Lpn Scope Of Practice

lpnflorida · Aug 22, 2008

I am interested to know why you feel the RN needs to be present at the time you are doing your assessment? New admission JACHO requirement Rn will assess within 24 hours. Do the Rn's I work with do a physical assessment after I have already completed an admission physical assessment and charted it. Some do, I have seen them. some I have not witnessed it, but that does mean they did not go into the room and I just missed it. Does it mean some don't, yes I suppose that can be true. Have I ever had an RN go into the room at the same as I did, yes . We did our assessment together. Everyone's style may be different. I will not pass judgment. I have great assessment skills, I know how to go to the Rn with a concern I have, ask them to check something out I want brought to their attention. Again, I am confused by what your concern is? Do you feel you should not have to do a physical assessment as that is the job of the Rn only? I would hope not even if that is true, as yes per requirements Rn's need to do a physical assessment every 24 hours on a patient. Do I complete my own physical assessments of my assigned patients even if for that day I am not doing primary nursing. Yes, you bet your bottom dollar. It is my license also. I want to be able to know what I chart is accurate based on what I have seen and done, just as they do. What I do is within my scope of LPN practice. Perhaps you need to go on line to view just exactly what the scope of practice is, then look to what your individual facilities says your duties are. Then clarify, what is meant by it , if it remains unclear.

Sometimes, they are grey areas. When I first moved here. I asked do you have a policy which shows me which drugs as an LPN I can administer IV. Nope, no such policy existed, 8 years later we have a policy, which clearly states which drugs we can and cannot give IV push.

If asked to do something you are not comfortable with, whether is it you have never done it before, its been years since you have performed, or you are not sure it is within your practice. Voice your concern to first your RN team leader, or Rn charge as the case may be. If still not satisfied then go to Rn Supervisor, etc.. in other words always follow chain of command in seeking direction.

Itsnotoveryet · Aug 22, 2008

thank you for your reply

my problem is that according to nys npa we are not allowed to do assessments. clearly it is a legal issue. and if the hospitals policies and procedures states the R. N. should be present than she should. i am not just goingto be expected to break the law.

we went to our DON and guess what all she did was change the word assessment to data collection. afterwords i was told i was no longer needed on the schedule all because i questioned this i have a federal labor charge against her and the facility...it's a nightmare but i refuse to stand down on what i believe.

lpnflorida · Aug 22, 2008

I looked up the New York Lpn Scope of Practice. pasted it below . Again I do not exactly know how to respond. As to collecting data, well my data is put into charting everyday. okay now, does that make it an assessment or data collection. I suppose a case could be made either way. I collect the date, my judgment then tells me what to do. who to go to with etc. of that data. Am I formulating a plan in my head with what to do, yes. I am. Do I look at the care plans seeing if the plan in my head corresponds, yes on some level I am doing that. Do I update the care plan showing methods used and outcome for that day on the patient. Yes, I do. If new information I have collected new new problem in the care plan I bring that to the attention of Rn who will then put in appropriate measures to be used.

Again assessment vs data and how we document that would have been determined by higher powers than me. All of which the organizations for which I work has done. Call it what they want. I collect what I see, feel, hear, smell, I chart my findings. I present to the Rn that which is out of the ordinary or bring directly to the attention of a doctor if need be.

LPN Scope of Practice in New York State

“Under the direction of a registered nurse” is understood to mean that a registered nurse is

present on the premises or immediately available by telephone when professional services are

rendered by a LPN. The degree of supervision shall be appropriate to the circumstances. LPNs

receive specific education and training through an accredited institution that has met the state’s

requirements and standards for excellence and quality. The National League for Nursing

characterizes the LPN’s practice as caring for patients with common illnesses and providing basic

therapeutic and preventive nursing procedures

While LPNs can do data collection, they cannot do patient assessments

good luck in your endeavor. I am sorry you lost your position over this issue.

gettingupthere · Aug 22, 2008

WOW! I have been an LPN for almost 40 years. I have to say that I would put my assessment skills up against most of the RNs I know and have worked with. Where I work, I do the " data collection" and an RN countersigns it. I assess wounds, take pictures, check my new patients head to toe, then take the admitting MD in and do it again!

I recently found a new resident of 1 week with a stage 4 wound on him, an RN admitted and assessed him AND the Dr supposedly admitted and assessed him. I happened to come upon this wound by accident.It was assessed by an RN as a stage 1 wound! when after looking into his hospital records he was discharged with an Unstageable wound!

This is typical of some of the RN assessments that I encounter at my facility!

Sooooo, when I come in in the am and find that a resident has been admitted while I wasn't there, I go reassess them, just so this doesn't happen again!

pagandeva2000, LPN · Aug 23, 2008

I do believe that many times, words are played with in order to get the same information done; it is semantics, basically. I have no problem if the BON or the powers that be want to say that I can't do certain things, but don't flip the script on me later when there is a desperate nursing shortage by saying that suddenly, I have the capabilities and knowledge to do something that say, 9 months ago, I could not.

skwlpn · Aug 23, 2008

Good luck to you Jessica. I would be concerned about working in a facility where they used word play to define my responsibilitites and duties for the purpose of staying within the states LPN scope of practice. You are right, data collection and assessment are the same thing in my book and is used by your state's board of nursing to give more latitude to facilities to change the rules as they see fit. Fact is, if you miss something big in your "data collection" would they call it an asssessment to take the heat off themselves and say that you were working outside your scope of practice? Likely.

Much of the fault lies with the ambiguous wording of the state policy as cited by another nurse here on this thread. You are right. Make them accountable.

In my state, I can do an assessment. The patient must be under the care of an RN (which in LTC is a pretty broad statement) at some time in a 24 hour period. At the hospital where I work, an LPN takes one 12 hour shift and an RN takes the next. Works out fine. We have very clearly defined boundries in all of our duties.

If the rules are so easily changable for the convenience of the facility, there are bound to be problems. Unfortunately, too often, the low guy on the totem pole is the one thrown under the bus!

Sandwitch883RN · Aug 23, 2008

WOW! I have been an LPN for almost 40 years. I have to say that I would put my assessment skills up against most of the RNs I know and have worked with. Where I work, I do the " data collection" and an RN countersigns it. I assess wounds, take pictures, check my new patients head to toe, then take the admitting MD in and do it again!
I recently found a new resident of 1 week with a stage 4 wound on him, an RN admitted and assessed him AND the Dr supposedly admitted and assessed him. I happened to come upon this wound by accident.It was assessed by an RN as a stage 1 wound! when after looking into his hospital records he was discharged with an Unstageable wound!
This is typical of some of the RN assessments that I encounter at my facility!
Sooooo, when I come in in the am and find that a resident has been admitted while I wasn't there, I go reassess them, just so this doesn't happen again!

I know many LPN's with more experience and expertise than the RN's they are working with. It's not an issue of skill level or competence. It is an issue of SCOPE of practice. I recently started working with an LPN for the first time. She's been an LPN for twice as long as iv'e been an RN. She is a very skilled nurse. However the fact remains that she isnt liciensed to perform initial assessments. I work in L&D and when it gets busy alot of the RN's are fine with her doing vag exams for them. I am not fine with that because it is not within her scope of practice. They defend that by saying ..."well...its fine. She's been here a long time and she's going back to get her RN this year". I'm going to midwifery school hopefully within the next two years but that doesnt mean I should start delivering babies!! That's not within my scope of practice regardless of my intention to further my education. :no:

lpnflorida · Aug 23, 2008

physical examination

a nursing assessment includes a physical examination: the observation or measurement of signs, which can be observed or measured, or symptoms such as nausea or vertigo, which can be felt by the patient.[2]physical examination

a nursing assessment includes a physical examination: the observation or measurement of signs, which can be observed or measured, or symptoms such as nausea or vertigo, which can be felt by the patient.[2]

the techniques used may include inspection, palpation, auscultation and percussion in addition to the "vital signs" of temperature, blood pressure, pulse and respiratory rate, and further examination of the body systems such as the cardiovascular or musculoskeletal systems

is it safe to say we lpn's do a physical examine as opposed to the nursing assessment which involves:

assessment is the first stage of the nursing process in which the nurse should carry out a complete and holistic nursing assessment of every patient's needs, regardless of the reason for the encounter. usually, an assessment framework, based on a nursing model is used.

the purpose of this stage is to identify the patient's nursing problems. these problems are expressed as either actual or potential

is it safe to say we lpn's do a physical examination or physical assessment or is it politically correct to call it a physical data collection ?

i am not looking to argue what our scope of practice is. i am aware of what it is. sometimes we simply interchangeably use terms such as finishing my assessment, when in fact we are doing a physical examination , gathering data whatever the term you want to use.

sandwich883 i believe you were trying to be helpful. i will take it in that context. :nurse: :balloons:

emijen2girls · Aug 25, 2008

I am not claiming to know anything.....except that I was just hired by one of the biggest hospitals in town (Spokane, WA) and when I asked my new manager if I can admit a new pt she said: I do the physical assessment, an RN (the charge) will verify Dr. orders and put them in the computer (for pharmacy, dietery, etc) and sign my assessment. Now, as far as signing my assessment when I worked for the sister hospital 5 years ago some RNs would actually go in the room and check my pt. and some would sign off without going in at all ( I do believe it was because of their own work load was big as well, not that they didn't care).

Simba&NalasMom, LPN · Aug 28, 2008

It is the same here in OR--not in the LPN scope to do assessments under our own licenses. However, I do them all the time; the understanding is that it IS under the direction of an RN, and thankfully the RNs I work under (typically they are the DONs) have confidence that I and other LPNs who do admissions in LTC and rehab know how to do assessments. For cryin out loud, if LPNs didn't do assessments in these settings the poor RNs would never get the mountains of paperwork done that gets thrown at them.

I believe it is a stupid, stupid part of our nurse practice act to not allow LPNs to do independant assessments as we spend a HUGE chunk of time doing just that; still, it's really not difficult to get around because there is always a "supervising RN" around or available via phone.

I really wouldn't sweat it, Jessica. Assessments are a fact of life for every nurse regardless of what the NPA reads; I would focus on getting good at them. Don't worry, in most cases you are covered, and if there is any doubt, you can always ask your nurse manager or talk to your board directly. :)

jbtampa · Sep 26, 2008

a recent nursing home employer changed "assessment" to "observations". truth is, some LPNs can out-perform some RNs, and vice versa. As a respiratory therapist, I quite frankly found many very poorly educated nurses, then once in nursing school, I learned why. Nursing schools admit more than average students and graduate them to require only 51 percent correct answers on a test developed for creating more nurses. my two cents, but any RT, PT, OT, SLP, or even xray tech will smile and agree privately. true statement.