LPN's managing RN's in LTC setting

Jules A, MSN · Aug 21, 2008

As long as they are practicing within their scope and you are also I don't see a problem. The experienced LPNs on my unit run circles around me and I have no problem taking direction from them.

:twocents:

RN1989 · Aug 21, 2008

It is not within the scope of practice for an LPN to direct the nursing practice of an RN. No exceptions.

This has nothing to do with the abilities of the LPN, it has to do with the limits of their license related to their FORMAL educational background.

There are several threads on the forum regarding this. They generally end up in a fight between LPNs who think they are being degraded by the RNs that insist on following the letter of the nurse practice acts.

TopazLover, BSN, RN · Aug 21, 2008

Does the LPN supervise the RN, or is it a management position with the supervisory tasks?

My lic. says that I can supervise LPNs. The LPN lic does not say they can supervise an RN. This is where I would see scope of practice coming in.

I agree that LPNs can run a unit well. Taking directions is a far cry from being supervised. I see the difference but it might not be the same in your state. You might want to have an open discussion with the LPN, if you have concerns. Probably there have been other RNs that worked here. :twocents:

mahoganybbw · Aug 21, 2008

As an LPN i still have to answer to an RN and or Physician..... even if i am supervisor of a unit so i'm sure any decision she makes is supported by an RN.

withasmilelpn · Aug 21, 2008

Administrative duties are primarily what I do when I supervise in the LTC/rehab that I work. Pretty much involves making sure all I's are dotted and all T's are crossed. Since I've been there what seems like forever, I know all our policies inside and out. Also handle family complaints and function as a resource to staff. When something is out of my scope, I make sure that there is someone available, and that they are appropriately trained. (For example, an admission came with TPN as an order. I made sure that our DON inserviced our recent new grad RN before she left for the day. Because it was going to be the new grad's responsibility to hang and mix it.) I make sure paperwork and our computerized charting is being done timely. I know where to find absolutely everything and who to contact to get a job done. Now clinically, that of course is another story. Of course I have oriented new nurses RNs and LPNs and often wonder how that fits into the grand scheme of things, but there you go... All this grey area stuff is pushing me finally to go back for my RN (now that my youngest is in 1st grade.) I just need to figure out what program will work best.:wink2:

Jo Dirt · Aug 21, 2008

I work the floor and there are LPN's in the office who direct me when it comes to administrative things.

Doesn't bother me at all.

pagandeva2000, LPN · Aug 21, 2008

I think that what gets to people is that this is not a traditional role, and nursing programs are not discussing this recent trend. Personally, I would be uncomfortable supervising an RN on any capacity because it doesn't sit well with me (and wouldn't do it). However, I have seen where it does happen. If it is done in a different capacity, such as administrative tasks such as what was mentioned by withasmilelpn, and no such supervision clinically, I can accept it much better, I just wouldn't do it myself.

RN34TX · Aug 21, 2008

There are several threads on the forum regarding this. They generally end up in a fight between LPNs who think they are being degraded by the RNs that insist on following the letter of the nurse practice acts.

Several threads?

I've seen a lot of discussion about this in recent months.

What is with the sudden intererest in LPN's supervising RN's in LTC?

It's hardly a new concept.

Since I've never worked as an RN in LTC, that's probably why I don't get it. The recurring arguement seems to be that the LPN's are in administrative positions and are there to supervise them from an administrative perspective rather than an RN vs. LPN scope of practice type of perspective.

I understand it from an RN perspective in that RN's become nurse managers every day in areas where they have no competency. Recent example being an RN who worked primarily in the OR becoming a nurse manager of a post-op med/surg unit who has no med/surg floor experience.

She literally could not do the job of people she supervises and evaluates on a daily basis. How can you evaluate people and supervise them when you couldn't perform their job requirements or even know what they are supposed to be doing in the first place?

From a former LPN/LVN perspective, I look back on my days of bartending and waiting tables in bars/restaurants. I may have had more education and even experience in working the bar and dining room areas, but it never failed that any particular restaurant that I was working for would let some smart mouth 28 year old be my boss who had zero bartending or waiting experience. He/she worked as a cook or whatever for 10 plus years and getting promoted was the reward the company gave them for staying with them. Nothing more.

How can being a cook or dishwasher for 10 plus years have anything to do with knowing how to evaluate and supervise waiters and bartenders?

My point is that education and experience are two different things and that one does not substitute for the other.

You can't be an experienced BSN or MSN RN who worked in the OR throughout their entire career to be ablre to manage an ICU. You wouldn't have the skill sets adequate to evaluate your employees.

On the other hand, being an experienced, well-seasoned and competent LPN expert in handling most patient situations in your specialty does not automatically make you qualified to supervise your unit or the RN's that staff it.

ilstu99 · Aug 21, 2008

A friend of mine is a new grad RN in LTC, and the NM is an LPN. It happens to be the facility in which my grandmother lives. She is also a nurse.

In her state, the biggest differences are no phone med orders, and no IV meds by LPN's. The NM does not do any bedside nursing care. Her duties are scheduling, reports, budgeting, etc. The people who supervise the nursing care are on-the-floor supervisors, and they are RN's for RN staff. Apparently, there are a couple of LPN supers, but they share supervisory responsibilities with the RN supervisors when needed.

As long as the patients are receiving great care and there are no laws being broken....whatever works for them. Gram says she loves it there, and she judges the nursing care to be "without peer." She would know.

Xbox Live Addict · Aug 21, 2008

Has anyone come across this? In the longterm care setting how do you deal with an LPN being a manager of a unit that has staff nurses that are RN'S??? It just seems off balance. Are there different rules in LTC? Curious for any opinions and if anyone has dealt with this issue...

In LTC, this is a fairly common occurence. In my state, an LPN can hold any position in a nursing home except as DON (which is an RN) - including as an administrator, the DON's boss. The DON functions as the RN supervision for LPNs mandated by nurse practice acts. Meanwhile, the LPN-ADON may have administrative authority over any staff RNs. RNs tend not to stay at LTC facilities for long stretches in any capacity except as DON, so the LPNs are often the ones with the most seniority when it comes to applying for administrative positions.

This is a strictly a function of the company's hierarchy. An LPN in a supervisory position still has a narrower scope of nursing practice as defined by a NPA than a staff RN, but holds a more powerful position in the company itself. They are acting as corporate officers rather than nurses. To that end, I don't think an administrative LPN can, in most settings, evaluate the NURSING performance of a staff RN, because of the NPA, and this is left to the DON. LPNs in administrative positions must operate at all times within their scope of nursing practice - meaning there are still nursing tasks (though in Oklahoma, LPNs have an incredibly broad scope of practice) that must be carried out by the staff RN, regardless of who is higher on the corporate food chain.

The hierarchy of health care professions does not necessarily apply when it comes to the company's structure. At my facility (a plasma facility), under our legally-binding SOP, the Center Medical Director, a MD, officially reports to our center manager, who in this case is an LPN and also has authority over a staff RN.

Don't forget - many of the top positions in many hospitals and nursing homes, and corporations are held by people from business backgrounds with minimal training in health care.

NewEnglandRN, RN · Aug 21, 2008

So, in an LTC facility, does there have to be an RN present in the building at all times?