LPNs being used as ADONs

tferdaise · Apr 1, 2012

Each state has it's own State board that dictates what each level of nursing can do, here in Arizona an LPN can be a ADON of a SNF (Skilled Nursing Facility). It is not uncommon to have a LPN as ADON. Just because you have an RN does not mean you have the skills to be a leader.

muffylpn · Apr 1, 2012

that's right, but then Im sure so many feel an RN should just get it cause they are an RN. Sorry same way in MA. LPNs can in

NHs be supervisors over RNs and ADONs can be LPNs

TheCommuter, BSN, RN · Apr 1, 2012

It is legal in many states for LPNs/LVNs to supervise RNs administratively, but not clinically. In every nursing home where I have been employed, LVNs are utilized as ADONs (assistant directors of nursing). These LVN ADONs are also responsible for supervising RN floor nurses in a purely administrative capacity, and if any clinical issues should arise with the RN, the DON (always an RN) would be the person to provide the counseling or disciplinary action.

CLUVRN, MSN, RN · Apr 1, 2012

Ditto here in Florida; an LPN can be an administrator over an RN. Actually, I've been employed in several facilities where this has been the case.

muffylpn · Apr 1, 2012

Have to disagree about clinical issues here is MA. Its the same reason an LPN can orient an RN. We can orient RNs within our scope of practice as I do in the hospital I've worked at for 23 yrs. And in the NH where I have worked for 16 PD we have nurse

managers who are LPNs who run floors. They can and do provided disciplinary action if the issue is in their scope of practice. And that would include the death cert. an RN might fill out that is not correctly done. Many new RNs in NHs have to be shown how to do this at 3am. We don't call the DON to provide over the phone instructions at that time of the morning.

nowim clean · Apr 1, 2012

[h=1]I

Licensed Practical Nurse Charge Nurses/Nurse Supervisors[/h] Authority:

The Massachusetts Board of Registration in Nursing issues this Advisory Ruling on Nursing practice pursuant to Massachusetts General Laws, chapter 30A, section 8 and chapter 112, section 80B. Date Issued: November 12, 1997

Date Revised: July 10, 2002

Scope of Practice:

Licensed Practical Nurse

Purpose:

To guide the practice of the Licensed Practical Nurse (LPN) who is employed and/or assigned to the functions of charge-nurse or supervisor and the Registered Nurse (RN) who is assigned to and/or employed as a staff nurse in the same facility.

This is an administrative function only.

Advisory:

Pursuant to the Board's regulations at 244 Code of Massachusetts Regulations (CMR) 3.04: Responsibility and Functions-Practical Nurse, it states "making appropriate assignments, teaching, directing and supervising unlicensed personnel, delegating activities to unlicensed personnel, participating in collaborative planning, and making informed judgements as to the specific elements of nursing care mandated by a particular situation.

The Registered Nurse (RN) who is employed or assigned to a staff position when the LPN is charge nurse or supervisor remains and retains full responsibility and accountability for the clinical course of the patients under his/her care.

The LPN charge nurse/supervisor does not mean clinical decision-making authority regarding the patients that are assigned to the RN.

So like most RNs have stated lpn legally have no clinical authority over the RN, it is a simple fix though....go back and get your RN then everything is legal with the board. I think alot of the lpns think rns think they are better smarter whatever than a lpn its not that we just simply are informing you its not in your scope.

nowim clean · Apr 1, 2012

CHAPTER 64B9-16 LPN SUPERVISION IN NURSING HOME FACILITIES

64B9-16.001 Definitions.

As used in this chapter, the following mean:

(1) "Certified nursing assistant" (CNA) is a person certified pursuant to Chapter 464, Part II, F.S.

(2) "Unlicensed personnel" (UP) are persons who do not hold licensure from the Division of Health Quality Assurance of the Department of Health but who have been assigned to function in an assistive role to registered nurses or licensed practical nurses in the provision of patient care services through regular assignments or delegated tasks or activities and under the supervision of a nurse. Unlicensed personnel do not include certified nursing assistants.

(3) Nursing services are acts that require knowledge and skill based on biological, social, behavioral, and nursing science. Only specified nursing acts can be performed by CNAs and UPs. RNs and LPNs can perform nursing acts as stated in Section 464.003, F.S.

(4) "Supervision" is the provision of guidance and periodic inspection by the nurse for the accomplishment of a nursing task or activity, provided the nurse is qualified and legally entitled to perform such a task or activity. Supervision may be provided by an LPN to another LPN, CNA, or unlicensed personnel.

(5) "General supervision" means the registered nurse is not on the premises but accessible by two-way communication, is able to respond to an inquiry when made, and is readily available for consultation.

(6) "Immediate supervision" means the supervisor is on the premises and is physically present where the tasks and activities are being performed.

(7) "Indirect supervision" means the registered nurse is not on the premises but is accessible by two way communication, is able to respond to an inquiry when made, and is readily available for consultation.

(8) "Nursing home" means a facility licensed under Chapter 400, Part II, F.S.

(9) "Hospital" means a facility licensed pursuant to Chapter 395, F.S.

(10) "Delegation" is the transference to a competent individual the authority to perform a selected task or activity in a selected situation by a nurse qualified by licensure and experience to perform the task or activity.

Specific Authority 400.23(3)© FS. Law Implemented 400.23(3)© FS. History–New 3-26-02.

64B9-16.002 Supervision by Licensed Practical Nurses in Nursing Home Facilities.

(1) The licensed practical nurse working in a nursing home shall qualify to supervise by meeting all of the following requirements:

(a) Completing a minimum thirty (30) hour post-basic, Board approved licensed practical nurse supervisory education course prior to accepting any supervisory assignments. The course may be provided by a Board approved continuing education provider or an approved school of nursing.

(b) Demonstrating a work history of no less than six (6) months of full-time clinical nursing experience in a hospital or nursing home.

(2) In lieu of the thirty (30) hour post-basic nurse supervisory education course referenced above, licensed practical nurses may qualify to supervise if the nurse has successfully completed a supervisory course on a post-graduate level and a provider credits the nurse for such course, providing each component of the course content of paragraphs 64B9-15.003(3)(a)-(m), F.A.C., is tested by and competency demonstrated to the provider.

(3) There shall be a registered nurse providing supervision of the licensed practical nurse.

(4) Tasks and activities shall be delegated by the LPN to the CNA or UP based on the following:

(a) The task/activity is within the area of responsibility of the nurse delegating the task.

(b) The task/activity is within the knowledge, skills, and ability of the nurse delegating the task.

(d) The CNA or UP can and will perform the task/activity with the degree of care and skill that would be expected of the nurse.

116 this is floridas once again it what the boards say not us RNs

muffylpn · Apr 1, 2012

Not speaking for FL. But I know my scope of practice in MA. ( but thanks for posting it). A RN NEVER has to do what an LPN says. As when it goes to hell in a handbasket in the court system. That RN would never be able to say the LPN told me to and that be ok. My point stands. I'm a relief supervisor in a NH over RNs- why 1) they are new nurses 2) agency 3) I been there going on 16 yrs. I have very little time to show people how to do things or make decisions to send people out to the hospital. On the other hand as the supervisor I will stop you the RN from the agency or the new grad from sending out a DNH Pt. by showing you the paperwork. Then my all means send them out. When the family and DON call to scream at me I will have my

documentation in place stating I showed you the RN this was not what the family wanted. And well we are at it call the DON at 3am ask her to go over filling out the death cert. with you as you are pretty sure I have no idea what I'm talking about and when she does not answer feel free to explain to the funeral home who has now arrive why it is not done. There is ALWAYS an RN on call at every NH around the clock if only LPNs are in the building-just FYI

NursesRns · Apr 1, 2012

As an RN, I can quickly and shamelessly attest to these facts: I'm a very good nurse, clinically, with a lot of bedside skill and experience, but I know relatively little about administration of a nursing home. I have no problem deferring to the LPN's I work with whose years of experience and body of knowledge are things I respect. I believe intensely in the value of team work and mutual support and respect. These things foster a positive work environment.

muffylpn · Apr 1, 2012

I agree with you (nursesRns). I never have or want any nurse (rn or lpn) to do what I say because of my title or my yrs of exp. Many Many Many times I tell all the nurses. This

is what the policy is or I've showed them paperwork or have even said I've took care of

this or that detail. BUT I ALWAYS say you need to do what YOU are comfortable with

even if that means double checking me. You have a license that YOU work hard for. Also

why should anyone who does not know me trust me. I have had many great RN supervisors at the hospital over 23 yrs who have treated me the same way. It is the only way to have

a gd work environment. I have learned ( and learned very early) it NEVER hurts to go with

the final decision of the RN. My documentation will always stand as to what my position was/is and there is always the chain of command. I have only used it afew times. But

every time I did I was right. The game plan was then changed and noboby was hurt.

RNs can tell Lpns what to do and 90% they are right 5% of the time I bite my tongue ( they

are in charge-at the hospital and the final say in the NH) 5% of the time I say "NO, I'm not

going to to that cause I feel it's wrong-but you can." I work under NOBODY's license ( that's

a myth) and I will also be held accountable for ALL I do within my scope of pratice no matter who told me to do it.

kellenl · Apr 4, 2012

LPN's can definetly be charges over RN. In my currently job the DON is an LPN who graduated from nursing school in 2001. She has 3 LPN's and 2 RN's under her. Most new grad LPN's are more knowledgable than RN's as RN's studies are more book work oriented.