100% LVN Administration and Managers...

[SoCalRN1976]

Hello all,

I won't give too much detail but I have been working this this organization for about a year. I am a clinical RN,BSN and work with numerous other RN's and other licensed staff including MSWS, LVN's.

When I was hired, I just assumed my immediate supervisor was an RN. It's a given that the Nurse Practice Act of the state of California clearly states an RN can only be clinically supervised by the same which hold the same scope of practice and privileges held by the RN licensure. I have been an RN 30 years. I have never been supervised by an entire management staff of LVN's. I found out shortly after starting when I obtained business cards from our management ... 100% LVN. in fact the administrator is smart, his card doesn't have his LVN title.. but this was confirmed by searching active licensure at the BRN.

We have two immediate managers confirmed hold LVN licensure, and our Director is also the same. This is a home based agency which requires the standard supervision, 90 and annual evals. These managers not only give us directives, but also CRITIQUE our performance on these evals and I have even been "coached" on their clinical opinion of mine. There is another service his care agency provides with a facility which is small. 6 beds. This facility is manned with licensed staff, RN, and is being managed by a non licensed individual who is a family member of our owner......

What do I do with this? I have seen multiple posts, read the law. Its illegal, yet it still is occurring. I am resigning based on this but haven't given this full explanation to the owner who is also hands on, and does not hold any licensure and is of a business background. Where do I bring this information too? BRN advised me to quit.. but other than that the advice or what regulatory entity who needs this information ?? We have a large census... our staff, and our patients deserve better than this.

[kbrn2002, ADN, RN]

I can't speak to the legality of this as every state has different rules and regulations regarding scope of practice. Some states including mine even have specific language that differentiates scope of practice for LPN's depending on the employment setting. LPN's in WI can be designated "charge nurse" in LTC but the language in the Nurse Practice Act is clear they can only directly supervise other LPN's and support personnel and then only under the general supervision of an RN. Here's the exact wording regarding this:

(3)  Assumption of charge nurse position in nursing homes. In assuming the position of charge nurse in a nursing home as defined in s. 50.04 (2) (b), Stats., an L.P.N. shall do all of the following:

(a) Follow written protocols and procedures developed and approved by an R.N.

(b) Manage and direct the nursing care and other activities of L.P.N.s and nursing support personnel under the general supervision of an R.N.

(c) Accept the charge nurse position only if prepared for the responsibilities of charge nurse based upon education, training and experience beyond the practical nurse curriculum. The L.P.N. shall, upon request of the board, provide documentation of the nursing education, training or experience which prepared the L.P.N. to competently assume the position of charge nurse.

So going under the assumption that few if any state's are going to allow an LPN to be in a position of direct supervision of an RN that would be a situation that could be brought to the BON's attention for follow up.

That being said, there shouldn't be any issue with the owner, administrator or other business management positions being LPN as those aren't nursing roles to begin with.