LPN supervising RN?

[TwoLayi, ADN, BSN, RN]

I am a RN and work in a SNF, in my facility we usually have an even mix of LPN/RN staff nurses. We have a DON that is a RN, BUT all of the supervisors/managers are LPNs with many years of experience. These supervisors are in charge of admissions/discharges, nursing assignments and patient care issues that come up, especially when the DON is not in the building. I am wondering if this is legal? The NPA for my state says that LPNs work under the direct supervision of RNs, and it goes on to say that RNs have the assumed role of supervisor even if it isn't in their official job title. So I was wondering if I could be held liable if I were the only RN in the building and something happened? Could I get in trouble for inappropriate delegation, even though I am not the one making those decisions.

[Jory, MSN, APRN, CNM]

It is not legal. The major difference between an RN and an LPN is assessment skills. I would be looking for another job because the DON appears to be very, very confused on the role of an LPN. It doesn't matter how long they have worked there. Assessment is not a part of their core competency.

[Davey Do]

5 hours ago, TwoLayi said:

The NPA for my state says that LPNs work under the direct supervision of RNs, and it goes on to say that RNs have the assumed role of supervisor even if it isn't in their official job title.

It sounds like you've answered your own question, TwoLayi, on whether you could be theoretically be held responsible for an LPN's action if something went wrong.

I had an LPN who's had 11 years experience in SNF read your post and she agrees with your perspective.

Somehow I think that there has to be some sort of safety net for such a situation.

Perhaps you could run this situation by Lorie Brown RN, MN, JD and see what she has to say?

https://allnurses.com/legal-advice-column-c224/

Good luck to you, TwoLayi!

[CharleeFoxtrot, BSN, RN]

7 hours ago, TwoLayi said:

These supervisors are in charge of .....patient care issues that come up, especially when the DON is not in the building.

In my State, everything was okay for an LPN to be charge of (scheduling, admits, discharges) until you got to patient care issues. There the RN license trumps the LPN and if you are the only RN in the building you are it. I would briefly in a SNF and I was expected from the minute I hired in to "supervise" LPNs that had been there significantly longer than my 3 days on the job.

[DirtyVA]

Hello All,

I think it is state specific, but an LPN can be a Supervisor/Manager. It is not "illegal" in the states near me and is normal in rural LTCs and ALFs. Being a supervisor or manager is a different role than the role of an LPN working under the clinical direction of an RN. You really need to break each task down and look at each task individually, the facility type and the patient population, and look at each task and their resultant 2nd, 3rd and f4th order effects. This is a major part of how I make my living, I have a working knowledge of these matters, I know about these things.

In the states near me the RN will always have the final say over any clinical decisions of any LPN who work under their license. They will always have the final say, and be responsible for, any administrative decision (supervisor/manager) an LPN makes that affects a patient clinically. But general administrative duties not so much. That's the risk an organization will need to accept, going cheap by (using an LPN v. RN) and be prepared to pay for it if things don't work out the way they hoped.

If an organization or DON wants to accept the risk (as in lawsuit risk, high monetary damages) and save money by letting LPNs run the place at all hours (i.e. NOC) when an RN is not physically on site, the organization better have at least an RN if not a provider available at the other end of a phone line at anytime STAT.

[Horseshoe, BSN, RN]

In my state, LPNs cannot supervise the clinical practice of an RN, no matter how many years of experience either of them have. Nor can LPNs perform comprehensive assessments (presumably involved with admissions/discharges). Administrative supervision (things not related to clinical practice) is not prohibited.

Your situation sounds very sketchy. I would also be concerned.

[Snatchedwig, BSN, CNA, LPN, RN]

You described administrative stuff...yes.

Clinically obviously not.

[Horseshoe, BSN, RN]

In the states near me the RN will always have the final say over any clinical decisions of any LPN who work under their license.

What do you mean by this? LPNs work under their own licenses, not under the license of any RN.

[Horseshoe, BSN, RN]

5 hours ago, Snatchedwig said:

You described administrative stuff...yes.

Clinically obviously not.

Admissions and discharges usually involve comprehensive assessments, which is definitely a clinical issue. In certain states, comprehensive assessments are out of the scope of the LPN, so depending on the state, this could be a violation of the NPA.

[OldDude]

It's my guess that the job description is totally administrative on paper and thus, the LPN could legally supervise any employee designated by the facility. It's also my guess this is simply a "cheap out" move to cut costs by the facility and the supervising LPN actively participates in overseeing areas not allowed by the BON.

[Snatchedwig, BSN, CNA, LPN, RN]

1 hour ago, Horseshoe said:

Admissions and discharges usually involve comprehensive assessments, which is definitely a clinical issue. In certain states, comprehensive assessments are out of the scope of the LPN, so depending on the state, this could be a violation of the NPA.

As i said , CLINICALLY no.

[FolksBtrippin, BSN, RN]

I know an RN who had an LPN supervisor in a nursing home. It did not bother her at all, because she refused the position herself. She did not want to supervise people and this LPN did.

She did wind up quitting though. She says her LPN supervisor was not the reason.

I personally would not do this. The dynamic is just all wrong, even if the RN and LPN respect each other as in my friend's situation.