LPNs Supervising RNs

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I am a "mature" RN who left the field of long term care after nearly 30 years. After several years off,I decided to return and took a job with an agency. My first day back was with a LTC facility and my job was to pass meds. I find that my direct supervisor, who was the unit charge nurse was an LPN. Back in the day, this would never have happened. I have always had great respect for LPNs but their area of practice was not equilivant to mine. I found it quite uncomfortable to digress to a young woman who frankly didn't know what she didn't know. I refused to carry out an order that I felt was a detrement to my patient. I felt I was within my scope of practice. My question is: Has this happened to any one else or has things changed so much that we now have LPNs supervising RNs.

Specializes in LTC.

I never thought my original question would start WWIII. I only wanted to know if the rules had changed since I had originally retired from Nursing. The reason for the question was that I was a bit shocked to see the situation. I noticed that most of the replys came from Nurses and yes I include LPNs in that sisterhood,who are either early in their practice or are youngish. And apparently things have changed. In my day LPNs could not practice anywhere but long term care and did the same things as a CNA with a bigger pay check. When I was a student nurse we stood when a doctor entered the nursing station and offered him our seat. Yes there was a pecking order and it wasn't built on experience.It was built on education. Some of that still holds true. I don't care how the cake is cut. There is still a big difference between a 14 month LPN program and 5 year BSN. Now ADNs require 3 years.In the Medical Fiels its the Sheepskin that counts. It's unfortunate but true. Can't be the CEO of IBM without at least a Masters:redbeathe:heartbeat

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There again it differs from state to state. I have sent many a resident to the hospital without having an RN assessment. In some cases, where are we going to find an RN to do that? We don't have RNs on all shifts, in many places.

Were I work we have to have an RN on duty at all times. Actually with all of the LTC facilities (my CNA days) there always had to be at least one RN in the building. I know some facilities are different and not all states have the same nurse practice act.

I have to admit, being a new RN there have been times that I have gone to the LPNs for advice!

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Specializes in Emergency, LTC, Med/Surg.

I need to apologize to you Aloha 551. After reading your first statement a third time I realized that I was responding to the statements of the person after you.

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Specializes in Geriatrics, Family Practice.

I don't get it:banghead:, you are wondering why you got the responses that you did from your post ,but yet you are still making harsh comments based on our responses. What does being "youngish" have to do with anything. We are all NURSES get over it! We went to school for the same reason, to care for patients! Anyway there isn't an "I" in TEAMWORK, it takes a team to get the job done.

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After reading this message I felt I needed to respond. As an LPN that works in both LTC and emergency I find these comments insulting. The idea that an LPN can't possibly be as skilled or in some settings more skilled than an RN is appauling. At the LTC facility that I work at, we never allow agency workers to act in a charge role, regardless if they are LPN or RN. One reason is that it is unreasonable to expect that an agency RN would have enough knowledge of a resident to make a informed decision. LPN's that are aware of the past of a resident, would be better equipped to make decisions regarding that residents care.

The bottom line is and everyone knows that it is true that LPN's and CNA's are the low men on the pole and it is no secret. It doesn't matter if you have 1000 years experience behind you as an LPN, it is based on the initials behind your name. That is why I went on and I get much more respect in the profession as an RN than an LPN.

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Specializes in ICU/Critical Care.

Some people never clue in.

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Specializes in LTC.
And I don't recall learning in school that LPNs are lowly servants to RNs.

Me, neither. :no:

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Specializes in LTC.
Were I work we have to have an RN on duty at all times. Actually with all of the LTC facilities (my CNA days) there always had to be at least one RN in the building. I know some facilities are different and not all states have the same nurse practice act.

I have to admit, being a new RN there have been times that I have gone to the LPNs for advice!

In MO, a skilled facility is required to have a Registered Nurse in the building for 8 hours. Otherwise, as long as there is an RN on call, the LPNs run the show. And I'm learning that this policy varies widely between states.

And I love it when RNs come to me for advice because you know what? It goes both ways. I've been in my facility for a long time, know P&P and my residents like the back of my hand so I'm usually called on to orient new nurses, the most recent being a master's prepared nurse. I know that there will be times when I need help or a question answered from one my RNs and they will be more than happy to help because I was able to help them, happily and professionally. Especially now that I'm less than a year away from graduating from an RN program, I find their experience, knowledge and outlook helpful to me. Just as I am for them. It's a win/win situation, even if I am their supervisor.

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Specializes in LTC, Acute Care.
There again it differs from state to state. I have sent many a resident to the hospital without having an RN assessment. In some cases, where are we going to find an RN to do that? We don't have RNs on all shifts, in many places.

I'm a fairly new lpn and my first nursing job was in an ltc. The charge nurses there are all lpn's well seasoned ones might I add. The RN's were the Nurse Educator, DON, ADON, and Administrator. Everyone else there is an lpn and they handle assessing to residents being sent out of the facility to the hospital and also the assessments of the residents returning to the facility from the hospitals. As an lpn, I am trained to initiate IVs, change fluids and tubing, administer meds through a PICC line, and depending on the place of employment may even administer some meds via IV push. You are right about not having RNs on all shifts because the RNs at that particular facility do not work nights or weekends and are only on an on-call capacity at those times.

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Staffing decisions are made to guarantee that appropriate staffing patterns exist to ensure patient safety and quality patient care. Changes in clinical practice, patient needs, and financial resources have prompted the implementation of skill mixes in providing patient care. Today, RNs may have to delegate certain aspects of care to licensed vocational nurses (LVNs), licensed practical nurses (LPNs), unlicensed assistive personnel (UAP), and monitoring technicians.

Patient care team members and their roles

RNs

Determine the scope of nursing practice.

Are responsible and accountable for the provision of nursing services.

Supervise and determine the appropriate use of any UAP involved in patient care.

Define and supervise the education, training, and utilization for any UAP.

LVN/LPN

Complete a 1-year to 18-month educational program.

Provide basic patient care that includes but is not limited to taking vital signs, dressing changes, performing phlebotomy, and assisting with activities of daily living, under the supervision of the RN.

UAP

3

Work under the direct supervision of an RN to implement the delegated aspects of nursing care.

Assist the RN in providing patient care.

Enable the RN to provide nursing care for the patient.

May include but are not limited to the following titles:

o Patient care assistants

o Nurses aides

o Technicians

o Multi-skilled workers

o Practice partner

o Nursing assistant

o Nurse extenders

o Orderlies

o Support personnel

o Practice partners

The healthcare delivery system seems to be in a constant state of flux. The delegation of direct and indirect patient care enables the RN to devote more time to patient care, patient advocacy, and patient education, resulting in improved patient outcomes and increased satisfaction for both the patient and the nurse. Effective use of delegation and skill mix can allow the RN to make his or her optimal contribution to patients and the healthcare system.

The following institutional guidelines must be met before delegation of a selected nursing activity, direct or indirect, can be considered:

There must be a written job description specifying the patient care activities that can be routinely delegated to support personnel.

Training requirements and demonstration of competency must be defined.

Competency in performing delegated patient care activities by support personnel must be verified and documented annually.

Support personnel must always be assigned to, responsible to, and supervised by an RN.

The maximum number of support personnel to be supervised by one nurse is institutional specific. The maximum number of patients to be assigned to the RN support person team is specified by regulations, community standards, staffing, acuity tools, and institutions.

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Aloha,

Things have not changed since you left nursing. The RN continues to be responsible for the care. Many LTC facilities place LPNs in leadership positions to save money. As an RN going into a facility where your supervisor is an LPN, you are treading on dangerous ground.

It does not matter how knowledgeable the LPN in charge is, by virtue of their education, state and federal regulations, the RN is the top of the nursing food chain. If there was an incident in a facility where an LPN was in charge, you could be brought into the investigation and lawsuit. They would want to know why you did not do anything to rectify the situation and/or prevent it from happening in the first place. As an RN with so many years of experience, you would definitely be a target. Granted, you might not know of the situation but the fact that you were present in the building would be enough for them to go after you. You would spend a lot of time explaining that you had nothing to do with the management structure of the facility and was unaware of the situation. The same would be true if you worked with an RN with less experience then you - if you didn't do something and you were there - they'd be questioning you about it. I am sure that you already know all this but I can see by the postings that the anger has overriden many people's sensibillities regarding this issue.

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Specializes in LTC.

RN 1989 THANK YOU THANK YOU THANK YOU.The answere to my question. Honestly I don't hate LPNs. I just needed to know what their roll was .:yeah::yeah::yeah::redpinkhe:redpinkhe

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