LTC/rehab facility: ?'s --LPN Scope of Practice

dream'n, BSN, RN · Jun 25, 2009

Okay...as a new RN, I'm hazy on this, so please help me out:
Can a LPN:
1.) Assess lung sounds? I thought they couldn't, but my facility has them doing this job, and other assessments, such as wounds, behavioral, GI, etc.....
2.) Can a LPN take MD phone orders? I thought they couldn't, but again, my facility has them doing so....
3.) Can a LPN develop a Short-term plan of care? I thought that that was another no-no....
They also don't have anyone do a double check on insulin to be administered, and they don't do counts on their narcotics half the time.
I'm really worried, as I don't want to jeopardize my license in any way. Thanks for any and all help!

Honestly things vary state to state and you will need to check with your particular BON. BUT when I worked as a LPN in LTC I was able to take MD phone orders and we didn't double check insulin. Narc counts were always done by the offgoing and incoming LPN. LPNs did do assessments but they had to be checked and signed by the RN within 24 hours I think. Only RNs did the POC.

stelon · Jun 25, 2009

As far as I know they can take phone orders--they do have a license after all. As for assessing the patient it is something taught in the LVN program and it should be expected that any nurse involved a patient's care would do one in my opinion, but I believe the RN is ultimately responsible for performing the assessment and ensuring it is documented accurately.

Care plans are also taught in the VN program and drilled into our heads, but again is something the RN must do. As for the insulin and narcotic checks--they better be checking and counting!

SlightlyMental_RN · Jun 25, 2009

I wasn't too worried about the phone orders, but in nursing school, even the LPN's weren't allowed to take MD orders, so I was a bit thrown by the whole thing.

As for the assessing.....I guess that it just bothered me, as I know that the RN's in the facility aren't going around and assessing these people. They go by whatever the LPN says he/she heard/saw. It just seems so wrong--I went and listened to one person that the LPN said that the lung sounds were clear bilaterally. Ummm...no. There were Insp./Exp. wheezes--and we're supposed to monitoring this resident's respiratory status, as they had a recent URI?

The ST-POC thing also really floored me, as I don't feel it's right that they are developing these. I mean, that's why we have the additional training to be RN's. Right?

I wish that they did checks on the insulin or did their narcotics checks. You wouldn't believe the other stuff I witnessed today: One LPN was eating her whole shift (candy and snacks on her med cart)--not washing hands (ever!)--even after taking blood sugars and administering insulin (w/out gloves). Other LPN's had snacks in the pockets of their scrubs and were munching their entire shift. All I could think was "Wow." I know they thought I was weird because I contacted supply and made them bring up 4 bottles of hand sanitizer, and I kept asking where the gloves were, so I could keep myself and my patients safe. :banghead:

so alive LPN · Jun 25, 2009

Okay...as a new RN, I'm hazy on this, so please help me out:
Can a LPN:
1.) Assess lung sounds? I thought they couldn't, but my facility has them doing this job, and other assessments, such as wounds, behavioral, GI, etc.....
2.) Can a LPN take MD phone orders? I thought they couldn't, but again, my facility has them doing so....
3.) Can a LPN develop a Short-term plan of care? I thought that that was another no-no....
They also don't have anyone do a double check on insulin to be administered, and they don't do counts on their narcotics half the time.
I'm really worried, as I don't want to jeopardize my license in any way. Thanks for any and all help!

When I worked agency(and went to LTC facilities) the following applied at every single facility I went to:

1. Yes

2. Yes. Especially on NOC, when there was no RN.

3.No

As far as double-checking insulin, some places required it and some didn't. And I would NEVER leave until I counted narcs. That's just too risky for MY license!

palaoa · Jun 25, 2009

i work nights in a LTC/Rehab facility, we are so short that there is usually only 1 or 2 RNs in the whole facility and whats left of us ar LPNs...

1. yes, but not GI sounds

2. Yes even in the dayshift

3. no no no, but we can updated them

and the insulin..well we have such a heavy pt load that there is no time for double checks

Narcotics; ARE ALWAYS DOUBLE CHECKED going on and off shift. you have to be realistic here, this isn school

jnrsmommy · Jun 25, 2009

As for the assessing.....I guess that it just bothered me, as I know that the RN's in the facility aren't going around and assessing these people. They go by whatever the LPN says he/she heard/saw. It just seems so wrong--I went and listened to one person that the LPN said that the lung sounds were clear bilaterally. Ummm...no. There were Insp./Exp. wheezes--and we're supposed to monitoring this resident's respiratory status, as they had a recent URI?

You are going to find that scope of practice for an LPN/LVN is going to vary greatly from state to state. You need to check with your BON about what their scope of practice is, and also become familiar with your facility P&P.

As for the above example, you are going to find staff that say they checked/did something, and you know there's no way that they did (this includes nurses, aides, med aides, etc). I say that this nurse just let you know that you can take what she said with a grain of salt. On the other hand, I've had patients conditions change drastically in the matter of minutes, but you say they were follow-up for recent URI, so I doubt that was the case.

Just my :twocents:

CoffeeRTC, BSN, RN · Jun 25, 2009

Things will varry from state to state, so check you BON.

LPNS take verbals, assess the residents, do care plans and can do the MDS but need the RN to co sign, there is no way that we can do double checks (rn or LPN) with the insulin..I have at least 12 diabetics in my 26 pts that get qid accuchecks with coverage. NARCS are counted by everyone at the start and end of the shifts..doesn't matter if you are an LPN or RN.

As far as the eating....they are probably too busy to take a break, but eating at the cart is just yucky all around.

For the most part...LPNs and CNAs are the mainstay of LTC.

Head over to the LTC threads and you can read more.

tkane · Jun 25, 2009

I am an LPN & I work in a LTC facility. I assess lung & bowel sounds. I take MD orders over the phone & in person. We do not double check insulin & you ALWAYS count off narcs @ the end of your shift. As far as lung sounds go perhaps the LPN you followed has some hearing loss, or uses the facility stethoscope(which we know is the least expensive). LPN stands for Licensed Practical Nurse.

rnlately · Jun 25, 2009

I am an LPN & I work in a LTC facility. I assess lung & bowel sounds. I take MD orders over the phone & in person. We do not double check insulin & you ALWAYS count off narcs @ the end of your shift. As far as lung sounds go perhaps the LPN you followed has some hearing loss, or uses the facility stethoscope(which we know is the least expensive). LPN stands for Licensed Practical Nurse.

Yeah, what she just said. I perform all of the above at the facility where I work except intiating the care plans; we are however, allowed to make changes to the care plans as we see fit since we are the ones actually in contact and caring for the residents. The RNs at our facility ONLY work in management and do not participate in direct patient care. Yes, we count all of our narcs lest we want to put our licenses in jeopardy.

zuzi · Jun 25, 2009

My darling I am tired about this subject...this subject IS A **** is a big humoungus ****, is all about money my dear we are in USA and is ALL ABOUT MONEY and network......forget about it and pass by......say thank you that you have a job now on these times and you could feed your family...... the right thinks may be in the front of God and neither there....I start to have doubts than even GOD see the diference, but who is GOD? God is in people my dear...looool... is ok...

I am tired darling and old....and foreign...be good, behave. Love you!

Midwest4me · Jun 25, 2009

i am an lpn & i work in a ltc facility. i assess lung & bowel sounds. i take md orders over the phone & in person. we do not double check insulin & you always count off narcs @ the end of your shift. as far as lung sounds go perhaps the lpn you followed has some hearing loss, or uses the facility stethoscope(which we know is the least expensive). lpn stands for licensed practical nurse.[/quote
when i worked in the nursing homes i did all the above but the "assessment" was called "data collection".:angryfire good grief! we're licensed nurses for heavens' sake! not many rns who want to work in ltc so the floor nurses/charge nurses are usually lpns with the don available and at least one rn on in the building per shift. i honestly think we need to be grandfathered in as rns after so many years' experience.