LPN as supervisor?

Specialties Geriatric

Published

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)

In many states, LPNs can be directors of nursing at MRDD facilities. Directly in charge of RNs. I do know of one particular LPN who was very efficient, reducing budget, errors, increasing patient and Physician satisfaction. However, she had many years of experience, Physician backing, Administration backing, and staff backing. Very effective person. over 70 MRDD clients, with very severe disabilities. Doesn't happen often.

LPNs can be in charge of RNs, for example, RNs working staffing relief at LTC facilities. Some facilities will place their own people in charge, and let temps pass meds. In that case, the LPN would be in charge of the RN. I have seen this happen on occasion.

Never in a hospital or sub-acute.

Mschrisco

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Specializes in ICU, PICC Nurse, Nursing Supervisor.

Do you live in Texas, of course LVN's write orders. Ive been writting them all day. I also was charge nurse today ,while there was a RN on the unit. And Im not sure what a BSN can do that a ADN cannot ,they are both RN's. And once you are a RN you are a RN.

Check your nurse practice act. Mine has a long list of various responsibilities related to the various levels of licensure and education. Some things a BSN can do that an ADN cannot, an ADN can do but an LVN cannot, etc.

It would seem pretty clear that "supervisor" implies more education and a higher professional licensure. Afterall, RN's can write nursing orders and delegate them to LVN's or PCT's, and RN's receive and follow doctor's orders, but you don't see RN's writing orders for doctors to carry out, right? LVN's, to my knowlege (and I could be wrong), don't write orders for anyone, do they?

Your point is well taken. Perhaps there is some missing info?

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this is one issue that really depends on what state you live in. each state has a different nurse practic act for lvn's and rn's with the bon as will as different state regs that apply to nsg. homes. that is where the difference lies. california is very clear on their position in regards to lpn's and rn's. the web cite for the california nurses association explains things in a very clear cut manner. if you want to understand my point of view check it out. i have practiced in other states & contries and have noticed that each state has a different guidelines. i probably should have found out first what state we were discussing before i put my 2 cents in.:)

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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"NO, A RN's clinical practice cannot be supervised by a LPN. I am not one who puts much emphasis on someone's title. I have worked with outstanding nurses, both LPN's and RN's. Remember WE ARE ALL NURSES. However, we still must follow the regulatory process"

We have investigated this thoroughly and have found that it is not true in our state. We just had our survey and it was not an issue. The first year we did this, the surveyors questioned this practice, examined the regs, and decided it was okay to do it! A surveyor's blessing! What more could you ask for!:balloons:

The State surveyors may have said it was "okay". and as I said, a LPN can hold administrative roles in LTC/SNF and sub acute rehab facilities. I am a LPN and have held such roles myself. However, a LPN cannot Clinically supervise a RN. Note that the key word here is "Clinically". Check your nurse practice act for your state. They may be vague, but all nures practice acts in the country have some indication that a RN can practice the profession of nursing independantly, under the direction of a advanced nurse practioner, MD, DDS, etc. A LPN/LVN cares for, assists with the gathering of information, and assists with the planning of care, under the direct supervision of a RN, advanced RNP, MD, DDS, etc. Some states do not allow a LPN to assess, only gather information. You can obtain the Federal regulations manual for LTC, for a cost, from the goverment. Your surveyors in your State should be following these regualtions, unless your state LTC regulations superceed the federal ones.:)

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"NO, A RN's clinical practice cannot be supervised by a LPN. I am not one who puts much emphasis on someone's title. I have worked with outstanding nurses, both LPN's and RN's. Remember WE ARE ALL NURSES. However, we still must follow the regulatory process"

We have investigated this thoroughly and have found that it is not true in our state. We just had our survey and it was not an issue. The first year we did this, the surveyors questioned this practice, examined the regs, and decided it was okay to do it! A surveyor's blessing! What more could you ask for!:balloons:

The State surveyors may have said it was "okay". and as I said, a LPN can hold administrative roles in LTC/SNF and sub acute rehab facilities. I am a LPN and have held such roles myself. However, a LPN cannot Clinically supervise a RN. Note that the key word here is "Clinically". Check your nurse practice act for your state. They may be vague, but all nurse practice acts in the country have some indication that a RN can practice the profession of nursing independantly, under the direction of a advanced nurse practioner, MD, DDS, etc. A LPN/LVN cares for, assists with the gathering of information, and assists with the planning of care, under the direct supervision of a RN, advanced RNP, MD, DDS, etc. Some states do not allow a LPN to assess, only gather information. You can obtain the Federal regulations manual for LTC, for a cost, from the goverment. Your surveyors in your state should be following these regulations, unless your state LTC regulations superceed the federal ones.:)

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Specializes in LTC, MDS/careplans, Unit Manager.

i realize there are different regs for each state.

i have, however, worked as an medicare mds/careplan coordinator (i was able to sign off the mds's with an rn co-signer, my don)

i have also worked as a unit manager in a ltc facility. i gave general instruction to rn's, but never clinical instruction. there was a don (an rn) and 2 unit managers (myself and another lpn) for this facility. i had many responsibilities, none of which included telling the rn's how to do their job.

as far as judgement goes, i do not feel higher education is necessary to have good judgement. as long as the topic is within my scope of practice, i do not have any problem with giving my input to anyone, rn, lpn, etc...

i certainly do not intend this reply to imply that i am on the same level as an rn, as i know i am not. i just wanted to share the things i have done as an lpn that may not have been traditional roles, but have still been within my scope of practice.

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ok im not trying 2 start a flame war here ........but i am currently a student going for my rn, and the conversation in this forum makes it sound like why even be an rn, when you could be an lpn/lvn,why go to 3-4 more years of school to get your bsn(degree) when you could go to 10mo-1yr of school and get your lpn/lvn (non-degree) and hold the same responsibilities clinincally (writing orders, pushing meds) the same responsibilities administratively( unit director,don, adon,charge nurse). what i have read from this forum is that lpn/lvn's can fill all of these shoes. the vibe is why even hire rn's when you could pay an lpn/lvn considerably less to do the same exact duties???!!! next we will have the line between cna and lpn/lvn blurring, then the line between rn and md's blurring. all joking aside..there is a reason that to become an rn you have to have as much as 4x the education as lpn/lvn's, not saing rn's are better just more educated. i think that cna/lpn/lvn's are a vital part of the healthcare system but there is a distinct difference and distance between rn and cna/lpn/lvn's. imho

never forget...................

"its never to late to be what you might have been"

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this is one issue that really depends on what state you live in. each state has a different nurse practic act for lvn's and rn's with the bon as will as different state regs that apply to nsg. homes. that is where the difference lies. california is very clear on their position in regards to lpn's and rn's. the web cite for the california nurses association explains things in a very clear cut manner. if you want to understand my point of view check it out. i have practiced in other states & contries and have noticed that each state has a different guidelines........

in ohio it states that an lpn must work under the supervision of a doc, rn, podiatrist, etc.

it makes no mention of the rn must be the charge nurse if there is one in-house.

i did not want to say it here, but here is my opinion. just because a person has rn behind their name does not mean i will follow their instructions without using my own nursing judgement. if i do not agree you can bet i'll be on the phone with the doc or don in a heartbeat. it is my license on the line if the rn is mistaken, not hers. theoretically yes, the rns also; however, since the rn did not give correct instructions it was my responsibility to know better. now, how many rns are going to stand up and say, it's not her fault, i told her to do it.

oh, by the way... just because an lpn must work under the supervision of a doc, podiatrist, dentist, rn, etc does not mean that is any particular rn! simply being an rn does not automatically make you the boss. lol we can both work on a unit and both of us be working under the supervision of the doc with no further hierarchy involved.

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ok im not trying 2 start a flame war here ........but the conversation in this forum makes it sound like why even be an rn, when you could be an lpn/lvn,why go to 3-4 more years of school to get your bsn(degree) when you could go to 10mo-1yr of school and get your lpn/lvn (non-degree) and hold the same responsibilities clinincally (writing orders, pushing meds) the same responsibilities administratively( unit director,don, adon,charge nurse). what i have read from this forum is that lpn/lvn's can fill all of these shoes. the vibe is why even hire rn's when you could pay an lpn/lvn considerably less to do the same exact duties???!!! next we will have the line between cna and lpn/lvn blurring, then the line between rn and md's blurring. all joking aside..there is a reason that to become an rn you have to have as much as 4x the education as lpn/lvn's, not saing rn's are better just more educated. i think that cna/lpn/lvn's are a vital part of the healthcare system but there is a distinct difference and distance between rn and cna/lpn/lvn's. imho

never forget...................

"its never to late to be what you might have been"

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

Hmmm...didn't the above post arrive in my email inbox yesterday under the name of FNP2B? Change your sig name or something? If I remember correctly, you haven't even started nursing school yet...

At any rate, I'm guessing that since you went through the trouble of changing your sig name to get the above posted, that maybe you are wanting a flame war.

No one is saying that an LPN can do everything clinically that an RN can do.

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[QUOTE=RN,BSN,MSN]Ok im not trying 2 start a flame war here ........but the conversation in this forum makes it sound like why even be an RN, when you could be an LPN/LVN,why go to 3-4 more years of school to get your BSN(degree) when you could go to 10mo-1yr of school and get your LPN/LVN (non-degree) and hold the same responsibilities clinincally (writing orders, pushing meds) the same responsibilities administratively( Unit Director,DON, ADON,charge nurse). what i have read from this forum is that LPN/LVN's can fill all of these shoes. the vibe is why even hire RN's when you could pay an LPN/LVN considerably less to do the same exact duties???!!! Next we will have the line between CNA and LPN/LVN blurring, then the line between RN and MD's blurring. All joking aside..there is a reason that to become an RN you have to have as much as 4x the education as LPN/LVN's, not saing RN's are better just more educated. I think that CNA/LPN/LVN's are a vital part of the healthcare system but there is a distinct difference and distance between RN and CNA/LPN/LVN's. IMHO

In Kansas and Missouri, LPNs cannot hang blood products or give IV pushes. Otherwise, in hospital setting, they do everything an RN does. I believe that some states allow LPNs to give IV pushes and blood products. So, yes, LPNs have same responsibilities as RNs in some settings.

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i dont understand what all the confusion is about. in california the roles of the rn, lvn & cna are clearly defined by the bon, state regulations, obra and our california nurses association in terms of scope of practice. some of them are overlapping, but distinct. the rn has a much broader scope than the lvn's. :uhoh3:

ok im not trying 2 start a flame war here ........but the conversation in this forum makes it sound like why even be an rn, when you could be an lpn/lvn,why go to 3-4 more years of school to get your bsn(degree) when you could go to 10mo-1yr of school and get your lpn/lvn (non-degree) and hold the same responsibilities clinincally (writing orders, pushing meds) the same responsibilities administratively( unit director,don, adon,charge nurse). what i have read from this forum is that lpn/lvn's can fill all of these shoes. the vibe is why even hire rn's when you could pay an lpn/lvn considerably less to do the same exact duties???!!! next we will have the line between cna and lpn/lvn blurring, then the line between rn and md's blurring. all joking aside..there is a reason that to become an rn you have to have as much as 4x the education as lpn/lvn's, not saing rn's are better just more educated. i think that cna/lpn/lvn's are a vital part of the healthcare system but there is a distinct difference and distance between rn and cna/lpn/lvn's. imho

never forget...................

"its never to late to be what you might have been"

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