LPNs working unsupervised in nursing homes

SlightlyMental_RN · Aug 9, 2009

As I've stated before, other states have a different scope of practice for LPNs. My state, however, does not have that as part of LPN's scope of practice. That's all I'm saying. If LPNs work outside of their scope of practice with the facility's knowledge, then the facility and the LPN would be in legal jeopardy. This is why it is required that there is a RN in the building at all times (for my state).

If you want to pick apart my post as to why you're qualified to handle it as a LPN, that's entirely your right....it looks like many of you have multiple of years experience with nursing so I'm sure that you've seen it all, done it all. Just be aware, that I omitted many other details of these patients very complex backgrounds to post them on the board. I worked in LTC a while back, but it was surprising to me how actually ill people would be, and they were in a nursing home. Many were not very stable AT ALL, and we would be coding them, calling EMTs regularly. The level of "skilled nursing care" had been significantly bumped up since I had been a CNA in the early 90's. (That's a hint that I'm not too young, btw I also have great respect for LPNs. :redbeathe)

tattooednursie, LVN · Aug 9, 2009

It's legal in Ohio. We have to have 8 hours of RN coverage per day and after that, we don't have to, and often don't have an RN in the building. This isn't to say that we don't have access to our RN's. We do. We have an RN on call every day of the week.

That's how ours operates. I was really surprised by the question, since that is what I am used to. Really the only difference between RN's and LVN's in my facility is the LVN's cannot do IV medications. If there is someone on IV medications they are either in the acute facility, or an RN will come to our facility (if there is not one there at the time) and carry out the task depending on the condition of the patient. If possible we stick to PO and IM medications though.

TheCommuter, BSN, RN · Aug 10, 2009

I'm in Texas, where nursing homes require only 8 hours of "RN coverage" per day.

The DON (director of nursing) usually provides the "RN coverage" Monday through Friday by simply being in the facility. The weekend supervisor usually provides the "RN coverage" on Saturdays and Sundays.

These RNs are not providing any bedside care, performing any patient assessments, or even laying a finger on any of the residents; rather, their presence in the facility is to fulfill the legal requirement of 8 hours of "RN coverage" per day.

Don't be fooled, people. The LPNs/LVNs are the absolute backbone of nursing homes and extended care facilities across the country, and we're absolutely capable of the provision of safe, effective patient care.

caliotter3 · Aug 10, 2009

I asked this same question when I was hired to be the only licensed nurse on duty for the night shift at a facility. I was told that it was legal because of the number of beds (in CA) and that if I had any questions or problems to call the ADON at home. Well, one night, I did have a problem. The ADON never answered her phone. That certainly opened my eyes. I resigned not long afterward.

TheCommuter, BSN, RN · Aug 10, 2009

I asked this same question when I was hired to be the only licensed nurse on duty for the night shift at a facility. I was told that it was legal because of the number of beds (in CA) and that if I had any questions or problems to call the ADON at home. Well, one night, I did have a problem. The ADON never answered her phone. That certainly opened my eyes. I resigned not long afterward.

In Texas, the nursing homes utilize LPNs/LVNs as the ADONs. Often, the only RN employed at the entire facility will be the DON.

KarynicaRN · Aug 11, 2009

I was wondering if anyone knows the laws for allowing LPNs to work unsupervised in a nursing home setting. I realize they can dispense medications and follow the existing plan of care...but isn't there supposed to be an RN in the building at least.
I ask because I realized today that a nursing home in Illinois has one nurse, a LPN, and two aides working the 11p to 7 am shift. There is no RN in the building. Is this legal?

It must be legal in Illinois because I see it all the time. I am a registered nurse and I have worked 12 years off and on in LTC and the night nurse usually is an LPN along with 2 certified nurses aides. It's kind of scary to think about, but it seems to be the way of the state. Even as a RN I would like to have another nurse, LPN or RN with me on the evening/night shift, but no way is the facility going to pay for two nurses. Usually the LPN is just told to call the DON if something comes up.

I found this too:

Nursing services. The competence and attitude of the nursing staff probably affect a resident's sense of well-being more than other services. Registered nurses (RN’s), with their extensive training and minimum of two years of special education, should direct nursing services in homes with residents who are ill enough to need skilled nursing care. An RN may not be on duty during all shifts, but must be responsible for the nursing staff. Licensed practical nurses (LPNs), with at least one year of specialized training, should be on duty day and night.

From: http://www.idph.state.il.us/public/books/nhbroc.htm

arelle68 · Aug 11, 2009

I'm a new RN and the LVNs supervise me. They are awesome. They have made a nurse of me over the last several months. I really need their help. We say I am supervising them, but everyone knows it's a joke. Experienced LVNs are the best nursing professors I've ever had.

KarynicaRN · Aug 11, 2009

I'm a new RN and the LVNs supervise me. They are awesome. They have made a nurse of me over the last several months. I really need their help. We say I am supervising them, but everyone knows it's a joke. Experienced LVNs are the best nursing professors I've ever had.

oh yeah, I have worked with some awesome LPN's who are old school and knew more than I ever knew as an RN right out of school. I have worked with some LPN's that picked up on a resident's "condition" before I even knew what what happening. When I first started working LTC it was the LPN's who trained me. They knew I was their supervisor only because I was the RN, but they knew their stuff and I was proud to have them working with me. I can also say I have known some great certified nurses aides who just through doing their bed checks knew something was just not right with certain residents. They would help me get the O2 tanks and help me by making copies of the paperwork for transport to the hospital. If an LPN or nurse assistant has known the resident long enough, they can make really good calls and help the new RN tremendously.

pagandeva2000, LPN · Aug 11, 2009

My state will allow an LPN to work in nursing homes without RNs on the site, but they must be available by telephone. I have not worked in a nursing home since becoming an LPN, but I am not comfortable with this. While I believe that LPNs can critically think within our scopes, I would be too afraid that this RN on call may not be available. Also, since I work in the clinic, I don't see too many unstable patients and would certainly want the support of a more experienced nurse AT MY SIDE rather than a phone call away. Bad enough a physician is not available on site, but no RN?? Sounds like trouble to me...