LPNs need co-signer for verbal orders

[KatieNoelLPN]

I work in home health. THe other day a fellow nurse told me that any verbal order that an LPN takes has to be co-signed by an RN. I told her I didn't think so. I worked in a hospital for 5 years and the verbal orders taken by ANY nurse, LPN or RN, had to be co-signed by a doctor within 24 hours but not another nurse.She got really nasty and said 'Well, I used to be an LPN too and believe me you have to have an RN sign them.' We live in GA and I can't find anything in our nurse practice act about this.

[KateRN1]

I found this thread while I was searching for an answer to the same question. Per the Home Care Association of Florida:

LPN's do have to have their orders co-signed. It's based on the nurse practice act (NPA) - LPNs have no scope of practice on their own (except for a very narrow venous central line provision) and thus have to operate under a RN's license. Thus the need to co-sign. The NPA is very hard to read and very vague. Go here to read the NPA statute and its various rules -- http://www.homecarefla.org/displaycommon.cfm?an=1&subarticlenbr=17 (scroll down to "Practice Act - Nursing).

Also, per the Medicare COPs, a qualified RN must initiate the POC & necessary revisions to the plan of care (G-Tag 173). So technically, an LPN cannot make a change to the plan of care, which includes a verbal order for treatment changes or medications. What this means in states in which LPNs are permitted to take verbal orders, is that they can still take the order, but there must be an RN who is responsible for oversight of the care of the patient that co-signs it. This is acceptable per the COPs.

[Weebee, LVN]

Im sure its company policy, I have worked in California for 5 years and never needed a RN to co sign however, It was understood there are orders I could not take over the phone, for example DNR and Restraint orders but again, was company policy.

HOWEVER, the post just above this one states otherwise... hummmmm

[guest2210]

I've been an LPN for almost 30 years. I started in LTC and never had to have an RN co-sign any verbal orders.

[HazelLPN, LPN]

I never needed an RN to cosign my verbal/telephone orders. Definately depends on state and facility.

[e_warren2]

For Illinois LPNs:

(225 ILCS 60/54.2)

(Section scheduled to be repealed on December 31, 2013)

Sec. 54.2. Physician delegation of authority.

(a) Nothing in this Act shall be construed to limit the delegation of patient care tasks or duties by a physician, to a licensed practical nurse, a registered professional nurse, or other licensed person practicing within the scope of his or her individual licensing Act. Delegation by a physician licensed to practice medicine in all its branches to physician assistants or advanced practice nurses is also addressed in Section 54.5 of this Act. No physician may delegate any patient care task or duty that is statutorily or by rule mandated to be performed by a physician.

(b) In an office or practice setting and within a physician-patient relationship, a physician may delegate patient care tasks or duties to an unlicensed person who possesses appropriate training and experience provided a health care professional, who is practicing within the scope of such licensed professional's individual licensing Act, is on site to provide assistance.

© Any such patient care task or duty delegated to a licensed or unlicensed person must be within the scope of practice, education, training, or experience of the delegating physician and within the context of a physician-patient relationship.

(d) Nothing in this Section shall be construed to affect referrals for professional services required by law.

(e) The Department shall have the authority to promulgate rules concerning a physician's delegation, including but not limited to, the use of light emitting devices for patient care or treatment.

(f) Nothing in this Act shall be construed to limit the method of delegation that may be authorized by any means, including, but not limited to, oral, written, electronic, standing orders, protocols, guidelines, or verbal orders.

(Source: P.A. 96-618, eff. 1-1-10; 97-622, eff. 11-23-11.)