LPN primary role

[AnythingLPNWa]

Need some advice! As I'm leaving my home health job, one of the RN's I work with expressed strong concern over the legality of my primary nurse role. She's had attitude towards me off and on this whole year, which I expect to encounter again, meaning condescending because of our titles (RN vs. LPN). That doesn't bother me honestly, I've done an awesome job and that's her problem. Now, the primary role is almost entirely administrative and I have never supervised her in a clinical capacity, never stepped outside my scope, never delegated tasks to her and always came to her with concerns and followed her clinical opinion. I was made primary because of my previous nurse experience as well as 5yrs acute care experience as a CNA. She has no other experience other than the one patient we've been working with. I find nothing on the BON about this being illegal. Does she have a point about legality or even appropriateness*? I would like to be better able to anticipate if this will be a problem with my future work with people whose licenses are above mine...

[HouTx, BSN, MSN, EdD]

In every state NPA that I have ever heard of - LPNs CANNOT "delegate" anything to an RN. Simply cannot happen because LP/VN practice is limited - can only function under the direct supervision of RN or MD. You can only 'supervise' non-clinical administrative activities/tasks that do not involve any clinical judgement. The RN is always responsible for clinical supervision and direction of subordinate nursing staff - the amount of experience does not matter; it's simply a matter of the scope of licensure.

This type of 'matrix' management used to be popular in health care... non-nurses promoted to administrative roles in patient care areas. However, it required dual management... with a nurse manager overseeing all nursing function/activities and evaluating clinical performance of nurses while the non-nurse had authority only over non-nursing factors. It is clumsy and ineffective, so it's been largely abandoned in favor of simply utilizing qualified nurse managers who have both administrative and nursing knowledge & skill.

[jadelpn, LPN, EMT-B]

It is my understanding that in some states, an LPN can delegate to an RN in a "charge" capacity, meaning for instance, a patient assignment, however can not DIRECT an RN clinically. LPN's scopes can sometimes and are vauge depending on the state the LPN is licensed in, but most are clear in the DIRECTING and not the DELEGATING. Depends on the state, depends on the facility policy, depends on a number of things.

Clearly in an acute care setting, an LPN's scope is limited, but usually due to facility policy rather than scope issues. There are many LPN's who are DON, ADON, and charge nurses in nursing homes and skilled care. Those facilities also have RN's working as well. It is a rumor that circulates time and again that an LPN works "under" the license of the RN. That is absolutely not true. LPN's work under their own licenses, and are responsible for the same. It is unlicensed personnel that one delegates to that could be a "held responsible" for or "working under one's license" issue. Again, states vary widely. There are also LPN's who work under the direction of MD's. In other words, OP, you are responsible for what you do clinically, can--if provided for in your scope--administratively act as a "charge" nurse, give assignments to RN's--but what you can't do is to tell the RN how to care for the patient assigned to him/her.

OP, it is difficult to try and change someone's understanding of your role and scope. Make sure you are well aware of what your scope is, and look at your practice act on the BON website for your state, and be mindful of the policy in your company.

I would think that you were given a "primary" role due to your experience as a nurse. Your years as a CNA, although may have prepared you for some of the aspects of home care, would not have been a deciding factor--as that is comparing apples to oranges.

I would also have conversation with your supervisor. Ask for the policy regarding your role in the team for their agency/facility.

And as a complete aside, be sure that you have malpractice insurance of your own. Just good practice.

[AnythingLPNWa]

Thanks for the insight! I've taken it up with HR and am going to let them handle it. Like I said, I've never stepped outside my scope, and I know it well. Doubt I will take such a role again with rn's given the potential for trouble!

[CYoungLPN, LPN]

My unit manager is a LPN & she delegates to RNs

[BrandonLPN, LPN]

My unit manager is a LPN & she delegates to RNs

Not really.

A LPN asking a RN to do something isn't the same as delegating. Delegating implies that the person doing the delegating is ultimately responsible for the task. This can't be the LPN in a LPN/RN scenario. Licensure is what it is, its pretty cut and dry. The BON won't care who has what job title.

In practice, of course, this is rarely a real issue. Unit managers do their thing and staff nurses do their thing. It's really a non-issue most of the time.