LPN's managing RN's in LTC setting

[Thor77]

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...

[Xbox Live Addict]

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

Varies from state to state. In Oklahoma, the RN has to be on-site for 8 hours a day... if the facility is Medicare/Medicaid certified.

[bklynborn]

There are many ways around things, this I found while working as an ADON in a LTC. It's of course all about money. An LPN can work as a resident care coordinator, which means they do the same job as a unit manager for less money than an RN would get. They technically run the unit but do not supervise RN's. That is the job of the ADON and DON. It's a great way to stay within budget. Seems to be the going thing around here. In fact it's getting harder and harder to find a RN position since LPN's are cheaper.

[TheCommuter, BSN, RN]

An LPN can manage an RN administratively, but never supervise an RN clinically.

Every nursing home where I've ever been employed has used ADONs (assistant directors of nursing) who are experienced LPNs. They manage the bedside RNs in a purely administrative capacity, but cannot supervise them clinically. I've never seen any issues arise out of this type of managerial setup.

To be frank, many nursing homes prefer to utilize highly experienced LPNs in managerial roles because they are more cost-effective. I've seen LPNs used as directors of staff development, HR managers, assistant directors of nursing, staffing coordinators, medical office managers, and so forth.

[sistasoul]

I find this thread interesting. I am a new grad RN and have been applying to LTC/rehab facilities for a job. I have never put a Foley in or straight cathed someone. If I am the only RN on the floor can an LPN help me with this skill? I have no problem having the LPN help me as she/he has a lot more experience than I do.

[TheCommuter, BSN, RN]

I have never put a Foley in or straight cathed someone. If I am the only RN on the floor can an LPN help me with this skill?

Of course the LPN can assist you with these skills.

[Lovely_RN, MSN]

I find this thread interesting. I am a new grad RN and have been applying to LTC/rehab facilities for a job. I have never put a Foley in or straight cathed someone. If I am the only RN on the floor can an LPN help me with this skill? I have no problem having the LPN help me as she/he has a lot more experience than I do.

Um, I don't see why not.

Most scope of practice issues relate to assessment, IV therapy, and hanging blood.

I'm not blasting you but I really do WONDER just what it is that some RNs think we are trained to do? Do you really think that an LPN can't insert a Foley catheter or straight cath a patient? :stone

It seems to me like a lot of RNs think that we are like CNAs. There is a need for more communication and education between LPNs/RNs.

Anyway, the scope of practice for RNs and LPNs is usually on your States BON website. So if the OP feels concerned about the 'natural order' of things being out of whack then she/he should check out the facts for them self.

[sistasoul]

Um, I don't see why not.

Most scope of practice issues relate to assessment, IV therapy, and hanging blood.

I'm not blasting you but I really do WONDER just what it is that some RNs think we are trained to do? Do you really think that an LPN can't insert a Foley catheter or straight cath a patient? :stone

It seems to me like a lot of RNs think that we are like CNAs. There is a need for more communication and education between LPNs/RNs.

Anyway, the scope of practice for RNs and LPNs is usually on your States BON website. So if the OP feels concerned about the 'natural order' of things being out of whack then she/he should check out the facts for them self.

Hello,

I did not mean to offend anyone. I was reading the posts on this thread and I may have been confused as to the way some of the posts were worded regarding this matter. I did not in any way think that an LPN could not perform these tasks.

[Lovely_RN, MSN]

Hello,

I did not mean to offend anyone. I was reading the posts on this thread and I may have been confused as to the way some of the posts were worded regarding this matter. I did not in any way think that an LPN could not perform these tasks.

No offense taken...my ego isn't that fragile :)

I just think that RNs pursuing employment in areas where there are a lot of LPNs need to be educated about scope of practice issues. If you are working in an area that does not employ LPNs then it doesn't really matter but the information is readily available so there is no need for confusion.

I don't know what it says in your states scope of practice but I have never seen anything written in mine that states that an LPN cannot supervise an RN in an administrative capacity. Is this done in practice? No, where I live RNs are the supervisors because there are no lack of RNs here and its not customary to have LPNs supervise. This doesn't mean that any law would be broken if an LPN became a supervisor because there is nothing in our scope that specifically says that we can't be supervisors.

Personally, I like to know what the people that I work closely with can and cannot do. :wink2:

[TopazLover, BSN, RN]

I appreciate others who can do the activities of scheduling, budgeting, etc. It allows me more time to do those things I was educated to do. This includes supervision of staff. LPNs have not had that education, nor have they had the psych. experience required for us. This experience is critical when working with many residents in LTC. It is sad that we take good LPNs had have them do tasks that could be done by an office manager. That said I am glad that there is someone from nursing to have input about the budget, staffing, education needs for the unit.

As an RN I have refused to be evaluated by an LPN. It is a matter of scope of practice.

[TheCommuter, BSN, RN]

As an RN I have refused to be evaluated by an LPN. It is a matter of scope of practice.

Would you also refuse an evaluation from a facility administrator who is not a nurse?

[TopazLover, BSN, RN]

In that facility RNs ended up evaluating other RNs who were are a different level. The higher level RNs were evaluated by the administrator. This person made it clear that nurse practice was not being by her. The administrator took info from other higher level RNs as basis for any nurse type evaluation. It worked well. The administrator learned lots about nursing using this tool. RNs felt they had professional evals and that the evaluation was not a one way situation.:typing

[Xbox Live Addict]

In that facility RNs ended up evaluating other RNs who were are a different level. The higher level RNs were evaluated by the administrator. This person made it clear that nurse practice was not being by her. The administrator took info from other higher level RNs as basis for any nurse type evaluation. It worked well. The administrator learned lots about nursing using this tool. RNs felt they had professional evals and that the evaluation was not a one way situation.:typing

I actually mentioned this earlier, that even in cases where an LPN was of superior rank to an RN in the company's hierarchy, that evaluation of an RN's clinical practice was done by the DON (an RN) specifically, never done by a LPN ADON, and this does fall somewhat under scope-of-practice rules. However, again, most administrators - who are higher-up than the DON, and make hiring/firing decisions with regards to DONs - are not nurses, while I have seen a few LPN administrators.