LPN as supervisor?

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My question....I practice in the state of Massachusetts in a SNF. I have always been under the impression that an RN "outranks" an LPN and therefore an LPN cannot supervise an RN. Does anyone know where I can find the regs? I tried the state website and this issue wasn't addressed. (and please, don't think I care what initials are after someone's name. I've worked with some outstanding LPN's)

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.

In KY, LPNs do write orders and can be ADONs.

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Usually in a LTC facility the supervisor is for paperwork and communication. This is often an LPN. Sometimes when a RN is new to the facility or simply doesn't want the responsibility she/he will staff a unit while a LPN is the supervisor.

In this case, the LPN is not actually supervising the RNs clinical practice, she is filling our the paperwork and taking administrative responsibilites.

Whoever thinks they would neveer depend or trust the nursing abilities/judgement of another nurse simply because he/she did not have as much education as them is really depriving themselves of a valuable resource; especially if that LPN has been around for awhile.

Nobody knows everything and somebody always knows something more about something than anybody else.

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Usually in a LTC facility the supervisor is for paperwork and communication. This is often an LPN. Sometimes when a RN is new to the facility or simply doesn't want the responsibility she/he will staff a unit while a LPN is the supervisor.

In this case, the LPN is not actually supervising the RNs clinical practice, she is filling our the paperwork and taking administrative responsibilites.

Whoever thinks they would neveer depend or trust the nursing abilities/judgement of another nurse simply because he/she did not have as much education as them is really depriving themselves of a valuable resource; especially if that LPN has been around for awhile.

Nobody knows everything and somebody always knows something more about something than anybody else.

:balloons: amen and amen!:balloons:

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Specializes in Registered Nurse.

It's really something how all these LPN scope of practice and RN scope of practice typed topics turn into the same discussion. :uhoh3:

Yes, LPNs are usually smart. Yes, some LPNs know a lot, etc., etc. Fact is, in a clinical situation, the RN is supposed to know more (in general because of the license she/he holds) in order to make a clinical judgement. Maybe the LPN may know just as much about some things in a certain circumstance, it's true. But that is just the way it is. I wouldn't expect that (in most situations) a CNA would have better clinical judgement than a LPN. But no matter...this discussion had been gone over many times before in one form or another and will be gone over many times again.

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It's really something how all these LPN scope of practice and RN scope of practice typed topics turn into the same discussion. :uhoh3:

Yes, LPNs are usually smart. Yes, some LPNs know a lot, etc., etc. Fact is, in a clinical situation, the RN is supposed to know more (in general because of the license she/he holds) in order to make a clinical judgement. Maybe the LPN may know just as much about some things in a certain circumstance, it's true. But that is just the way it is. I wouldn't expect that (in most situations) a CNA would have better clinical judgement than a LPN. But no matter...this discussion had been gone over many times before in one form or another and will be gone over many times again.

When I was young I learned a lot from the NAs (there was no such thing as a CNA then) that worked at the hospital I worked at. The two of them had done a lot of things over their years that I had only heard about in school. No, they couldn't help me with some things but there was a lot they could help me with and I appreciated it and felt no superiority over them just because I had been to nursing school!

That just reminded me of a situation at a foster home i work at as a home care nurse. There are usually 2 nurses there (4 special needs kids) and we ran out of velcro trach ties. The other nurse, younger than I and an RN, had been washing them out and reusing them until I mentioned that there was a drawer full of trach ties. She was totally suprised becasue she was sure we were out. (I work in this home only part time and she is full time there.) I went and pulled a couple out. One for my kid and one for hers (each nurse has 1 kid with trach, one on vent, one on BIPAP)anyway she had never seen those kind of trach ties before. Regular twill tapes. She was amazed at how simple they were to use after I showed her and she thanked me over and over again for showing her something "new." So you see, even if you are more educated, you don't always know more than somebody less educated.

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Specializes in Registered Nurse.
......i went and pulled a couple out. one for my kid and one for hers (each nurse has 1 kid with trach, one on vent, one on bipap)anyway she had never seen those kind of trach ties before. regular twill tapes. she was amazed at how simple they were to use after i showed her and she thanked me over and over again for showing her something "new." so you see, even if you are more educated, you don't always know more than somebody less educated.

i said something similar in a different way. lol. everyone does know something more than someone else. but that is something different. maybe under the category of respect for workers with different titles. i was a cna, then a lpn for 13 years, and now a rn for a year and a half. i know about these things. been in all the shoes. ;) but there is a reason for the different licenses. cna is not lpn and lpn is not rn. just the facts, nothing more. not putting anyone down. if you think i am putting someone down in saying that, then you are reading into it or sensitive about the issue, i'd say. i have also seen some really good cnas.....many good lpns...and also great rns too.

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I said something similar in a different way. LOL. Everyone DOES know something more than someone else. But that is something different. Maybe under the category of respect for workers with different titles. I was a CNA, then a LPN for 13 years, and now a RN for a year and a half. I know about these things. Been in all the shoes. ;) But there is a reason for the different licenses. CNA is not LPN and LPN is not RN. Just the facts, nothing more. NOT putting anyone down. If you think I am putting someone down in saying that, then you are reading into it or sensitive about the issue, I'd say. I have also seen some really good CNAs.....many good LPNs...and also great RNs too.
Oh I mistook what you were saying then. Becasue that's what I had siad in my post just before that and thought you were debating THAT.

I have no problem with RNs, work with a bunch of really great ones (only a couple of boobs, but then the case manager for a couple of my cases is a boob too and she is an LPN! LOL) It truly does go both ways.

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Specializes in Registered Nurse.
Oh I mistook what you were saying then. Becasue that's what I had siad in my post just before that and thought you were debating THAT.

I have no problem with RNs, work with a bunch of really great ones (only a couple of boobs, but then the case manager for a couple of my cases is a boob too and she is an LPN! LOL) It truly does go both ways.

Yes, it goes both ways...and we can agree on that. :)

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If you have IP's (Interim Permittees) both LVN and RN they can only practice nursing under the direct supervision of an RN. A DON can only be an RN. Only an RN can sign off MDS's. Only RN's can give medications IV push and into IV's. These things are all outside of the scope of an LVN. An LVN will NEVER be held accountable for the actions of an RN, but an RN could be held accountable for the actions of an LVN. This has nothing to do with the persons IQ. NO matter how high an LVN's IQ is she cannot practice outside of her scope. NO matter how low an RN's IQ she has to practice within her scope. According to the Department of health, the LVN boards, the RN boards, LVN's cannot legally supervise an RN. LVN's do hold admistrative positions, but if you look on the Organizational Chart you will notice that the DON will be on top and the ADON (if it is an LVN) will be directily under her and then on the side the RN's will fall still under the DON not under the ADON.

If an LVN gives a directive to an RN, an RN could call the LVN boards and report the LVN for practicing outside of her scope.

Administrators and DON's who allow LVN's to supervise RN's could be charged with Gross negligence or Incompetence. How can an LVN be supervising RN's when RN's are performing functions that are not within an LVN scope???

The health dept., LVN boards, & RN boards in the state of California told me that LVN's cannot supervise RN's.

LVN's can supervise LVN's and CNA's.:o

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Specializes in Registered Nurse.
If you have IP's (Interim Permittees) both LVN and RN they can only practice nursing under the direct supervision of an RN. A DON can only be an RN. Only an RN can sign off MDS's. Only RN's can give medications IV push and into IV's. These things are all outside of the scope of an LVN. An LVN will NEVER be held accountable for the actions of an RN, but an RN could be held accountable for the actions of an LVN. This has nothing to do with the persons IQ. NO matter how high an LVN's IQ is she cannot practice outside of her scope. NO matter how low an RN's IQ she has to practice within her scope. According to the Department of health, the LVN boards, the RN boards, LVN's cannot legally supervise an RN. LVN's do hold admistrative positions, but if you look on the Organizational Chart you will notice that the DON will be on top and the ADON (if it is an LVN) will be directily under her and then on the side the RN's will fall still under the DON not under the ADON.

If an LVN gives a directive to an RN, an RN could call the LVN boards and report the LVN for practicing outside of her scope.

Administrators and DON's who allow LVN's to supervise RN's could be charged with Gross negligence or Incompetence. How can an LVN be supervising RN's when RN's are performing functions that are not within an LVN scope???

The health dept., LVN boards, & RN boards in the state of California told me that LVN's cannot supervise RN's.

LVN's can supervise LVN's and CNA's.:o

I think it depends on how they are supervising. They cannot supervise clinically....but they can be a DON or ADON in some states! I think there are some grey areas and some different laws here and there, etc. We have LPNs ARE Supervisors in my LTC facility!...but if I or other RNs are in the building, we would be ultimately responsible if there is a clinical emergency situation, IMO.

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If you have IP's (Interim Permittees) both LVN and RN they can only practice nursing under the direct supervision of an RN. A DON can only be an RN. Only an RN can sign off MDS's. Only RN's can give medications IV push and into IV's. These things are all outside of the scope of an LVN. An LVN will NEVER be held accountable for the actions of an RN, but an RN could be held accountable for the actions of an LVN. This has nothing to do with the persons IQ. NO matter how high an LVN's IQ is she cannot practice outside of her scope. NO matter how low an RN's IQ she has to practice within her scope. According to the Department of health, the LVN boards, the RN boards, LVN's cannot legally supervise an RN. LVN's do hold admistrative positions, but if you look on the Organizational Chart you will notice that the DON will be on top and the ADON (if it is an LVN) will be directily under her and then on the side the RN's will fall still under the DON not under the ADON.

If an LVN gives a directive to an RN, an RN could call the LVN boards and report the LVN for practicing outside of her scope.

Administrators and DON's who allow LVN's to supervise RN's could be charged with Gross negligence or Incompetence. How can an LVN be supervising RN's when RN's are performing functions that are not within an LVN scope???

The health dept., LVN boards, & RN boards in the state of California told me that LVN's cannot supervise RN's.

LVN's can supervise LVN's and CNA's.:o

As most of us have already noted, an LPN with a supervisory position in a LTC facility does not direct the RN in any clinical situation. Matter of fact, they rarely the nursing supervisors rarely "direct" any nurse within the facility in clinical practice.

However, if the supervisor is an LPN and the two staff nurses (assuming there are like 3 wings in the facility) the supervisor will make the assignment and the RN will work the wing she/he is assigned. This is NOT clinical supervision. I think you are misunderstanding the difference between clinical supervision and administrative supervision.

There is an argument going on here that that is not saying anything. Nobody has said an RN SHOULD/COULD/WOULD take clinical supervision from an LPN. Why do you keep saying the same thing over and over. Nobody is arguing that point.

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Chris, if you reread what I said in 2-3 total messages, what I think is true is that a LPN can be the acting supervisor....meaning, she is doing the work,...but if a RN is also in the building, she is *really* in charge, even if the LPN is going around with a notebook and the census in tow. What I mean is, the LPN can fullfill the the duties but, if something happens,...an emergency, the RN is ultimately in charge. I believe a LPN CAN be in charge of a RN as far as title....but not when it comes to clinical judgement. It's hard to explain! LOL! ARGH. A LPN can be ADON and even DON in some states, I believe. But that does not mean her judgement will supersede the RN in a clinical circumstance. Does that say it better? That is my understanding.

If the emergency occured on the RNs unit she would be clinically in charge because the supervisor is the LPN; however, if it were not on her unit, she would not be involved and the LPN supervisor would be in charge.

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