-level health care provider who is responsible for rendering basic nursing care.
a vocational nurse practices under the direction of a physician or registered nurse.
" licensed practical nurses care for the sick, injured, disabled or convalescent. they bring their caring, sympathetic natures to hospitals, home health care services, nursing care facilities, physicians' offices and other health care providers and agencies.
working under the direction of physicians and registered nurses (rns), lpns and lvns attend to patients in a number of ways. depending on the nature of their job, they might:
* take vital signs
* gather patient health information
* prepare and deliver injections
* assist patients in personal hygiene tasks
* collect lab samples and perform routine lab tests
* help care for and feed infants
* teach patients and family members about good health habits
* supervise nursing assistants and aides
get more information in our article about licensed practical nurse jobs."
i have loads of respect for my lpn's but by definition they work under the direction and supervision of rn's. i can not sugar coat it . i am sure i will be flamed for this. just as i am an acceptance letter and many years short of my md license to i have to accept the fact that i am an rn and not an md or a medic, or a lawyer or an indian chief for that matter and i have to respect myself for what i am , i have to clarify that lpn's or lvn's are not rn's as well
i have already stated that your title does not make you qualified, i have seen cna's with better diagnostic abilities that an rn or md and i have see lpn's who are more dedicated and "smarter" than the rn's who supervise them. i did not write the rules, i did not decide who is what and what they can do, each state has its own standards. i respect that you managed nursing homes as an lpn supervisor, if they hired you i am sure you had the qualifications and i bet you did a great job. i worked in ny and israel where rn's are the standard for supervision. i would feel uncomfortable having an lpn supervise me just as my md would feel uncomfortable having a pa supervise him. i hope i am not insulting you, and i hope you can respect my feelings on the matter (even if we disagree).
what is important is the work that we do- and the care that we give our patients
all the best and good luck on your exams this february, i will be praying for you!
I am not quite sure how an LPN would supervise an RN..I will supposedly have my own patients and be doing all the meds and treatments. While the LPN nurse manager does the admits and such..There are a hundred more patients on the ward so who is ultimately responsible? If it is me then I would be out of the loop as I would be down the hall tending to my own patients...Very confusing..
I am not quite sure how an LPN would supervise an RN..I will supposedly have my own patients and be doing all the meds and treatments. While the LPN nurse manager does the admits and such..There are a hundred more patients on the ward so who is ultimately responsible? If it is me then I would be out of the loop as I would be down the hall tending to my own patients...Very confusing..
There are two aspects of every admit- the administrative part and the professional part. Anyone - even a secretary (no disrespect intended) can do the administrative part as long as they are properly oriented and instructed, The professional assessment should be done (ideally) by an RN
My two cents worth. We don't take admits unless there is an MD and RN around to do the assessments
First of all one needs to review the nurse practice act in their state in regards to LVN's LPN's and RN's.
In my state in the RN practice act it states that the RN " Delegates tasks to subordinates based on the legal scopes of practice of the subordinates and on the preparation and capability needed in the tasks to be delegated, and effectively SUPERVISES NURSING CARE being given by subordinates.
The LVN nursing practice act states that the LVN works under the supervision of an MD or RN.
But, in a case where an RN is jeopardizing a residents safety the LVN/LPN does not have the authority to delegate to the RN but the LVN/LPN can act under their own license and call and MD and ask for the MD's opinion and follow the MD's orders to either send the patient out or take some other nursing measure and take care of the patient. The LVN/LPN can call the administrator, director of nurses, medical director, nursing boards, department of health services and report the RN.
In skilled nursing facilities the regulations mandate that there is a Director of Nursing who is responsible for the nursing services being rendered at the facility.
An RN does have the legal responsiblity for assessing residents and formulationg a nursing diagnoses and care plan (in my state) but also has to include other people and there input who are involved with the residents care.
The correct attitude is team work and promoting the highest level of functioning for the resident.
If the facility has a policy that a person would get a written warning if they are late more than once time in a month for example if it doesnt state that a specific person is responsible for issuing the warning then technically anyone who is authorized by the administrator or DON can issue the warning.
I agree it depends on the state and the size of the facility. I am a LPN and worked as an Acting DON for almost three years. I feel that it is base on the state laws and ultimately the LPN's expierence. Some states allow you to apply for waivers where you can have the DON be an LPN.
I hate to be sucked into this but if you look up the definition of LVN you will get:
"An LVN is a Licensed Vocational Nurse which is a nurse that is licensed by the state to provide routine patient care. Some states use the term LPN or Licensed Practical Nurse rather than LVN. An LVN can work in a hospital, long-term care facility, convalescent home, doctor's office or surgical center, providing many of the same services also performed by Registered Nurses (RNs).
The LVN, however, must be supervised by RNs or doctors, and cannot do everything an RN does The LVN is usually trained for a year to two years in anatomy, physiology, and patient care, differing from the RN, who has several more years of advanced science and frequently a four-year education. Once education is completed, the LVN must also do supervised work prior to applying for licensure. Many would argue that the LVN is one of the hardest of workers, though most receive about half the salary of an RN, approximately 24-48,000 US dollars (USD) per year. Many LVNs decided to achieve their RN after a few years of work, to take on more challenging work or to have the salary to which they are richly entitled"
Another site(State of California Board of Consumer Affairs) gave this:
" Licensed Vocational Nurses (LVNs)
1. What is a licensed vocational nurse (LVN)?
An entry-level health care provider who is responsible for rendering basic nursing care.
A vocational nurse practices under the direction of a physician or registered nurse.
" Licensed practical nurses care for the sick, injured, disabled or convalescent. They bring their caring, sympathetic natures to hospitals, home health care services, nursing care facilities, physicians' offices and other health care providers and agencies.
Working under the direction of physicians and registered nurses (RNs), LPNs and LVNs attend to patients in a number of ways. Depending on the nature of their job, they might:
* Take vital signs
* Gather patient health information
* Prepare and deliver injections
* Assist patients in personal hygiene tasks
* Collect lab samples and perform routine lab tests
* Help care for and feed infants
* Teach patients and family members about good health habits
* Supervise nursing assistants and aides
Get more information in our article about licensed practical nurse jobs."
I have loads of respect for my LPN's but by definition they work under the direction and supervision of RN's. I can not sugar coat it . I am sure I will be flamed for this. Just as I am an acceptance letter and many years short of my MD license to I have to accept the fact that I am an RN and not an MD or a Medic, or a Lawyer or an Indian Chief for that matter and I have to respect myself for what I am , I have to clarify that LPN's or LVN's are not RN's as well
I have already stated that your title does not make you qualified, I have seen CNA's with better diagnostic abilities that an RN or MD and I have see LPN's who are more dedicated and "smarter" than the RN's who supervise them. I did not write the rules, I did not decide who is what and what they can do, each state has its own standards. I respect that you managed nursing homes as an LPN Supervisor, If they hired you I am sure you had the qualifications and I bet you did a great job. I worked in NY and Israel where RN's are the standard for supervision. I would feel uncomfortable having an LPN supervise me just as my MD would feel uncomfortable having a PA supervise him. I hope I am not insulting you, and I hope you can respect my feelings on the matter (even if we disagree).
What is important is the work that we do- and the care that we give our patients
All the best and good luck on your exams this February, I will be praying for you!
No one is saying that an LPN does or does not work UNDER the supervision or direction of an RN. BUT we DO NOT work under their license. We have our own. A mistake an LPN makes could not and would not effect an RN license.
CapeCodMermaid, RN
6,092 Posts
I had the unfortunate task to report a nurse once to the BON. A representative came to the facility. She told me it's not that easy...at least in this state...to lose your license. When nurses who steal drugs from residents or come to work 'impaired' don't lose their licenses it can't be all that easy.