LPN'S Supervising RNs'? How would you feel?

[cowgirl4u]

I would like to start out by saying that I do respect LPN's and I am in favor of advancing in everyones careers. I am an RN on a PCU. Our hosp changed the "directors" title to Clinical Care Coordinator. Now, our floor with mostly RN's are under the direction of a LPN whom reports to the director of acute care/pcu. Let me explain further, we had seperate directors at one time, but now have one director. We are in the basement of the hospital and our director in upstairs on the acute floor. However, our newly hired clinical care coordinator is in an office with us downstairs. I am having a very difficult time in falling under this type of leadership umbrella. I also think its a dif positon for the LPN to be in too. Any thoughts?

[sheilagh]

i have worked as a unit mgr ( I am an LPN ) where I had RN's on my unit and therefore under my direction. The distinction here in florida is that the LPN can supervise the unit and make assingments etc...she/he is responsible as supervisor to coordinate any ER's and manage all daily functioning of the floor and the nurses, however in specific clinical instances the RN cannot differ to the LPN for clinical judgement and she/he is responsible for her scope of practice. I have had to orient many new RN's to the floor,facility, and with new grads to nursing in general, but wherever the scopes of practice differ an RN had to orient them.

Perfect example: 3-11 shift, I am unit supervisor and an RN with 4 years experience comes running to me to say pt is unresponsive. I run and do assessment and knowing she is diabetic first check glucose which is 14 ! pt had central line so I follow our protocol and get the push Dextrose from E-kit and hand it to RN. She looks at me and says " what do I do? You give it!" my response....LOL " I can't only an RN can push and thats you and your pt !" I stood beside her and had to talk her thru it as she seemed scared and unsure. The pt came around and we followed out the rest of protocol. Afterwards everyone said I shouldn't have told her what to do as clinically the RN was my superior...all I saw was that I had no other RN's immediately available and a pt in crisis. The RN was counseled after and chose to leave bedside nursing.

[PANurseRN1]

I guess the people around you thought it would have been better to just let the pt. code.

Maybe that nurse didn't have experience with central lines. Then she's supervised by someone who is not licensed to administer meds through a central line.

This is one example why having an LPN "supervise" an RN is a bad idea. No matter what the LPN's title is, at the end of the day the RN has a higher level of accountability. So there should be someone there for the RN to defer to for advice/assistance with unfamiliar procedures.

It's also incumbent on the facility to make sure that staff are oriented properly. It's not necessarily the RN's fault she didn't know how to give a push med through a central line; maybe she never worked with central lines before. It is the facility's responsibility that she wasn't properly oriented.

And a new grad should be oriented by someone with equivalent licensure, period. How on earth does a new RN learn how to be an RN when she's being oriented by LPNs?

I'm sure I'll get flamed and labeled anti-LPN. Nothing could be further from the truth. I've worked with many LPNs who were excellent nurses. But having an LPN in a supervisory relationship over an RN is just a set up for a myriad of problems.

[PANurseRN1]

i have worked as a unit mgr ( I am an LPN ) where I had RN's on my unit and therefore under my direction. The distinction here in florida is that the LPN can supervise the unit and make assingments etc...she/he is responsible as supervisor to coordinate any ER's and manage all daily functioning of the floor and the nurses, however in specific clinical instances the RN cannot differ to the LPN for clinical judgement and she/he is responsible for her scope of practice. I have had to orient many new RN's to the floor,facility, and with new grads to nursing in general, but wherever the scopes of practice differ an RN had to orient them.

Perfect example: 3-11 shift, I am unit supervisor and an RN with 4 years experience comes running to me to say pt is unresponsive. I run and do assessment and knowing she is diabetic first check glucose which is 14 ! pt had central line so I follow our protocol and get the push Dextrose from E-kit and hand it to RN. She looks at me and says " what do I do? You give it!" my response....LOL " I can't only an RN can push and thats you and your pt !" I stood beside her and had to talk her thru it as she seemed scared and unsure. The pt came around and we followed out the rest of protocol. Afterwards everyone said I shouldn't have told her what to do as clinically the RN was my superior...all I saw was that I had no other RN's immediately available and a pt in crisis. The RN was counseled after and chose to leave bedside nursing.

This situation would certainly qualify for "nurse eating," BTW. If it indeed really happened that way. I hope that RN found a job where she was able to be properly precepeted and supervised.

[Alexsys]

That was not a competent nurse that you worked with IMO. But you should be commended for at least helping a fellow nurse out of a bad situation.