LTC RN Supervisor

Editorial Team / Admin · Mar 23, 2023

Moved to Geriatric/LTC forum for best responses. You may find several posts here that will provide advice as you read through the forum.

downsouthlaff, LPN · Mar 24, 2023

Experienced LPN here in the LTC realm. Yes this is typically how LTC facilities are staffed. CMS only requires an RN be present eight hours a day seven days a week. A weekend RN supervisor covers this requirement on the weekends. You have one of two choices here, you should either decline the position, or accept the fact that your going to have to take a fair amount of direction and input from the seasoned LPNs. Long Term Care is so much different from acute care, there are rules and regs present that you couldnt even dream up. Working at an acute care facility does not give you the experience needed to call the shots in LTC. Trust this.

If you do accept the position, even tho its a part time weekend postion, ask your DON for plenty orientation, and ask your DON who your most seasoned and competent LPNs are, and listen to them. They know the routine to nurse those patients, they know the CNAs, and thet probly already have a great rapport withe the families and physicians to know which shots need to be called. The best RN superiviors I have ever worked with are the ones who know how to respect the facilities routine, and not throw their weight of being an RN around. And also, offer to be of help, when nursing is overwhelmed.

This could be a great opportunity for you, or one that could be really negative, depending on how you approach it. LPNs and CNAs have much greater responsibility in LTC facilities than in hospitals. And typically RNs who are anti LPN, generally don't like long term care. Good luck to you ! Hope it goes well.

nursingstudentwannabe, BSN, RN · Mar 24, 2023

downsouthlaff said:

Experienced LPN here in the LTC realm. Yes this is typically how LTC facilities are staffed. CMS only requires an RN be present eight hours a day seven days a week. A weekend RN supervisor covers this requirement on the weekends. You have one of two choices here, you should either decline the position, are accept the fact that your going to have to take a fair amount of direction and input from the seasoned LPNs. Long Term Care is so much different from acute care, there are rules and regs present that you couldnt even dream up. Working at an acute care facility does not give you the experience needed to call the shots in LTC. Trust this.

If you do accept the position, even tho its a part time weekend postion, ask your DON for plenty orientation, and ask your DON who your most seasoned and competent LPNs are, and listen to them. They know the routine to nurse those patients, they know the CNAs, and thet probly already have a great rapport withe the families and physicians to know which shots need to be called. The best RN superiviors I have ever worked with are the ones who know how to respect the facilities routine, and not throw their weight of being an RN around. And also, offer to be of help, when nursing is overwhelmed.

This could be a great opportunity for you, or one that could be really negative, depending on how you approach it. LPNs and CNAs have much greater responsibility in LTC facilities than in hospitals. And typically RNs who are anti LPN, generally don't like long term care. Good luck to you ! Hope it goes well.

Thank you so much! This is valuable insight. I also heard from a family member who works in LTC that the LPNs are often more experienced than the RNs and are excellent resources. At the rehab I applied to, most of the LPNs have been there for years, so that makes me feel a lot better knowing I have coworkers there who are knowledgeable of the residents and the work environment. Again, thanks very much for your advice, I appreciate it!

downsouthlaff, LPN · Mar 24, 2023

nursingstudentwannabe said:

Thank you so much! This is valuable insight. I also heard from a family member who works in LTC that the LPNs are often more experienced than the RNs and are excellent resources. At the rehab I applied to, most of the LPNs have been there for years, so that makes me feel a lot better knowing I have coworkers there who are knowledgeable of the residents and the work environment. Again, thanks very much for your advice, I appreciate it!

Not a problem at all! You sound like the kind of nurse who would take the input and do well. But yes indeed. LPNs are usually the direct care staff nurses in LTC. Doing the assessments, notifying the physician, charging over the CNAs. Long term care is where you will see LPNs working the most autonomous. Now with that being said it still doesnt change the legality that the RN is some degree responsible for the LPNs practice. But if your willing to trust and learn from the seasoned LPNs youll do just fine!

Googlenurse, ASN, BSN, RN · Mar 25, 2023

downsouthlaff said:

Not a problem at all! You sound like the kind of nurse who would take the input and do well. But yes indeed. LPNs are usually the direct care staff nurses in LTC. Doing the assessments, notifying the physician, charging over the CNAs. Long term care is where you will see LPNs working the most autonomous. Now with that being said it still doesnt change the legality that the RN is some degree responsible for the LPNs practice. But if your willing to trust and learn from the seasoned LPNs youll do just fine!

An RN isn't responsible in any capacity for an Lpn's practice.

An lpn does something illegal, that's on the Lpn's license.

Tired nurse · May 6, 2023

A second year RN should not even think about this position you will be responsible for the whole building residents and staff. I donnot care of you are an RN! A more seasoned RN doesn't even want to be put in that position! RUN And I know I have worked LTC for years.

Tenebrae, BSN, RN · May 10, 2023

I used to have overall supervision of 75+ residents on the afternoon shift, 40 in the care centre, 20 in the memory care centre, and 15+ in the serviced apartments

That involved giving meds for half of the care centre residents. If a resident fell I would have to attend. Once spent an hour lying on the floor doing spinal cares for a serviced apartment resident who had fallen while we waited for the ambulance.

One night had an ambulance rock up, the ambos were like 'does this person belong to you' turned out it was one of our dementia residents who had gone for a walk (we were not a secure facility) and had fallen and hit his head (was on blood thinners).

If the shift goes fine its a doddle. It tends to turn into a dumpster fire more often than it doesnt.

As a second year nurse I would suggest you spend more time in an environment that has more auxillary staff before making the jump to this type of role. In this role you are the last port of call and it can be full on when its all going pear shaped. I've been out for 12 years now and I still have those moments of 'crap I'm in charge"

If you do go this route a few hints

- time management is key

- as long as the patient is breathing and not bleeding, finish up what you are doing before attending next crisis

- don't work for free. If your shift finishes at 1515, be ready to leave at 1515. I'll give my work place 15 minutes because sometimes stuff happens. Management rely on staff who will work overtime for free. If your managers don't work for free neither should you.

nursingstudentwannabe, BSN, RN · May 10, 2023

Tired nurse said:

A second year RN should not even think about this position you will be responsible for the whole building residents and staff. I donnot care of you are an RN! A more seasoned RN doesn't even want to be put in that position! RUN And I know I have worked LTC for years.

Thanks for you response! I also felt the same way in regards to this. I was told I would be fine and that I wouldn't be alone, but I feel this is what they always say to get you to accept the position.

nursingstudentwannabe, BSN, RN · May 10, 2023

Tenebrae said:

I used to have overall supervision of 75+ residents on the afternoon shift, 40 in the care centre, 20 in the memory care centre, and 15+ in the serviced apartments

That involved giving meds for half of the care centre residents. If a resident fell I would have to attend. Once spent an hour lying on the floor doing spinal cares for a serviced apartment resident who had fallen while we waited for the ambulance.

One night had an ambulance rock up, the ambos were like 'does this person belong to you' turned out it was one of our dementia residents who had gone for a walk (we were not a secure facility) and had fallen and hit his head (was on blood thinners).

If the shift goes fine its a doddle. It tends to turn into a dumpster fire more often than it doesnt.

As a second year nurse I would suggest you spend more time in an environment that has more auxillary staff before making the jump to this type of role. In this role you are the last port of call and it can be full on when its all going pear shaped. I've been out for 12 years now and I still have those moments of 'crap I'm in charge"

If you do go this route a few hints

- time management is key

- as long as the patient is breathing and not bleeding, finish up what you are doing before attending next crisis

- don't work for free. If your shift finishes at 1515, be ready to leave at 1515. I'll give my work place 15 minutes because sometimes stuff happens. Management rely on staff who will work overtime for free. If your managers don't work for free neither should you.

Thank you, thank you, and thank you again for all of of this information! You have no idea how invaluable all you experienced nurses' input is. my goodness, the scenarios you related sound absolutely stressful. Being the head honcho in that situation would terrify me. After reading your replies, I think I will spend some more in gaining experience in the field before I venture into this position. Thank you again!