lpn supervising RN!!!

[masry123]

I am very confused, my facility just hieared 2lpn to supervise day shift during weekday and weekends. we do have more than 6 RN {new grad} on diffrent floors. my question is 'is it possible for lpn to supervise RN if she have mor exp":idea:?

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[Crash_Cart]

I don't want to sound ignorant, but I didn't know that an LVN could be a charge nurse. I thought to be charge you would need to make assignments for others, which I thought was out of the LVN's scope. Am I way off?

Here's a scenario example.

Let's say my official job title is "Executive Director of Patient Services." Part of my qualifications for this position is that I should hold a valid license and registration with the board of nursing. Such a valid license that would qualify me for such a position could be an LPN license.

OK, lets say now I am hired and have the job at the facility. The door on my office says I am the Executive Director of Patient Services for this facility.

So as the newly hired Executive Director of Patient Services (who happens to hold an LPN license) does this mean I am in charge of any RN's now working at this facility?

Of course an LPN working in this capacity would be supervising RN activities. That would be the required function of the Executive Director of Patient Services at the facility wouldn't it?

I don't think that would be particularly unusual.

[NRSKarenRN, BSN, RN]

Director level = responsibility for Supervision, assessment of RN/LPN competency, performance evals, nursing Quality assurance and Nursing Education along with ability to hire/fire from position based on violation of these standards. Most nursing practice acts restrict theses responsibilities to RN"S , especially in acute care and LTC settings--- other states across the board in ANY health care setting.

[RN_Canada]

"Supervision" in the formal sense usually implies a level of responsibility in scheduling, providing performance evaluations or feedback on performance, assuming responsibilities for monitoring safety and quality, and assisting with decision making. However, the role of "supervisor" can be defined differently depending on the context.

For example in my area the Workers Compensation board defines "supervisor" quite loosely and suggests that it is anyone on site who even informally assume leadership responsibilities!

However, with unionization comes a more formal way of defining levels of supervision because those levels bring with it higher levels of authority and pay.

One thing is for certain in Canada - no union would allow an LPN to supervise an RN in a formal context in the Canadian health care system.

I just cannot see how that could be reconciled within the current union structures.

In might be important to note that in Canada RN is a university degree and LPN is anywhere from 1 - 2 yrs of education. So the structures in the workplace reflect those different levels of education.

There is absolutely no question in my mind that if an employer created a position for an LPN that was formally supervising RN's (in any context) that the Registered Nurses would grieve it (I know I certainly would) and also no doubt in my mind that the grievance would be resolved in their favour.

[RN_Canada]

In my State of Arizona it is illegal for a LPN to delegate a task to a RN, although there are LPN supervisors.

Delegation by definition means a task outside of the scope of practice of the professional. Therefore, legalities aside, it is impossible for an LPN to delegate to an RN. There is nothing within the LPN scope of practice in Canada or the US that is outside of the scope of practice of an RN.

A RN scope of practice wholly and completely contains the scope of practice of an LPN.

Is it even possible for a nurse to delegate nursing to a nurse? There is even a lot of discussion about whether or not a RN can actually delegate nursing tasks to an LPN.

[Asystole RN]

Delegation by definition means a task outside of the scope of practice of the professional. Therefore, legalities aside, it is impossible for an LPN to delegate to an RN. There is nothing within the LPN scope of practice in Canada or the US that is outside of the scope of practice of an RN.

A RN scope of practice wholly and completely contains the scope of practice of an LPN.

Is it even possible for a nurse to delegate nursing to a nurse? There is even a lot of discussion about whether or not a RN can actually delegate nursing tasks to an LPN.

Is this a Candian v. US language difference? Football v. Foot-ball, petrol v. gas?

Merriam-Webster

delegating

Function: verb

intransitive verb : to assign responsibility or authority

Arizona Revised Statutes 2009

ARTICLE 1. BOARD OF NURSING

32-1601. Definitions

7. “Delegation” means transferring to a competent individual the authority to perform a selected

nursing task in a designated situation in which the nurse making the delegation retains accountability for the delegation.

biz-development.com

]"Delegation is management style where the certain task is given to subordinate. Prerequisite for this is that the subordinate is competent and that there is a certain level of control of activity. Delegation is not the loading of subordinates with work, but simply distribution of tasks based on complexity of task and utilization of employees."

[RN_Canada]

Arizona Revised Statutes 2009

ARTICLE 1. BOARD OF NURSING

32-1601. Definitions

7. "Delegation" means transferring to a competent individual the authority to perform a selected

nursing task in a designated situation in which the nurse making the delegation retains accountability for the delegation.

good point AsystoleRN - there may be some differences in definitions of terms.

The definition of delegation I gave is the one we use to differentiate delegation from assignment.

The words assignment and delegation are used interchangeably in common language and the nursing authorities have defined the terms in order to make sure that the difference between the two are clear when used in the context of the practice of the various health care professionals who often have overlap in their practice.

When you assign a task it must be within the person's job description and training. When you delegate it is outside the usual scope of practice.

We have legislation that defines "restricted acts" in many provinces so the act would be restricted to a specific group of regulated health care professionals. A delegation must go through a specific process and the health care provider accepting the delegation must be willing to take on the task. Mostly this is done when specific nursing tasks are delegated to unregulated care providers. A delegated task is also client specific meaning that the person can do it only for that client and only if that client's condition remains the same as it was when the delegation was made. ( I think this is consistent with the definition you gave that states "in a designated situation")

It is not the same across Canada in all provinces and I suspect there are variations from state to state in the US as well.

In some provinces RN's can delegate restricted acts to LPN's but when the LPN is performing the act the professional who owns the act in their regulation must be available for consultation to the LPN. This usually happens in provinces that do no require the LPN to practice under the supervision or direction of the RN.

However, even using the definition you gave of delegation (Arizona Board) I would submit that an LPN cannot delegate to an RN.

I would even argue that an RN cannot delegate nursing to an LPN under that definition because as a regulated professional the LPN must maintain accountability for their own practice. That cannot be transferred to the RN.

I do not see legally, how a person can be accountable for outcomes for actions done by others. This accountability can only be shared. The registered nurse maintains accountability for making the appropriate delegation, training the care provider to do it, and monitoring the ongoing competence of the care provider who is doing the task. The unregulated care provider also must maintain accountability for their own ongoing competence and doing the task in the proper way. Accountability for the actual outcome must be shared.

I for one would not want to be totally accountable for the outcomes of acts done by others. If this was the case why would anyone even do a delegation? Isn't that kind of risky?

I would be interested to know how the Arizona State Board would define "competent individual". I find that a really interesting term as it does not suggest that the individual is a regulated professional and how could they be competent with the task before they are trained?

[Asystole RN]

good point asystolern - there may be some differences in definitions of terms.

the definition of delegation i gave is the one we use to differentiate delegation from assignment.

who is we? i am curious where you are getting that definition, can you cite law or a definition? i am surprised we are using the term differently...i do believe canadian nurses along with other nurses throughout the world take the same nclex that has been established here in the united states. considering delgation is a major topic within the nclex i am surprised there is a difference of definition.

the words assignment and delegation are used interchangeably in common language and the nursing authorities have defined the terms in order to make sure that the difference between the two are clear when used in the context of the practice of the various health care professionals who often have overlap in their practice.

when you assign a task it must be within the person's job description and training. when you delegate it is outside the usual scope of practice.

i am not sure where you are getting this definition from. as i have come to understand through the bon, u.s. law and the ana, task is a simple "do this" specific thing. a nurse may not delegate a task that is outside either the nurse's or the subordinate' scope of practice. this is a major topic of nursing school in the united states and there are several examples of licensure discpiline for delegating outside the sop. example, delegating to a lpn to access a central line when such a task is outside of that lpn's sop.

we have legislation that defines "restricted acts" in many provinces so the act would be restricted to a specific group of regulated health care professionals. a delegation must go through a specific process and the health care provider accepting the delegation must be willing to take on the task. mostly this is done when specific nursing tasks are delegated to unregulated care providers. a delegated task is also client specific meaning that the person can do it only for that client and only if that client's condition remains the same as it was when the delegation was made. ( i think this is consistent with the definition you gave that states "in a designated situation")

it is not the same across canada in all provinces and i suspect there are variations from state to state in the us as well.

in some provinces rn's can delegate restricted acts to lpn's but when the lpn is performing the act the professional who owns the act in their regulation must be available for consultation to the lpn. this usually happens in provinces that do no require the lpn to practice under the supervision or direction of the rn.

however, even using the definition you gave of delegation (arizona board) i would submit that an lpn cannot delegate to an rn.

actually arizona law specifically states that a lpn may never delegate a task to a rn.

i would even argue that an rn cannot delegate nursing to an lpn under that definition because as a regulated professional the lpn must maintain accountability for their own practice. that cannot be transferred to the rn.

i do not see legally, how a person can be accountable for outcomes for actions done by others. this accountability can only be shared. the registered nurse maintains accountability for making the appropriate delegation, training the care provider to do it, and monitoring the ongoing competence of the care provider who is doing the task. the unregulated care provider also must maintain accountability for their own ongoing competence and doing the task in the proper way. accountability for the actual outcome must be shared.

i for one would not want to be totally accountable for the outcomes of acts done by others. if this was the case why would anyone even do a delegation? isn't that kind of risky?

a supervisor is always responsible for their subordinate's actions. if a lpn makes a mistake that lpn is will be disciplined in addition to the supervising rn. this is as true in nursing as it is in any profession. the manager, ceo, supervisor is always responsible for the actions of their employees.

accountability is shared but the emphasis on the "accountability lays with the person delegating" is to make certain that you know that just because you ask someone else to do something, you are still responsible for that task and how it is performed. if you have been a nurse for any length of time you have already delegated 1,000s of times even if you don't know it. the cna getting vitalsigns for exaqmple. the rn is still responsible for those vitals signs. you cannot tell the board,"oops, well the cna was supposed to get them, i told him to so its his fault." you must ensure that those delegated tasks are performed, performed ontime, and the subordinate has the knowledge and ability to carry out those tasks.

i would be interested to know how the arizona state board would define "competent individual". i find that a really interesting term as it does not suggest that the individual is a regulated professional and how could they be competent with the task before they are trained?

someone who is trained to and is able to perform the task. licensed or not. the az regs do specifically refer to licensed personel delegating to other licensed personel.

[RN_Canada]

practice standard for nurses for delegating to an unlicensed care provider (ucp) as provided by the regulatory nursing organization in my province.

it clearly states that the nurse in responsible for the process of delegating nursing tasks and that accountability is shared- this is in reference to unlicensed care providers not lpn's.

https://www.crnbc.ca/downloads/429.pdf

here is the official reference for the process of assignment and delegation to unregulated care providers in my jurisdiction.

https://www.crnbc.ca/downloads/98.pdf

and...

here is the document outlining the practice expectations of lpn's and rn's in my jurisdiction.

http://www.clpnbc.org/content_images/documents/nurses_working_together.pdf

i do believe canadian nurses along with other nurses throughout the world take the same nclex that has been established here in the united states. considering delegation is a major topic within the nclex i am surprised there is a difference of definition.

you see this is where you are wrong. canadian nursing candidates do not write an exam based on american standards. canadian candidates must write the canadian registered nurse exam that is based on the 148 competencies identified by the canadian nurses association as necessary for entry level practice in canada.

the nclex is not a competency based exam in fact, based on my research and confirmation from the national body responsible for the nclex exam content, there are no identified competencies for the nclex exam in the us.

there are many differences between the two entry level requirements between canada and the usa. one of the major ones being that community health nursing competencies are required for entry level practice in canada. the canadian exam is focused on the canadian context and you can see that by reviewing the competencies through the link i gave.

nurses in other countries do not write the nclex.

actually i am flabbergasted that you think the nclex is the basis for all nursing exams throughout the world?

the philippines and other jurisdictions have their own entry level exams and some countries do not even have entry level exams for nursing. if you pass your program finals you get registration!

actually arizona law specifically states that a lpn may never delegate a task to a rn.

thank goodness!

a supervisor is always responsible for their subordinate's actions. if a lpn makes a mistake that lpn is will be disciplined in addition to the supervising rn.

not in canada - lpns' are self regulating.

a supervisor is always accountable for making sure that the subordinate knows how to act, but may not be accountable if the subordinate clearly ignores these directions, and acts in a way that is contrary to their education and training.

the exception to this would be in the case of a regulated professional. the lpn as a regulated profession, must act in the interest of the public and be accountable for their own actions. if this is not the case then they are not self regulating.

in canada they have a regulatory body and standards and competencies that they must meet. the licensing exam is again a competency based exam.

if an rn directs an lpn to act in a way that the lpn knows is wrong (ie the action contravenes their own professional standards) the lpn must say "no". if they comply with this direction they are accountable for the outcome and that is shared with the rn who gave the direction.

if an rn sees an lpn not meeting professional standards then the rn must intervene in the interest of the patient and report that or take over those aspects of care that the lpn cannot complete competently until the situation is remedied and the same goes for an lpn if they see an rn or any health care provider not acting in accordance with professional standards.

in health care as in any employment setting, a supervisor cannot direct an employee to act illegally, immorally, in an unsafe manner or in health care specifically, the employer or supervisor cannot direct the nurse or care provider to act in a way that is not in the public interest, or that contravenes professional standards.

an employer or a supervisor cannot direct you to be a bad nurse! no way no how!

please bear in mind that i am commenting from the perspective of a universal health care system with a strong public accountability framework and that is my only experience.

accountability is shared but the emphasis on the "accountability lays with the person delegating" is to make certain that you know that just because you ask someone else to do something, you are still responsible for that task and how it is performed.

the two points to be made here...

delegation in my jurisdiction is not asking someone to do something. that is an assignment and the task must be within the legal scope of practice or within their job description, education and training. delegation is much more complex than asking someone to do something.

your definition also emphasizes "how it is performed." if a nurse delegates a nursing task the nurse is responsible for delegation process which includes ongoing monitoring to make sure the task is being performed properly.

that is why in my jurisdiction there is a process for delegation that the nurse must follow and that is why there is a difference between delegation and assignment.

there is a difference between being responsible for the process of delegation and being responsible for the outcome.

the cna getting vital signs for exaqmple. the rn is still responsible for those vitals signs

this is not a delegation this is an assignment - again according to the definitions used in my jurisdiction, if this is a normal and expected part of their job it is not a delegation.

in my province we do not have a regulated professional designation of cna (certified nursing assistant?). in some provinces there is this designation but it is accepted as an lpn license and they must write the entrance exam for lpn's - so essentially they are at an lpn level.

if a cna is a regulated professional then they would have training and standards that must be met and being able to take vital signs would be in their job description. if they are not good at their job and are not taking vital signs properly then it is the job of their supervisor to give feedback and provide opportunities for remediation so that they can perform their job to the standard that is set by their professional association.

if an rn asks an lpn to complete nursing tasks that are within the leagl scope of practice (this is an assignment not a delegation) then the rn has every right to expect that the lpn acts as a competent and safe practitioner within the established professional standards.

if that does not happen the rn is responsible to make sure that the standard of care is maintained and must ensure client safety ( take the vs yourself) and then report to the manager or supervisor so that this can be remedied. but the rn is not responsible for the lpn's actions.

often the rn and the cna ( or lpn) have the same supervisor but the reporting rn is not directly responsible for the remediation, that is the supervisor's job.

the az regs do specifically refer to licensed personel delegating to other licensed personel.

not here. the emphasis is on delegation to unlicensed personel not licensed health care providers.

regulated or licensed health care providers are guided by their legal scope of practice and professional standards. since these are not in existence for unregulated health care providers more guidance is needed.

all of this points out the wide variation in regulation in the nursing profession depending on the social context.

the canadian context is one of public accountability and that is why health care professionals are highly regulated with practice standards and documents such as i have given here.

i do realize that it is not the same in all countries and i find it fascinating to explore the differences in a forum such as this where we can all learn from each other.

[smartnurse1982]

I still don't understand how an Rn could be responsible for something an lpn does when the lpn has there own license.What is the point of having an Lpn license if someone else is going to be responsible for your mistake? To be honest,I have not read a single thing on the Bon's websites and the practice act that reads that an rn is responsible for other licensed nurses(lpns). Now, I have read about Uaps but they are different in that they don't have a license.

[kcochrane]

I still don't understand how an Rn could be responsible for something an lpn does when the lpn has there own license.What is the point of having an Lpn license if someone else is going to be responsible for your mistake? To be honest,I have not read a single thing on the Bon's websites and the practice act that reads that an rn is responsible for other licensed nurses(lpns). Now, I have read about Uaps but they are different in that they don't have a license.

I think it would be more in the case of a RN acting as a charge nurse or supervisor. If they delegate to an LPN and that task is beyond that LPN's scope or they know the LPN is not trained for that task, they can be held responsible.

[smartnurse1982]

I hope I'm not coming across as stupid,but this the last question,I promise. An administrator who is an lpn can fire an Rn?it would seem a little to awkward for me because I know sometimes an lpn can get jealous of an rn,and would seem to me they could just make anything up to fire someone,esp in and adminstrative position

Question is an rn can get fired for being late by the lpn administrator,but can't get fired for something like forgeting to start a gt feeding?

[Charlotte23]

I totally understand what your wife is going through. I am a relatively new RN at a LTC facility. I was trained on meds there by a med tech who now thinks she is my boss. She tries to tell me when to give PRNs and how much with no thought of assessment.. It makes me so angry. I assume since she "trained" me she thinks she knows more. All she needed to teach me was who was who and how they document.. which she mostly showed me what not to do. Similarly, on most days an LPN (who has worked there for a long time but is not all that knowledgeable) works as charge nurse. It is one thing if the people in charge (or think they are) have the skills to back up what they are saying.. For instance, the LPN has been at it much longer than I have but without continuing education... I feel (even as a novice) that in many situations, I have a clearer understanding. Is it legal for me to work with the charge nurse being an LPN? I know there are great LPNs but... my nurses education is much more than clinical/hands on skills. I feel like I should be able to educate the LPN on things such as communication... but she thinks she is my boss and because I am new, she will not take it well. I try to be humble but having someone with less education telling me what to do (and being rude about it and often wrong) is starting to get to me. Also, if everyone is going to the charge nurse for questions.. and she isn't reporting the info to me, how will I know what is going on. I worry about people working under my license but I am being kept in the dark. I ask the LPN a question and she acts as though I have ruined her day!