lpn as ADON? - page 5

Lpn as ADON? Just wondering how that works. Are they in charge when the DON is gone? That doesn't make sense because legally a lpn can't supervise Rns. Just wondering how a lpn can get by with... Read More

  1. by   katoline
    Wow. I have been a nurse for 28 years. This argument has been going on this long at least. I am on here today after moving to Texas and checking the Nurse Practice Act myself about just these issues.

    Making Assignments
    The LVN’s duty to patient safety when making assignments to others is to take into consideration the education, training, skill, competence and physical and emotional ability of the persons to whom the assignments are made. 11 12 If the LVN makes assignments to another LVN or UAP, he or she is responsible for reasonable and prudent decisions regarding those assignments. It is not appropriate and is beyond the scope of practice for a LVN to supervise the nursing practice of a RN. However, in certain settings, i.e.: nursing homes, LVNs may expand their scope of practice through experience, skill and continuing education to include supervising the practice of other LVNs, under the oversight of a RN or another appropriate clinical supervisor. The supervising LVN may have to directly observe and evaluate the nursing care provided depending on the LVN’s skills and competence, patient conditions and emergent situations. Timely and readily available communication between the supervising LVN and the clinical supervisor is essential to provide safe and effective nursing care. - from the Texas Nurse Practice Act.

    Has nothing to do with 'the alphabet' or years of 'experience', it is the scope of practice. In certain circumstances and Lvn/Lpn can supervise and evaluate the care given by another Lvn/Lpn. Anyone with experience can give 'guidance' or 'words of wisdom' to another. An experienced nurse might suggest to a new MD or Advanced Practice Nurse that perhaps 'such and such'? It's all about approach, respect, and the common goal of best outcome for the patient. Often a CNA notices something about a patient because of their hands on care, that a nurse or even an MD might not.

    With things going the way they have been in health care for a long time now, more and more practitioners with less 'formal' education will find themselves in charge. The Assistant Therapist as the department manager, with the Licensed Therapist doing the evaluation and writing the plan of care. The Lvn Unit Manager or ADON as department managers, an RN might be needed for a 'comprehensive' patient assessment and initial plan of nursing care. I guess what bothers me at times is more of a 'control' issue and not a team approach. One DON I knew once said 'we (nurses) tell doctors what to do'. That was just so wrong. But often case managers do go over charts and leave MDs notes on what to chart about, what tests need to be run or questions about where things are headed. It's all about reimbursement, what is covered and what is not and in the best interest of the patient to get where they need to go by going about it in the manner required by insurance and/or Medicare and Medicaid guidelines. Not saying I agree with it. I have found myself on the phone with insurance companies about certification actually crying because of some denial and asking 'what if this were your mother??' And the Doctors are left shaking their heads. katoline